A 20-year-old man complained of pulse-synchronous noise in the ear and recurrent bleedings in the nose and throat region. From birth he had had an extensive haemangioma, black-blue with dark-red parts. It had been diagnosed as a cavernous haemangioma, part of a Sturge-Weber syndrome. An angiogram was performed before intended dermatological treatment of the disfiguring venous angioma. It demonstrated the capillary venous angioma (slow-flow angioma) in the lateral triangle of the neck, extending up to the skull base. In addition there was an arteriovenous angioma (high flow angioma) in the region of the clivus, which was supplied bilaterally largely by the ascending pharyngeal artery. The arteriovenous angioma also had connections to the outflow area of the capillary venous angioma. These findings and absence of ocular changes excluded Sturge-Weber syndrome. Because of the risk of life-threatening bleedings, the arteriovenous malformation was superselectively embolized by multiple injections of nonresorbable polyvinyl-alcohol particles via a microcatheter. This brought about the collapse of the cutaneous angiomatous spaces. This case demonstrates that external appearance indicating a capillary venous angioma is not reliable. Before treatment of this malformation a neuroradiological diagnosis should be undertaken.
