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Abstract: Cavernous hemangioma of mediastinum is a rare, benign tumor originating from vascular endothelial cells. It typically arises in the anterior mediastinum but has also been reported in the posterior mediastinum or the middle mediastinum, and occasionally involves both the anterior and middle compartments. We present the case of a 20-year-old man with a cavernous hemangioma of mediastinum initially misdiagnosed as a reproductive tumor by 18 F-FDG PET/CT., Competing Interests: Conflicts of interest and sources of funding: The authors have no potential conflicts of interest to disclose. This work was supported by the National Natural Science Foundation of China-Youth Science Foundation (82302259)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: A 50-year-old woman underwent 18 F-FDG PET/CT to evaluate possible abdominal malignancy, which was revealed by CT. The images showed a large cystic-solid lesion with peripherally increased FDG activity in the left mid-abdomen. Histopathology of the excised lesion confirmed a jejunal cavernous hemangioma. We reported a rare case of jejunal cavernous hemangioma with FDG accumulation on PET/CT, mimicking malignancy., Competing Interests: Conflicts of interest and sources of funding: The authors have no conflicts of interest to report. This project was sponsored by the grant provided by Zhuhai People’s Hospital (2021KYQD-03)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This study aimed to describe 99mTc-labeled RBC scintigraphy as a diagnostic method for orbital cavernous hemangiomas and to evaluate this diagnostic tool according to surgical outcomes., Methods: Fifty-five patients with clinical and radiological (US, CT, and/or MRI) suspicion of unilateral cavernous hemangioma of the orbit underwent 99mTc-RBC SPECT study.Qualitative and semiquantitative evaluations were performed, and results were statistically analyzed., Results: SPECT images showed focal uptake in the orbital mass in 36 of 55 patients. Nineteen patients had a negative scintigraphic pattern, with concordance of early and late absence of uptake of 99mTc-RBC.Our procedure showed 100% sensitivity and 88.9% specificity for the diagnosis of orbital cavernous hemangioma, with a positive predictive value of 90.9% and a negative predictive value of 100%., Conclusions: 99mTc-RBC imaging is safe, easy to perform, and highly accurate in providing adequate clinical and surgical management. As a noninvasive and highly specific method for diagnosing orbital hemangioma, 99mTc-RBC scintigraphy can avoid more invasive imaging or biopsy.

A 55-year-old woman with abdominal pain, trace hematochezia, and anemia underwent 99mTc-labeled RBC scintigraphy to assess for gastrointestinal bleeding. The patient had a remote history of malignant melanoma and had been in a motor vehicle collision 3 weeks prior. The scintigraphic findings were compatible with a giant cavernous hemangioma in the liver. A subsequent contrast-enhanced abdominal CT scan demonstrated venous extravasation into a ruptured liver metastasis.

A 30-year-old man diagnosed with follicular thyroid carcinoma treated previously with total thyroidectomy was referred to radioiodine treatment. Post-therapy scan performed 10 days after a 150 mCi 131NaI revealed radioiodine uptake in left temporal region. To elucidate the abnormal head uptake, Tc-99m MDP bone scan and head magnetic resonance image was performed. No anomalous uptake was observed in the bone scan. Head magnetic resonance image found a well-circumscribed lesion in temporal was compatible with a vascular malformation. Angioresonance confirmed the diagnosis of cavernous angioma, a benign vascular tumor.

Giant cavernous hemangioma of the liver sometimes has a very inhomogeneous appearance with intratumoral degeneration on computed tomography or magnetic resonance imaging, and may mimic a malignant hepatic tumor, including angiosarcoma. There are many reports about F-18 fluorodeoxyglucose (FDG) uptake of angiosarcoma; however, knowledge regarding positron emission tomography findings with FDG for giant hepatic cavernous hemangioma is still limited. We herein present 2 cases of giant hepatic cavernous hemangioma in which low FDG uptake was considered helpful to differentiate from malignant hepatic tumor.

Hemangioma is the most common benign liver tumor. Hepatic blood pool imaging is an effective technique with a specificity approaching 100%. Typically, hemangiomas are completely filled on hepatic blood pool imaging. However, incomplete fill-in can be seen in larger hemangiomas complicated with thrombosis, fibrosis, or bleeding. We report a hepatic cavernous hemangioma with atypical peripheral rim activity.

