Medical Imaging Analysis Report

1. Imaging Findings

The patient is a 14-year-old female with congenital swelling of the right upper limb who has undergone multiple surgeries. The currently provided CT, MRI, and angiography imaging data show:

• Extensive vascular anomalies are observed in the right upper limb, manifested as tortuous, dilated vascular appearances, indicating the presence of a high-flow arteriovenous shunt (AVF) or a combined-type vascular malformation (e.g., CAVM).
• Bone changes: The cortical structure around the shoulder joint and in the humerus exhibits alterations such as bone deformity or thickening related to the vascular malformation, presumably caused by prolonged high-flow vascular shunting.
• In the soft tissues, abundant vascular channels can be seen, which show significant enhancement after contrast, suggesting prominent arteriovenous flow pathways.
• An MRI-based cardiac function evaluation shows an increased cardiac output (CO = 12.2 L/min), indicating elevated cardiac load due to high-flow shunting in the systemic circulation.
• At present, there is no obvious limb length discrepancy, skin thickening, or excessive fat deposition, and no significant skin surface lesions are observed.

2. Potential Diagnoses

Based on the patient's age, history of congenital vascular malformation, and imaging findings, the following diagnostic or differential diagnoses can be considered:

• High-flow arteriovenous fistula (AVF): A simple type of high-flow vascular malformation in which an artery is directly connected to a vein. It often leads to local vascular structural disruption and distal venous return compromise, consistent with the extensive arteriovenous shunting seen on imaging.
• Combined-type high-flow vascular malformation (CAVM): A vascular malformation composed of arteries, veins, and other vascular elements, potentially resulting in more complex hemodynamics and tissue changes. Clinical and imaging findings are in line with this case, but pathological or dedicated imaging analyses are required for confirmation.
• Other vascular malformations with bony involvement: Such as Parkes Weber syndrome or Klippel-Trenaunay syndrome. However, there is currently no clear evidence of limb hypertrophy, skin changes, or superficial vascular tumor-like lesions, so these possibilities are relatively low.

3. Final Diagnosis

Considering the history of congenital right upper limb swelling progression, multiple surgeries, and current imaging features (high-flow vascular shunt, bone changes, elevated cardiac output, etc.), the most likely diagnosis is:

High-flow arteriovenous fistula (AVF) or combined-type high-flow vascular malformation (CAVM). Further pathological or specialized examinations are needed to confirm the specific type.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Interventional therapy: For high-flow arteriovenous fistulas or combined-type vascular malformations, endovascular embolization with coils or other embolic agents is commonly used to block abnormal shunting pathways, thereby reducing the high-flow load on the heart and alleviating local symptoms.
• Surgical treatment: If interventional measures fail to achieve adequate control, or if local tissue destruction and severe functional impairment occur, surgical ligation or partial resection of the malformed vessels may be considered. A thorough assessment of possible bleeding risks and impact on surrounding normal structures is necessary.
• Comprehensive management: Multidisciplinary collaboration with vascular surgery, orthopedics, cardiology, and other specialties is often required to manage complications (such as excessive cardiac load) and to monitor for postoperative recurrence or new shunts.

4.2 Rehabilitation / Exercise Prescription Recommendations

Because vascular malformations can lead to fragile local vessels and increased cardiac load, rehabilitation should focus on controlling exercise intensity and preventing trauma. The FITT-VP principles (Frequency, Intensity, Time, Type, Progression, Volume) can be referenced as follows:

• Type: Primarily choose low-impact forms of aerobic exercise, such as light walking, seated stretching, or swimming, and avoid high-impact or weight-bearing activities that may increase local vascular pressure.
• Frequency: Start with about 3 sessions per week, gradually increasing to 4-5 times per week according to the patient's tolerance.
• Intensity: Maintain low-to-moderate heart rate zones (e.g., 40%-60% of maximum heart rate), closely monitoring heart rate and blood pressure to avoid excessive cardiac load from the high-flow shunt.
• Time: Begin with 10-15 minutes per session and gradually extend to 30 minutes, progressing slowly to avoid fatigue-related injuries.
• Progression: Adjust training load every 2-4 weeks based on patient tolerance and follow-up metrics (cardiac function, local vascular condition).
• Volume: Keep the total exercise volume moderate. If there is any sign of chest tightness, palpitations, or significant limb pain, training should be paused and medical evaluation should be sought promptly.

Throughout the rehabilitation process, pay particular attention to protecting the affected limb. Avoid trauma or excessive force that might cause bleeding or further expansion of the vascular malformation. If pain or local swelling significantly worsens, stop immediately and reassess.

Disclaimer: This report is based solely on the current imaging and clinical data. The suggested plan is for reference only and cannot replace in-person consultations or professional medical advice. For specific diagnosis and treatment, please consult the appropriate specialist.