Intramuscular hemangioma of the hypothenar eminence. A case report

Trauma-induced dual-plane hemangioma in the hand: A case report

INTRODUCTION AND IMPORTANCE

Hemangioma is a neoplastic disorder of vascular structures that can manifest at any site of the body. It is a rare ailment in general, and the intramuscular type is particularly uncommon and accounts for approximately 1 % of all hemangiomas. The presentation of hand hemangioma differs from other sites due to the restricted space and compression of vital structures, which frequently manifests as pain and functional impairment alongside mass. In this article, we present a case of trauma-induced dual-plane hemangioma in the hand.

CASE PRESENTATION

A 55-year-old right-handed individual, without any significant medical background, sought medical attention for a painful mass on his right hand that had developed over the past year. He indicated a history of blunt trauma to the hand, with the mass becoming apparent two months post-injury. With the growth of the mass, the severity of pain progressively escalates; however, there is no loss of function observed. The diagnosis was established through duplex ultrasonography, and the patient received surgical excision utilizing the WALANT technique. Intraoperatively, the hemangioma was identified in two planes: one beneath the skin over the thenar eminence and another within the adductor pollicis muscle. The follow-up period proceeded without any complications or recurrence of the condition.

CLINICAL DISCUSSION

Hand hemangiomas are relatively rare, and a history of trauma may lead to misdiagnosis as other conditions. There are various management strategies that are not suitable for hand hemangiomas. While surgical excision can alleviate symptoms, it carries the risk of increasing disability if muscle tissue is excised.

CONCLUSION

Trauma-induced dual-plane hemangioma in the hand is a phenomenal condition that has been successfully treated surgically. Despite the removal of a portion of the adductor pollicis, both functional and aesthetic satisfaction was achieved. Hence, it is advisable to employ surgical management for such a presentation.

The Challenges of Upper Extremity Intramuscular Hemangioma: a Case Study and Systematic Review

BACKGROUND

Intramuscular hemangiomas (IMHs) are rare, benign vascular tumors, comprising 0.8% of all hemangiomas. Upper extremity (UE) IMHs pose diagnostic and therapeutic challenges given their rarity, invasive nature, and potential for neurovascular involvement. We report a comprehensive systematic review of UE IMH management and a challenging case report.

METHODS

A systematic review was performed using PRISMA guidelines. Electronic databases were used to identify papers describing UE IMHs through 2019. Patient demographics, clinical presentation, management, complications, and outcomes were reviewed. Based on operative timing, cases were categorized as either "primary" (excision performed at initial diagnosis) or "secondary" (excision performed after failure of conservative treatment).

RESULTS

Eighteen articles encompassing 25 patients were included in our systematic review. Of those, 18 underwent primary excision and 7 underwent secondary excision. The majority involved the forearm or antecubital region. Complete excision, evaluated by gross examination or pathology, was reported in all primary cases and 71% secondary cases. Primary excisions demonstrated smaller mass size (19.4cm2 versus 165.3cm2) and superior reported functional outcomes (100% versus 33%). Complications were reported in 5% of the primary excisions compared to 71% of the secondary excisions, where 1 complication was a fatal hematoma.

CONCLUSION

The literature concerning UE IMH is limited to mostly case reports and several case series with the potential risk of bias. With careful dissection and microsurgical technique, wide local excision followed by complete reconstruction can be successfully performed at initial diagnosis for UE IMHs. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.

Two Cases of Intramuscular Hemangiomas in the Upper Limbs: From Sonography to Pathology

ABSTRACT

Intramuscular hemangiomas are benign soft tissue tumors that are rarely found in the upper limbs. Diagnosing these tumors may be challenging owing to their pertinent nonspecific symptoms-often leading to misdiagnoses like tendinitis or muscle strain. In this article, two cases of intramuscular hemangiomas are presented-one in flexor pollicis brevis muscle and the other one in flexor digitorum superficialis muscle. Both subjects had nonspecific clinical symptoms whereby ultrasound imaging led to prompt diagnosis. To this end, the authors strongly advocate sonographic examination as an extension of physical examination in the daily clinical practice of musculoskeletal physicians.

Easily misdiagnosed intramuscular hemangioma: a case report

An intramuscular hemangioma is a benign vascular tumor that often occurs in the lower extremities. We herein report a rare case of an intramuscular hemangioma that occurred in the gluteus medius muscle and was misdiagnosed as lumbar disc herniation. A 36-year-old woman presented with incidental and infrequent pain of the left buttock. She was diagnosed with lumbar disc herniation and underwent treatment. Although her pain was slightly relieved, relapse soon occurred. X-ray examination and magnetic resonance imaging revealed a mass in the gluteus medius muscle. The mass was suspected to be a malignant tumor and was therefore resected. The final diagnosis was an intramuscular hemangioma. Her pain completely disappeared thereafter and did not recur. Patients with intramuscular hemangiomas usually have no specific symptoms; therefore, this tumor is often misdiagnosed. When a satisfactory treatment effect is not obtained, the diagnosis should be reassessed in a timely manner.