Purpose: Giant cavernous hemangioma (GCH) of the liver has the potential risk for rupture and bleeding, which may cause sudden death. The purpose of this retrospective study was to compare the value of Tc-99m-labeled red blood cell (RBC) SPECT with ultrasound (US) in differentiating GCH from other solid liver masses., Methods: Twenty-two patients with giant solid liver masses, equal to or greater than 8 cm in at least one dimension, identified by US were examined by Tc-99m RBC SPECT. Final diagnoses were based on findings of surgery, biopsy or follow-up by US for a minimum of 24 months after the scan., Results: In all, US detected 23 giant liver masses in 22 patients (3 men, 19 women). Eighteen GCHs were detected in 17 patients by Tc-99m RBC SPECT. Nine showed a homogeneously increased blood pool; 9 revealed peripheral high, but central low, uptake. The US patterns in these 18 GCHs were mixed-echoic in 12, hyperechoic in 4, and hypoechoic in 2. The other five large liver tumors, all proved by operation, had no increased uptake area with Tc-99m RBC SPECT. The US patterns of these were mixed-echoic in 3, hyperechoic in 1, and hypoechoic in 1., Conclusions: Our study showed that there was no specific US pattern that would differentiate GCHs from other giant liver masses. Tc-99m RBC SPECT appeared to separate them clearly.

Hepatic cavernous hemangiomas rarely grow. Although a few cases have been reported in the literature, none used Tc-99m red blood cell scintigraphy. The authors describe such a case here.

Purpose: To determine the value and diagnostic accuracy of planar and SPECT Tc-99m-labeled red blood cell (Tc-99m RBC) scintigraphy in the investigation of suspected hepatic cavernous hemangioma as found on ultrasound., Patients and Methods: One hundred patients, 89 women (89%) and 11 men (11%), between 22 and 67 years old (mean age, 38 years) were evaluated for liver masses found on abdominal ultrasound. All the patients had previous Tc-99m RBC scintigraphy. The size of the lesions ranged from 1 to 9 cm. The final diagnosis was reached through cytologic biopsy, or histopathologic tests (or all of these)., Results: One hundred thirty lesions were found. With regard to the distribution of the lesions, 116 (89%) were single; 14 (3%) were multiple, with 118 (91%) in the right lobe and 12 (9%) in the left lobe; 83 (64%) were posterior; and 47 (36%) were anterior. With respect to the pattern of radioactivity fill-in, 86 (66%) lesions were typical and 44 (34%) were atypical. The results of Tc-99m RBC scintigraphy showed sensitivity, specificity, and positive and negative predictive and accuracy values of 97%, 83%, 98%, 77%, and 96% respectively. The use of SPECT improved the sensitivity value by 11% for lesions of 1 to 2 cm., Conclusions: Tc-99m RBC scintigraphy is the noninvasive technique most helpful in the diagnosis of hepatic hemangioma, especially in those at risk for lesion rupture or bleeding. SPECT should be performed whenever planar imaging fails to show the lesion by 2 hours. The use of ultrasound should precede scintigraphy for two important reasons: the size and the location of the lesion. Location of the lesion (anterior or posterior) is important for optimal gamma camera acquisition parameters. Lesions less than 1 cm are cannot be detected because they are beyond the limit of spatial resolution of the gamma camera we used.

Purpose: We present two cases of diffuse cavernous hemangioma of the rectum that invaded the pelvic structures., Methods: Two young women suffering from intermittent rectal bleeding were studied using computed tomography and magnetic resonance imaging., Results: Beside the rectal hemangioma, computed tomography and magnetic resonance imaging revealed that the pelvic ureter and the iliac vessels were each eroded by the tumor that produced symptoms in these two patients., Conclusion: Computed tomography and magnetic resonance imaging permit direct visualization for tumor staging and also for recognition of any pelvic structure invasion, which facilitate preoperative assessment of diffuse cavernous hemangioma of the rectum.

Purpose: To determine whether rapid, dynamic SPECT imaging with Tc-99m labeled red blood cells was technically feasible and of value in the detection of cavernous hemangiomas of the liver., Materials and Methods: The acquisition protocol for Tc-99m labeled red blood cell imaging of hepatic hemangiomas was modified with six sequential 3-minute SPECT images replacing the planar flow phase. Delayed 20-minute SPECT of the liver was then performed 2 hours later., Results: The authors present examples of pathologically proven positive and negative cases and retrospectively review their patient series. Examination of 19 patients with 41 lesions revealed no evidence of a false-positive examination results and only one false-negative result. Only one lesion seen to be positive with a 2-hour delayed study was not seen within 18 minutes. Lesions as small as 1.0 cm could be detected with a 3-minute SPECT., Conclusions: Rapid, dynamic early SPECT hemangioma imaging is feasible, provides images with relatively good quality, and can replace the planar flow phase.

The authors report two cases of orbital cavernous hemangioma diagnosed by Tc-99m RBC SPECT. Tc-99m RBC SPECT showed a typical scintigraphic pattern commonly seen in hepatic hemangioma in which there is intense focally increased uptake on delayed SPECT images. Tc-99m RBC SPECT in orbital cavernous hemangioma may be as useful a diagnostic modality as in hepatic hemangioma.

