Intramuscular Hemangioma

 

Intramuscular hemangioma is a rare condition; it differs from infantile hemangioma simply because it occurs in patients older than children.

This condition is commonly confused with other hemangiomas. Most cases described as "intramuscular hemangioma" in the literature actually represent soft tissue venous malformations. This confusion cause inappropriate referrals, imaging studies and even therapeutic interventions in significant number of patients. Therefore, it is important to distinguish these two conditions (intramuscular hemangioma versus soft tissue venous malformation). 

Intramuscular hemangioma can be seen in any age, commonly diagnosed in early adulthood. In contrast to venous malformations, intramuscular hemangiomas have arterial feeders and in contrast to AVMs, these vascular birthmarks do not demonstrate arteriovenous shunting. 

 
    Typical MR Appearance of Intramuscular Hemangioma. This is a post-contrast axial T1 weighted MR image showing a relatively small intensely enhancing mass lesion in the beck of the neck with a small tortuous appearing dark area in it (representing arterial feeder; dark signal is due to fast flow in the vessel).

 

Prognosis: Overall, these lesions are benign anomalies. However, most lesions are problematic causing pain and discomfort and demonstrate progressive enlargement in some patients. Because of the fact that they are located in the muscle tissue, most patients experience various degrees of pain.

Therapy:    a- Embolization     b- Surgery

 
   

    

Gray-scale sonographic examination (ultrasonography) of the forearm lesion (1st image) demonstrates an infiltrative appearing intramuscular lesion. The lesion is significantly more echogenic than normal muscle. 2nd image is a T2 weighted image of the forearm. The mass lesion demonstrates high signal with multiple small tubular shaped signal voids representing fast flow arterial feeders. The lesion enhances intensely. 3rd image is a post-contrast axial image through the lesion demonstrating infiltrative involvement of the muscle tissue; the lesion demonstrates sharp, but irregular margins. 

           

1st image is a magnetic resonance angiography image showing prominent arterial feeders. DSA (conventional angiography - arteriography) image shows similar findings (arterial feeders, intense opacification of the mass lesion (cotton-wool appearance) with no evidence of rapid arteriovenous shunting. 3rd image is a post-embolization arteriogram (after particle embolization) demonstrating significantly reduced arterial inflow into the mass lesion.

 
 

Recent Literature

  • (Case Reports) Treatment with arterial embolization followed by immediate local excision decreases morbidity and potential mortality >>> abstract
  • (***) Case presentation - Intramuscular hemangioma in the arm (painful mass in the Flexor Digitorum Superficialis). Surgical excision was complicated with a Volkmann's like contracture >>> more
  • Case presentation - Intramuscular hemangioma in the posterior leg muscle treated with surgical excision >>> abstract
  • Case report of a posterior neck intramuscular hemangioma treated with a wide surgical excision >>> abstract 

 

 

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