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Cukman M, Luzaic K, Krstanovic K, Stevanovic S. Management of a rapidly enlarging supraclavicular mass of unknown aetiology. BMJ Case Rep 2024; 17:e255774. [PMID: 38383129 PMCID: PMC10882406 DOI: 10.1136/bcr-2023-255774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Intramuscular haemangiomas are benign tumours showing an extremely rare occurrence and making up less than 1% of all haemangiomas. The goal of this case report is to share our experience in treating a patient with an extremely rare intramuscular haemangioma, which occurred in the supraclavicular region VB level of the neck and extended towards the infraclavicular space, localised within and inferior to the trapezius muscle. The lesion was diagnosed by using multimodal imaging and a wide excision was performed with intraoperative feeding vessel ligation and a good postoperative result. The main difficulties regarding diagnosis and treatment include a lack of evidence-based guidelines, due to limited publications on this topic, the nature of the lesion frequently showing obscure anatomic localisation deep within muscles and unclear delineation, various anatomic origin requiring an individual treatment approach, inconclusive radiologic signs as well as non-specific symptoms.
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Affiliation(s)
- Mateo Cukman
- University of Zagreb School of Medicine, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Karla Luzaic
- University of Zagreb School of Medicine, Zagreb, Croatia
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Guedes PM, Saldanha NA, Matos PM, Carvalho FS, Veiga G, Norton P. Intramuscular Hemangioma: A Rare Cause of Omalgia. Rev Bras Ortop 2023; 58:e676-e680. [PMID: 37663185 PMCID: PMC10468241 DOI: 10.1055/s-0040-1722588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/17/2020] [Indexed: 10/21/2022] Open
Abstract
Intramuscular hemangiomas (IHs) are benign soft-tissue tumors that represent less than 1% of all hemangiomas. This clinical entity is rarely considered as a differential diagnosis in cases of musculoskeletal pain. A healthy 38-year-old woman presented to our office with complaint of left omalgia, with 8 months of evolution, limiting her daily activities. She reported the appearance of tumefaction in the previous 4 months. She was medicated with analgesic and antiinflammatory drugs with no clinical improvement. The objective examination showed limitation of left shoulder abduction (0-90°). The patient underwent a magnetic resonance imaging (MRI), in which a well-circumscribed nodular formation was detected in the deltoid muscle. Then, she underwent a biopsy, which confirmed the diagnosis of hemangioma. The patient was referred for sclerotherapy. Intramuscular hemangiomas are usually observed in young patients. The gold-standard examination for diagnosis is MRI, which often forestalls the need for a biopsy. In many cases, IHs are asymptomatic and tend to involute over time. Despite the low frequency of this clinical entity, it is important to place it as a diagnostic hypothesis in cases of chronic pain of the limbs in young patients with poor therapeutic response to antiinflammatory drugs and analgesia.
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Affiliation(s)
- Pedro M. Guedes
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
| | - Nuno A. Saldanha
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
| | - Pedro M. Matos
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
| | - Francisco S. Carvalho
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
| | - Graça Veiga
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
| | - Pedro Norton
- Medicina do Trabalho, Centro Hospitalar de Medicina do Trabalho, Centro Hospitalar Universitário São João, Serviço de Saúde Ocupacional, Porto, Portugal
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Chen ZX, Wang MY, Zhang C, Ding ZQ, Chen W. Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults: A case report. World J Clin Cases 2023; 11:2803-2810. [PMID: 37214575 PMCID: PMC10198100 DOI: 10.12998/wjcc.v11.i12.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described, and the evidence for treatment is limited. The purpose of this case study was to report the new application of the Ilizarov technique, which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma.
CASE SUMMARY A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery. The equinus deformity was roughly corrected after 2 years of follow-up, without significant secondary sequelae.
CONCLUSION Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique. The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.
