Intramuscular haemangioma of the anterior chest wall

Intercostal hemangiomas coexisting with multiple hepatic hemangiomas: Clinical and imaging findings in a single case report with a review of the literature

RATIONALE

Intercostal hemangioma (IH) is an extremely rare disease, with only 18 cases reported in the past 30 years. Herein, we report the first case of IH coexisting with multiple hepatic hemangiomas, which recurred 32 months after surgery with rib erosion. IHs are invasive and difficult to distinguish from other intercostal tumors on imaging. To date, there have been no review articles on the imaging findings of IHs. We hope that this article will help clinicians improve their ability to diagnose and treat IH.

PATIENTS CONCERNS

A 58-year-old male came to our hospital with gastrointestinal disease. Chest tumors were accidentally discovered on routine chest computed tomography (CT). The patient had no chest symptoms. The patient also had multiple liver tumors that had been present for 2 years but with no remarkable changes.

DIAGNOSIS

Plain chest CT revealed 2 adjacent masses protruding from the left chest wall into the thoracic cavity. Neurogenic tumors or hamartomas were suspected on enhanced CT scans. Abdominal contrast-enhanced computed tomography scan indicated multiple liver tumors as MMHs, which was consistent with the 2 previous Doppler ultrasound findings.

INTERVENTIONS

Surgeons removed the chest tumors by video-assisted thoracoscopic surgery. No treatment was provided for the MMHs.

OUTCOMES

Two tumors of the chest wall were diagnosed as the IHs. There were no significant changes in the hepatic tumors after 32 months of follow-up. Unfortunately, the IH recurred, and the left 5th rib was slightly eroded.

LESSONS

It is necessary to include IHs as a potential differential diagnosis for chest wall tumors because early clinical intervention can prevent tumor growth and damage to adjacent structures. The imaging findings of IH show special characteristics. Preoperative imaging evaluation and diagnosis of IH are helpful for safe and effective surgery. Because of the high recurrence rate, complete surgical resection of IH with a sufficient tumor-free margin is recommended. It should be noted that the ribs should also be removed when the surrounding ribs are suspected to have been violated.

Diagnosis and management of intercostal intramuscular hemangioma: an updated review

BACKGROUND

Intramuscular hemangioma (IMH) is an uncommon type of hemangioma, and primary IMH of the intercostal muscle is even rarer. Only a few reports describe IMH of the intercostal muscle, and there are no review articles on this topic. We report our experience with a younger female patient, who underwent video-assisted thoracic surgery with tumor resection and review the previous literatures of intercostal IMH.

CASE PRESENTATION

An asymptomatic 17-year-old woman showed a 29-mm, homogeneous, intrathoracic nodule in the left chest wall, attached to the second and third ribs on computed tomography. We performed exploratory thoracoscopic surgery and the tumor was excised without surrounding rib resection. Histopathologic examination of the surgical specimen revealed proliferation of small blood vessels within the surrounding striated muscle, leading to the diagnosis of intercostal IMH. The surgical margin was negative. The patient's postoperative course was uneventful, and there has been no evidence of recurrence for more than 18 months after surgery.

CONCLUSIONS

We describe a case of intercostal IMH, who received tumor resection with clear excision margin without surrounding rib resection. Preoperative diagnosis is challenging due to its rarity, but intercostal IMH should be recalled as a differential diagnosis of chest wall tumor. Tumor excision without surrounding rib resection is acceptable for intercostal IMH, when there is a good possibility of achieving negative surgical margin.

Characteristics, Natural Course and Treatment of Intramuscular Capillary-type Haemangioma: A Systematic Literature Review

Intramuscular capillary-type haemangiomas (ICTH) are rare vascular anomalies that can easily be misdiagnosed as other entities. A systematic review was performed of all cases of ICTH in the literature since its first description in 1972. An adjudication committee reviewed cases to include only ICTHs. Among 1,143 reports screened, 43 were included, involving 75 patients. The most frequent differential diagnosis was intramuscular venous malformations. The mean age of patients at diagnosis was 21.2 years. ICTH was mainly described as a gradually increasing mass (81.8%), painless (73.9%), that could occur anywhere in the body but most frequently on the head and neck (44.0%). Magnetic resonance imaging (MRI) was mainly used for diagnosis (69.1%) and displayed specific features. The most frequent treatment was complete surgical removal (73.9%), which could be preceded by embolization, and led to complete remission without recurrence in all but 1 case.

Intercostal hemangioma: Case report of a rare chest wall tumor in childhood

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Intercostal hemangioma is an extremely rare disease, accounting for approximately 0.01% of all benign hemangiomas.

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Hemangiomas are prone to bleed spontaneously or after minor traumatic injury.

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Complete excision of the tumor is mandatory even after embolization to prevent recruitment of a collatera1 blood supply.

Introduction

Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence.

Case presentation

A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5 × 4 × 5.6 cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma.

Discussion

Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas.

Conclusion

Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence.

Post-traumatic Intramuscular Hemangioma of the Chest Wall

Intramuscular hemangioma originated in chest wall is a rare benign tumor, with no relevant reports in Korea. In most cases, the tumor is discovered before the age of 30 years and it is reported that trauma operates as the initiation factor. It is essential to concern the clinical suspicion and conduct a CT scan for diagnosis. The principle of treatment is surgical excision with clear resection margin. The authors of this study report a case of surgical excision for post-traumatic intramuscular hemangioma of the chest wall with review of literature.

Giant intramuscular haemangioma of the chest wall with osteolytic change

Intramuscular haemangioma of the chest wall is very rare, and only few cases associated with rib destruction has been reported. Here, we describe a 37-year old woman with a giant intramuscular haemangioma arising in the left back and associated with rib destruction.

Vascular Tumors Arising in the Chest Wall: 25 Years' Experience

Seventy-three interventions for chest wall tumors were performed at our hospital from 1978 through 2003. Six (8.2%) tumors were vascular. Four of them were soft tissue tumors, and two involved bone. The histologic diagnoses were hemangioendothelioma (1), low-grade angiosarcoma (1), and hemangioma (4). The diagnosis was established after surgery in all cases except one that had been previously diagnosed during an attempted resection before the patient came to our hospital. Fine needle aspiration carried out in 4 patients was inconclusive in all cases. Complete tumor resection with a margin greater than 3 cm was performed in each patient. Embolization followed by ligation of the intercostal vessels was performed prior to tumor resection in 1 patient with arteriovenous fistula and diffuse angiomatosis. Chest wall reconstruction after tumor removal was carried out using autologous tissues except in 1 case in which a Marlex mesh (CR Bard Inc., Burlington, USA) and a metallic prosthesis was inserted to prevent deformity in the lower costal arch. All patients have been followed and have survived with no evidence of recurrence after follow up ranging from 2 to 25 years.

Intercostal hemangioma

This paper presents a case of intercostal hemangioma, in which a complete surgical resection was accomplished based upon a tentative diagnosis provided by magnetic resonance imaging (MRI). A 27-year-old man visited our hospital for the evaluation of chest pain and shortness of breath after exertion. Computed tomography showed a soft tissue mass, 5.5 x 3.5 cm in size, arising from the right lateral 7th intercostal space. Dynamic MRI showed that the mass was enhanced rapidly in the early phase and that this early enhancement was maintained during the delayed phase, which was compatible with a diagnosis of intercostal hemangioma. The patient underwent surgery, and a complete resection of the tumor with the right 7th and 8th ribs and their intercostal muscles was accomplished. Histopathological examination confirmed the diagnosis of intramuscular hemangioma of the large-vessel type. Presently, 6 months after the operation, the patient is doing well, without any evidence of local recurrence.