Intractable pain due to rectus abdominis intramuscular haemangioma

Unusual presentation of intramuscular hemangioma in abdominal oblique muscles

Intramuscular hemangiomas are rare benign tumors that are difficult to diagnose. We report a successful case of intramuscular hemangioma excision involving the external oblique muscles. The mass was excised successfully, and histopathology confirmed the diagnosis of intramuscular hemangioma with a negative margin and no malignancy.

Qualitative and quantitative diagnosis of intramuscular hemangioma subtypes: Diagnostic performance comparison of ESWAN and conventional MRI

BACKGROUND

Preoperative identification of intramuscular hemangioma (IMH) subtypes (capillary hemangioma, cavernous hemangioma, and mixed hemangioma) is urgently necessary. Enhanced T2*-weighted angiography (ESWAN) is sensitive to vessels and metabolites and can be used to diagnose IMH subtypes.

PURPOSE

To compare the diagnostic performances of ESWAN and conventional magnetic resonance imaging (MRI) for qualitative and quantitative diagnosis of IMH subtypes.

MATERIAL AND METHODS

In total, 23 patients with IMHs were examined using conventional MRI and ESWAN. The signal intensity ratios (SIRs) of conventional MRI and ESWAN were measured.

RESULTS

There was no significant difference for volume among the three subtypes (P = 0.124, P = 0.145). Various shapes and MRI signals were shown in the three subtypes of IMH. There was no significant difference for SIRs of conventional MRI (P = 0.558, P = 0.259, P = 0.385, P = 0.347). However, there was a significant difference for SIRs of ESWAN parameters (P = 0.050, P < 0.001, P = 0.005, P = 0.002). Capillary hemangiomas can be diagnosed when R2* SIR is <0.912 and intratumoral susceptibility signal (ITSS) percentage is <29.085%. Cavernous hemangiomas should be considered when R2* SIR is >0.912, ITSS percentage >35.226%, and phase SIR >2.536. In addition, mixed hemangiomas should be considered when T2* SIR is >0.662 and R2* SIR <1.618.

CONCLUSION

Conventional MRI can only display the volume, shape, and signal of IMHs. 3D-MinIP imaging of ESWAN can show the veins and minor hemorrhage. SIRs of ESWAN parameters including T2* value, R2* value, phase value, and percentage of ITSS can be used to quantitatively diagnose capillary hemangiomas, cavernous hemangiomas, and mixed hemangiomas.

Intramuscular hemangioma within the biceps brachii causing the limitations of elbow extension and forearm pronation: A case report

RATIONALE

Intramuscular hemangiomas are rare benign vascular neoplasms, merely accounting for 0.8% of all hemangiomas. Moreover, there are few case reports of intramuscular hemangiomas in the upper extremities.

PATIENT CONCERNS

A 24-year-old male patient presented with a 5-year history of intermittent pain of the right elbow joint. He had observed a swelling of the right cubital fossa over the past 2 years, leading to the limitations of elbow extension and forearm pronation.

DIAGNOSIS

The patient was diagnosed with intramuscular hemangioma of the biceps brachii.

INTERVENTIONS

Surgical excision of the tumor was performed for this patient and postoperative early functional exercises were permitted.

OUTCOMES

The movements of the right elbow and forearm reached the normal range of motion at 5 weeks after surgery. There was no evidence of recurrence during the 5-month follow-up.

LESSONS

Optimal management of intramuscular hemangioma is critical, including precise evaluation, good microsurgical technique and early functional exercises, which may result in a satisfying outcome.