Imaging of intravenous lobular capillary hemangioma of azygos vein

Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report

BACKGROUND

Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial.

CASE PRESENTATION

Herein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms.

CONCLUSIONS

Treatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome.

Intravenous pyogenic granuloma in the internal jugular vein: A case report and literature review

RATIONALE

Intravenous pyogenic granuloma (IVPG) is a special type of pyogenic granuloma, and its preoperative diagnosis is difficult. We report a rare case of IVPG that develops in the lumen of the internal jugular vein (IJV). Here, we analyze the imaging characteristics of present case and summarize the imaging characteristics of previous reported cases.

PATIENT CONCERNS

A 44-year-old man who presented with a growth in the IJV without any symptoms.

DIAGNOSES

A diagnosis of IVPG was made, based on the pathological examination after surgery.

INTERVENTIONS

The patient underwent surgery to excise the vein segment containing the neoplasm.

OUTCOMES

The patient did not present with any complications in the postoperative follow-up period.

LESSONS

For clinician, IVPG's preoperative diagnosis is difficult. Although histopathology remains the gold standard for diagnosis, the combination of multiple types of imaging examinations is necessary to rule out the differential diagnoses of IVPG.

Pyogenic granuloma originating in the pulmonary artery

We herein report an unreported case of pyogenic granuloma that originated in the pulmonary artery. A 38-year-old man was urgently hospitalized with dyspnea and back pain. He had been on hemodialysis for 2 years due to chronic renal failure. We performed contrast-enhanced computed tomography and detected a mass occluding the left main pulmonary artery. The maximum standardized uptake value (SUV_max) of ¹⁸F-fluorodeoxy glucose (FDG) in the mass was 4.1. We made a tentative diagnosis of pulmonary artery tumor, and planned an operation. We performed median sternotomy and left anterolateral thoracotomy. As the tumor had not reached the bottom of the left pulmonary artery, we first performed left upper lobectomy. We then performed resection of the pulmonary artery tumor under cardiopulmonary bypass and reconstructed the pulmonary artery with self-pericardium. The pathological diagnosis was pyogenic granuloma. To our knowledge, pyogenic granuloma originating in the pulmonary artery has never been reported before.

Intravenous lobular capillary haemangioma (pyogenic granuloma): A case report and a review of imaging findings as reported in the literature

INTRODUCTION

Intravenous lobular capillary haemangioma (IVLCH) is a rare benign lesion with minimal published reports containing a description of its appearance at medical imaging. We present the ultrasound and MRI images of a histologically proven IVLCH and provide the first review of the imaging findings reported in the literature.

METHODS

The imaging findings of a case of IVLCH are presented. A PubMed search of English language articles was performed from 1966 to October 2016, and all relevant papers were reviewed. Imaging findings from those papers are summarised.

RESULTS

Key features on ultrasound are of a well-defined, usually hypoechoic, mass which is highly vascular. The host vein is usually apparent. MRI imaging usually shows T1 signal isointense to muscle and variable T2 signal, either isointense or of high signal relative to the vein. The lesions enhance with gadolinium.

CONCLUSION

Intravenous lobular capillary haemangioma has distinctive ultrasound but less consistent MRI features although radiological diagnosis should usually be possible. Review of reported cases shows that a previously described gender bias is incorrect.

Retroperitoneal lobular capillary hemangioma with synchronous ipsilateral renal cell carcinoma

Lobular capillary hemangiomas (LCH) are acquired benign vascular tumors of skin and mucosal spaces of head and neck. Very few cases of LCH have been reported in the abdomen, predominantly occurring as mucosal polyps in the bowel. We present CT imaging features of solitary retroperitoneal LCH in a patient with synchronous ipsilateral renal cell carcinoma and review the available literature and imaging features in abdominal and extra-abdominal LCH. To our knowledge, there is no other case of retroperitoneal LCH available in the English literature.