Intramuscular Haemangioma of the Extensor Pollicis Brevis Muscle with Periosteal Reaction of the Radius: A Case Report and Review of the Literature

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.

Outcomes of Surgery for intramuscular Haemangiomas in the Extremities

PURPOSE

The objective of this case-series study was an assessment of outcomes of surgery for intramuscular haemangiomas in the extremities.

PATIENTS AND METHODS

Three women and one man with a mean age of 28 (23 - 34) years were operated on for intramuscular haemangiomas in the extremities, 3 in the forearms, and 1 in the calf. Three of them, 2 after resection of tumours from the forearm, and one after resection of the tumour in the calf, were available for follow-up assessment at an average of 1.5 (1 - 2) years after surgery. For patients with the tumour in the forearm, preoperative and at the follow-up examination pain was registered with use of the numeric rank scale (NRS), grip strength with the Jamar dynamometer, and function of the extremity with the quickDASH questionnaire. In the patient with the lower limb involvement, pain at the operation site, and efficiency (dexterity) of gait were evaluated.

RESULTS

All 3 patients with a follow-up examination reported significant reduction of pain. With regard to grip strength and hand function, one patient had significant improvement, whereas in the other, there were no real changes compared to preoperative. The patient with the calf involvement had no symptoms and walked normally. Over the follow-up period, no recurrence was noted.

CONCLUSION

The results of this small case-series study show that operative treatment of these rare tumours is safe and effective, however, it may be challenging in some cases.

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.

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.