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Affiliation(s)
- Zhang-Xin Chen
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Meng-Yuan Wang
- School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Cong Zhang
- School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Zhen-Qi Ding
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Wei Chen
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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Pirri C, Pirri N, De Caro R, Stecco C, Özçakar L. Ultrasound imaging as an initial diagnostic method for intramuscular hemangiomas: a narrative review. Postgrad Med 2022; 134:180-186. [PMID: 35076337 DOI: 10.1080/00325481.2022.2033562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intramuscular hemangiomas are benign vascular lesions, often misdiagnosed due to unfamiliarity. They are rare (but not very rare) causes of musculoskeletal pain and diagnosing these tumors may be challenging because of their pertinent non-specific symptomatology. Herein, as a convenient imaging tool, ultrasound examination appears to an important initial method to scan for these lesions after the clinical examination. To date, there are no studies that examined the state-of-the-art as regards the use of ultrasound imaging in the diagnosis of intramuscular hemangiomas. Accordingly, a literature search was performed using PubMed and Web of Science with the purpose to provide a conceptual understanding and awareness as regards the importance/utility of ultrasound imaging as a first step diagnostic tool for intramuscular hemangiomas at different muscles' locations.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Intramuscular Hemangioma of the Forearm with Flexion Contracture. Case Rep Orthop 2019; 2019:6024039. [PMID: 31192019 PMCID: PMC6525862 DOI: 10.1155/2019/6024039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/14/2019] [Indexed: 11/17/2022] Open
Abstract
Intramuscular hemangiomas can be an infrequent but important cause of musculoskeletal pain. This report describes a 25-year-old male who presented with pain in the right forearm and contracture of the right hand for 4 years. Physical examination revealed severe tenderness of the midforearm with contracture of the flexor tendons in the index, middle, ring, and little fingers. Conventional radiography of the forearm revealed a soft tissue phlebolith. Magnetic resonance imaging showed a well-defined lobulated mass partially involving the FDP tendon. An intramuscular hemangioma within the deep anterior compartment of the forearm was suspected. Following surgical excision of the hemangioma, the patient's symptoms resolved completely. In conclusion, intramuscular hemangioma can be a rare cause of flexion contracture of the hands and should be considered as a cause of a flexion contracture that fails to respond to conservative treatment.
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Yu X, Nie T, Zhang B, Dai M, Liu H, Zou F. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report. Oncol Lett 2016; 12:195-198. [PMID: 27347124 DOI: 10.3892/ol.2016.4610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/01/2016] [Indexed: 11/06/2022] Open
Abstract
Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature.
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Affiliation(s)
- Xiaolong Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Tao Nie
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Hucheng Liu
- Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Fan Zou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
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Wierzbicki JM, Henderson JH, Scarborough MT, Bush CH, Reith JD, Clugston JR. Intramuscular hemangiomas. Sports Health 2014; 5:448-54. [PMID: 24427416 PMCID: PMC3752185 DOI: 10.1177/1941738112470910] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Intramuscular hemangiomas are common in the general population and often present at medical and surgical clinics. Unfortunately, unfamiliarity with these lesions has led to a high percentage of misdiagnoses, inappropriate workup, and unnecessary referrals. Evidence Acquisition: A literature search was performed using Medline, Embase, PubMed, and Cochrane. The relevant articles and referenced sources were reviewed for additional articles that discussed the epidemiology, pathophysiology, investigation, and management of intramuscular hemangiomas. Clinical experience from experts in orthopaedics, musculoskeletal pathology, and musculoskeletal radiology was compared. The selected case studies are shared cases of the authors. Results and Conclusion: The pathophysiology of these lesions is not completely understood, but much can be implied from their underlying vascular nature. Isolated lesions are benign tumors that never metastasize but tend to enlarge and then involute over time. Magnetic resonance imaging is the imaging modality of choice. If a systemic disorder or malignancy is not suspected or has been ruled out, conservative management is the treatment of choice for most intramuscular hemangiomas.
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Affiliation(s)
- Joseph M Wierzbicki
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey H Henderson
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Mark T Scarborough
- Department of Orthopaedic Oncology, Orthopaedic and Sports Medicine Institute, University of Florida, Gainesville, Florida
| | - Charles H Bush
- Department of Radiology, University of Florida, Gainesville, Florida
| | - John D Reith
- Department of Pathology, Immunology, and Laboratory Medicine and the Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
| | - James R Clugston
- Primary Care Sports Medicine Fellowship, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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French K, Sanders K, Chin SS, Bromberg M. Adult-onset lower extremity weakness caused by venous malformation detected by magnetic resonance imaging. Muscle Nerve 2012; 46:129-33. [PMID: 22693001 DOI: 10.1002/mus.23359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Symptomatic venous malformation (VM) of muscle in adults is rare and usually presents in childhood or adolescence as the individual is growing. We describe an atypical presentation of a malformation affecting the gastrocnemius muscle asymmetrically with onset in adulthood, which created a diagnostic challenge. Electromyography (EMG) and muscle biopsy did not fit clinically and MRI of the gastrocnemius led to the diagnosis. METHODS The setting for the patient studied was a neuromuscular outpatient clinic. RESULTS EMG showed decreased insertional activity and motor unit potential recruitment in the right gastrocnemius muscle. Muscle biopsy showed mild neurogenic changes. MRI demonstrated VM in the contralateral gastrocnemius muscle. CONCLUSIONS This case represents a rare cause of atrophic weakness in adults, but muscle MRI should be considered when other tests are equivocal.
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Affiliation(s)
- Kris French
- Department of Neurology, University of Utah Hospitals and Clinics, 175 North Medical Drive East, Salt Lake City, Utah 84132, USA.
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