Abstract
Twelve patients with the histologic diagnosis of soft-tissue hemangioma of the extremities (nine intramuscular, two subcutaneous, and one synovial) were evaluated in a retrospective study using plain film radiography (n = 12), angiography (n = 8), computed tomography (CT; n = 4), magnetic resonance imaging (MRI; n = 3), and ultrasonography (US; n = 2). In eight of nine intramuscular lesions, the plain film demonstration of phleboliths suggested the diagnosis, while the plain radiographs were normal in three. Angiograms showed the pathognomonic features of soft-tissue hemangioma in six patients. MRI was characteristic in all three patients: The lesion demonstrated intermediate signal intensity on T1-weighted spin echo images and extremely bright signal on T2-weighting. US showed a hypoechoic soft-tissue mass in one case and a mixed echo pattern in the other. In one case, a central echogenic focus with acoustic shadowing consistent with a calcified phlebolith was identified, and one lesion exhibited increased color flow and low resistance arterial Doppler signal. CT showed a nonspecific mass in one of four cases and a mass with phleboliths in three. If a deep hemangioma is suspected, we recommend initial imaging with plain radiography followed by MRI. US may be useful in confirming the presence of a mass in doubtful cases or if MRI is unavailable. CT offers no distinct advantage over the combined use of plain radiography and MRI. Although angiography demonstrated the pathognomonic features in all six deeply situated lesions, because of its invasiveness it should be reserved chiefly for those patients undergoing surgical resection.
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References
Allen PW, Enzinger FM (1972) Hemangioma of skeletal muscle: an analysis of 89 cases. Cancer 29:8
Bendeck TE, Lichtenberg F (1957) Cavernous hemangioma of striated muscle. Review of the literature and report of two cases. Ann Surg 146:1011
Bernardino ME, Jing B-S, Thomas JL, Lindell MM Jr, Zornoza J (1981) The extremity soft-tissue lesion: a comparative study of ultrasound, computed tomography, and xeroradiography. Radiology 139:53
Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM (1990) Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR 155:1251
Buetow PC, Kransdorf MJ, Moser RP, Jelinek JS, Berrey BH (1990) Radiologic appearance of intramuscular hemangioma with emphasis on MR imaging. AJR 154:563
Cohen EK, Kressel HY, Perosio T, Burk DL Jr, Dalinka MK, Kanal E, Schiebler ML, Fallon MD (1988) MR imaging of soft-tissue hemangiomas: correlation with pathologic findings. AJR 150:1079
Cohen JM, Weinreb JC, Redman HC (1986) Arteriovenous malformations of the extremities: MR imaging. Radiology 158:475
Dahlin DC, Unni KK (1986) Bone tumors: general aspects and data on 8542 cases, 4th edn. Charles C. Thomas, Springfield
Derchi LE, Balconi G, De Flaviis L, Oliva A, Rosso F (1989) Sonographic appearances of hemangiomas of skeletal muscle. J Ultrasound Med 8:263
Engelstad BL, Gilula LA, Kyriakos M (1980) Ossified skeletal muscle hemangioma: radiologic and pathologic features. Skeletal Radiol 5:35
Enzinger FM, Weiss SW (1988) Benign tumors and tumorlike lesions of blood vessels. In: Soft tissue tumors, 2nd edn. Mosby, St. Louis, p 512
Fergusson IL (1972) Hemangiomata of skeletal muscle. Br J Surg 59:634
Fornage BD (1986) Achilles tendon: US examination. Radiology 159:759
Fornage BD, Schernberg FL, Rifkin MD (1985) Ultrasound examination of the hand. Radiology 155:785
Hawnaur JM, Whitehouse RW, Jenkins JPR, Isherwood I (1991) Musculoskeletal hemangiomas: comparison of MRI with CT. Skeletal Radiol 19:251
Hermann G, Yeh H-C, Schwartz I (1984) Computed tomography of soft tissue lesions of extremities, pelvis and shoulder girdles: sonographic and pathologic correlations. Clin Radiol 35:193
Kransdorf MJ, Jelinek JS, Moser RP Jr, Utz JA, Brower AC, Hudson TM, Berrey BH (1989) Soft tissue masses: diagnosis using MR imaging. AJR 153:541
McGahan JP, Hansen SK, Palmer PES (1981) Hemangiopericytoma of the soft tissues in the area of the left scapula. Case report 163. Skeletal Radiol 7:66
Nelson MC, Stull MA, Teitelbaum GP, Patt RH, Lack EE, Bogumill GP, Freedman MT (1990) Magnetic resonance imaging of peripheral soft-tissue hemangiomas. Skeletal Radiol 19:477
Palmieri TJ (1983) Subcutaneous hemangiomas of the hand. J Hand Surg [Am] 8:201
Petasnick JP, Turner DA, Charters JR, Gitelis S, Zacharias CE (1986) Soft-tissue masses of the locomotor system: comparison of MRI imaging with CT. Radiology 160:125
Pettersson H, Gillespy T III, Hamlin DJ, Enneking WF, Springfield DS, Andrew ER, Spanier S, Slone R (1987) Primary musculoskeletal tumors: examination with MR imaging compared with conventional modalities. Radiology 164:237
Sundaram M, McGuire M, Herbold D, Beshany S, Fletcher J (1987) High intensity soft tissue masses on T1-weighted pulsing sequences. Skeletal Radiol 16:30
Watson WL, McCarthy WD (1940) Blood and lymph vessel tumors: a report of 1056 cases. Surg Gynecol Obstet 71:569
Welsch D, Hengerer AS (1980) The diagnosis and treatment of intramuscular hemangiomas of the masseter muscle. Am J Otolaryngol 1:186
Yao L, Lee JK (1988) Case report 494. Skeletal Radiol 17:378
Yuh WTC, Kathol MH, Sein MA, Ehara S, Chiu L (1987) Hemangiomas of skeletal muscle: MR findings in five patients. AJR 149:765
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Greenspan, A., McGahan, J.P., Vogelsang, P. et al. Imaging strategies in the evaluation of soft-tissue hemangiomas of the extremities: correlation of the findings of plain radiography, angiography, CT, MRI, and ultrasonography in 12 histologically proven cases. Skeletal Radiol. 21, 11–18 (1992). https://doi.org/10.1007/BF00243086
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DOI: https://doi.org/10.1007/BF00243086