14h30 Calcifications in the neck: case report and literature review

The purpose of this presentation is to review the differential diagnosis of calcifications in the neck region. A case report also illustrates the case of a patient with an arteriovenous malformation containing phleboliths allowing to review clinical, pathophysiological and therapeutic aspects of this pathology. 

In the head and neck region, the diagnosis of phleboliths presents a challenge due to their rarity and their radiographic similarity to other calcifications, such as sialoliths or lymphatic

calcifications. Phleboliths are intravascular calcifications that typically develop within venous thrombi. Their occurrence in the soft tissues of the head and neck is rare. These calcifications may be associated with various vascular anomalies such as haemangiomas and vascular malformations, or may occur independently without any underlying vascular malformation.

Furthermore, the radiographic characteristics of phleboliths can vary significantly. Conventional radiographic imaging is important to differentiate phleboliths from other pathologies. Radiological diagnosis can be performed by ultrasound, CT and MRI. MRI is recommended to detect vascular lesions, while CT remains more accurate to identify phleboliths. 

Managing such cases necessitates a multidisciplinary approach to minimise the risks of complications, such as severe haemorrhage. The decision to adopt a conservative management approach for asymptomatic phleboliths  underscores the importance of careful patient monitoring. In cases where multiple phleboliths are present but asymptomatic, the risks associated with intervention may outweigh the benefits, making surveillance a prudent strategy. This approach aligns with the broader trend in medicine towards minimally invasive management, particularly in cases where the potential for spontaneous resolution or benign progression exists.