Intramuscular cavernous hemangioma of the vastus intermedius muscle with knee joint extension: A Case Report

Document Type: Case report

Authors

1 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Radiology and Advanced Diagnostic Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Intramuscular hemangiomas (IH) are benign vascular neoplasms usually arising within the striated muscle of the trunk and extremities. These constitutes for less than 1% of all hemangiomas. IH in the distal thigh with extension to knee joint are rarely reported, and may be confused with other lesions. We report a case of cavernous intramuscular hemangioma that involved distal third of left thigh with extension to knee joint in a 10-year-old girl who presented initially with sclerotic bony changes in imaging and slow growth during 4 years which at firt was misdiagnosed as osteoid osteoma for a long time. The patient's parents refused the recommended biopsy of the lesion. Four years later , follow the onset of the patient’s complaints of pain and swelling in the distal thigh, undergone another survey with doppler ultrasound and MRI. The tumor was finally diagnosed as hemangioma, and was completely resected. Histopathology confirmed a cavernous hemangioma with free margins. Our case was educational not only clinically, but also unusual radiological presentations like articular involvement of this extra articular hemangiona and delay in diagnosis

Keywords


1. Dinehart SM, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg 2001;27(5):475-85.  https://www.ncbi.nlm.nih.gov/pubmed/11359498

2. Pritchard DL. Surgical management of common benign soft-tissue tumors. In: Simon MA, Springfield DS, editors. Surgery for bone and soft tissue tumors. Philadelphia’ Lippincott-Raven; 1998. p. 525-40.

3. Moser RP, Barr MS. Musculoskeletal cases of the day. Intramuscular hemangioma of the thigh. AJR Am J Roentgenol 1994;162(6):1465-6.  https://www.ncbi.nlm.nih.gov/pubmed/8192029

4. Rosai J. Vascular neoplasms. Am J Surg Pathol 1986;10:26-31.   https://www.ncbi.nlm.nih.gov/pubmed/3296799

5. Costa e Silva I, Symon L. Cavernous hemangioma of the optic canal. Report of two cases. J Neurosurg 1984;60(4):838-41.  https://www.ncbi.nlm.nih.gov/pubmed/6707753

6. Missori P, Tarantino R, Delfini R, Lunardi P, Cantore G. Surgical management of orbital cavernous angiomas: prognosis for visual function after removal. Neurosurgery 1994;35(1):34-8.  https://www.ncbi.nlm.nih.gov/pubmed/7936149

7. Goto T, Kojima T, Iijima T, Yokokura S, Kawano H, Yamamoto A, et al. Soft-tissue haemangioma and periosteal new bone formation on the neighboring bone. Arch Orthop Trauma Surg 2001;121(10):549-53.  https://www.ncbi.nlm.nih.gov/pubmed/11768633

8. Ferri E, Pavon I, Armato E. Intramuscular cavernous hemangioma of the sternocleidomastoid muscle: An unusual neck mass. Otolaryngol Head Neck Surg 2007;137(4):682-3.  https://www.ncbi.nlm.nih.gov/pubmed/17903594

9. Buetow PC, Kransdorf MJ, Moser Jr RP, Jelinek JS, Berrey BH. Radiographic appearance of intramuscular hemangioma with emphasis on MR imaging. AJR Am J Roentgenol 1990;154(3):563-7.  https://www.ncbi.nlm.nih.gov/pubmed/2154914

10. Christenson JT, Gunterberg B. Intramuscular haemangioma of the extremities: is computerized tomography useful? Br J Surg 1985;72(9):748-50.  https://www.ncbi.nlm.nih.gov/pubmed/4041739