Posterior mediastinal capillary hemangioma misdiagnosed as neurofibromas: a rare case report and review of the literature

Thoracoscopic resection of a cavernous haemangioma of anterior mediastinum: case report and literature review

Background

Mediastinal haemangioma is a rare type of tumour and accounts for ≤0.5% of all mediastinal tumours. Mediastinal haemangioma is often nonspecific upon examination by imaging. Mediastinal haemangioma diagnosis is difficult to confirm before surgery because the characteristic features of diagnostic imaging are poor, and these lesions are extremely rarely encountered in clinical practice.

Case Description

We herein report a case of thoracoscopic resection of a cavernous haemangioma in the anterior mediastinum. A 40-year-old man was referred to our hospital for a health examination. A chest computed tomography scan showed a mass with irregular contrast enhancement and a smooth surface. Using video-assisted thoracoscopic surgery, the tumour was completely extirpated and confirmed histologically to be a cavernous haemangioma. The patient recovered well, was discharged, he has since had no recurrences, and continues to be closely monitored as an outpatient.

Conclusions

Mediastinal haemangiomas, a rare type of mediastinal tumour, are typically benign and located in the anterior mediastinum, and lack specific symptoms and relevant imaging features. We found that minimally invasive thoracoscopic resection provided a satisfactory view and facilitated correct handling of a mediastinal cavernous haemangioma. Although such tumours are mostly benign and the prognosis is good, we recommend aggressive surgical management to avoid missing malignant lesions.

Hemangioma Mimicking Left Atrial Mass in the Posterior Mediastinum

Primary hemangioma of the mediastinum is extremely rare. Herein, we present a unique case of hemangioma mimicking left atrial mass in the posterior mediastinum. We reviewed the literature and found 17 other hemangiomas in the posterior mediastinum. Herein, we summarize the age, gender, symptoms, diagnostic methods, image diagnosis, size, treatments, histologic features, outcomes, and follow-up of 17 cases. Most of the cases were asymptomatic and were accidentally detected in chest radiographs. Diagnostic methods mainly included chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). All patients underwent surgical resection, recovered well, and had no recurrence during follow-up.

A case of middle mediastinal cavernous hemangioma

While cavernous hemangioma are frequently observed in various tissues and locations in the body, mediastinal cavernous hemangiomas (CHMs) are rare, particularly in the middle mediastinum. Here, we report a case of a middle CHM which was diagnosed and treated in our hospital. A male patient age 57 years was admitted with a mediastinal circular low-density lesion. Preoperative examination was performed with a subsequent diagnosis of a mediastinal lesion. The lesion was resected and post-operative histopathology suggested that it was a cavernous hemangioma. Post-operative recovery was uneventful, and a follow-up examination nearly one year later showed that the patient had no recurrence.

Mediastinal hemangiomas: Spectrum of CT and MRI findings - retrospective case series study and systematic review of the literature

PURPOSE

To analyze the imaging manifestations of mediastinal hemangioma (MH) by CT and MRI to aid in its successful diagnosis and preoperative evaluation.

METHODS

Seventeen cases of MH diagnosed by histopathology combined with CT and MRI were retrospectively collected; and their CT and MRI features, including the lesions' site and range, shape, size, margin, density or signal, enhancement pattern, mass-cardiovascular interface, mass-pulmonary interface, and other characteristics were evaluated.

RESULTS

The anterior, middle, and posterior mediastinum were involved in 13, 13, and 8 cases, respectively. The masses size varied from 20 to 233 mm. Irregular, dumbbell-like, and oval masses were found in 13, 2, and 2 cases, respectively, while with pampiniform growth in 16 cases and expansive growth in 1 case. Mixed density, homogeneous density solid masses, and heterogeneous density masses with dominant fat were found in 9, 5, and 3 cases, respectively, showing mild or significant enhancement in aortic phase while no or mild enhancement in pulmonary artery phase. Draining veins were found in 16 cases and feeding arteries in 10 cases. Phleboliths were detected in 10 cases, splenic hemangiomas in 6 cases, and left lateral-chest-wall hemangioma in 1 case. In MRI sequences, mixed signal was found on T₁WI and heterogeneous hypersignal with nodular or linear hyposignal on T₂WI in 5 cases, mild or significant enhancement in 4 cases, draining veins in 2 cases, and no feeding arteries or phleboliths were seen.

CONCLUSION

Presence of phleboliths, pampiniform growth pattern, and aberrant draining veins are relatively specific characteristics in diagnosing MH.