Purpose: To investigate the significance of increased perfusion associated with some hepatic hemangiomata during radionuclide blood volume imaging., Methods: Immediate dynamic planar projections and delayed SPECT imaging of a hepatic lesion were obtained after the administration of Tc-99m-labeled RBC. Scintigraphic data were compared with X-ray CT, contrast angiography and postresection histopathology., Results: A surgically proven, cavernous hemangioma with typical findings on delayed radionuclide blood-pool imaging showed markedly increased perfusion by scintigraphy. This correlated with arterioportal venous shunting (AVPS) on contrast angiography., Conclusion: Increased perfusion on radionuclide blood-volume imaging of hepatic hemangiomata may be a scintigraphic marker of AVPS. This may serve to identify patients with increased risk for spontaneous rupture or may identify them for the development of portal hypertension.

Five hemangiomas were found in four patients and were assessed by three-phase blood perfusion and blood-pool scintigraphy to determine the usefulness of this method for the imaging characteristics of different types of hemangiomas of the extremities. After injecting Tc-99m RBC or Tc-99m DTPA HSA, dynamic perfusion and early and delayed pool images were obtained and analyzed. The perfusion images of one cavernous hemangioma and two venous hemangiomas showed normal activity, but blood-pool imaging showed increased activity, whereas on perfusion imaging and early blood-pool imaging, another cavernous hemangioma showed a partial increase in activity in its periphery and on delayed blood-pool imaging, diffuse increase in activity. Further, the remaining hemangioma, a mixed-type hemangioma, showed, diffuse increase in activity on both perfusion and blood-pool imaging. Thus, three-phase scintigraphy was found useful in evaluating and achieving a diagnosis of a hemangioma of the extremities.

Radionuclide hepatic blood pool scintigraphy is an extremely sensitive and highly specific test in diagnosing cavernous hemangioma of the liver. The authors report a false-positive hepatic blood pool scintigram for hepatic hemangioma in a patient with liver metastasis from adenocarcinoma of colon.

To determine if the sonographic appearance of cavernous hemangiomas of the liver correlated with their detectability on Tc-99m labeled red blood cell (RBC) SPECT scintigraphy, studies of 30 cavernous hemangiomas, 14 with typical and 16 with atypical sonographic appearance, were retrospectively reviewed. The 14 typical hemangiomas had uniform hyperechoic sonographic appearance, and ranged in size from 0.8-3.9 cm (mean 2.0 cm). The 16 atypical hemangiomas ranged in size from 1.0-9.0 cm (mean 3.4 cm) and sonographic appearance was hypoechoic (n = 9), echogenic (with hypoechoic or cystic center [n = 3] or with irregular margins or shape [n = 2]); or heterogeneous (n = 2). Nine of 14 (64%) typical cavernous hemangiomas were identified on SPECT, compared with 15 of 16 (94%) atypical cavernous hemangiomas (P = 0.07). All 18 lesions > or = 2 cm (6 typical, 12 atypical) were identified on SPECT. Sensitivity of SPECT for hemangiomas of smaller than 2 cm was 38% (3 of 8) for those with typical and 75% (3 of 4) for those with atypical sonographic appearance. Four of the five typical hemangiomas not seen on SPECT were < or = 1 cm in at least one dimension. Detection of cavernous hemangiomas on RBC liver SPECT is primarily dependent on lesion size, with the influence of the sonographic appearance of these lesions mostly associated with the smaller size of those with typical characteristics.

Hemangiomas are congenital vascular tumors frequently referred for Tc-99m RBC imaging. A case of soft tissue cavernous hemangioma located in the right side of the face and neck is presented. The importance of the Valsalva maneuver in outlining this lesion is described, and a brief review of the literature is presented.

The utility of Tc-99m RBC imaging in the diagnosis of hepatic cavernous hemangiomas has been established. Of the 25 patients with various focal hepatic lesions evaluated, 16 were diagnosed as having hemangiomas: eight proven by surgery, two proven by angiography, and six proven by maintaining a stable clinical course ranging from 6 to 12 months with normal follow-up liver function tests. Although fourteen of these were detected by planar imaging, two were detected by SPECT only. Two patients with large hemangiomas had false-negative scans, whereas the remaining seven patients had other liver lesions.

Diffuse cavernous hemangioma of the rectosigmoid is a rare lesion. Preoperative recognition has been recorded but, because of lack of awareness and inconsistent diagnoses, inappropriate therapy still persists. Surgical therapy is the hallmark of treatment. Abdominoperineal resection has been advocated. Three cases of diffuse cavernous hemangiomas of the rectosigmoid, recognized preoperatively and treated successfully with sphincter-saving procedures, are reported. Use of the CT scan as a consistent diagnostic tool will be presented for the first time.

Cavernous hemangiomas are the most common benign tumors of the liver. Although their clinical course is usually uncomplicated, an accurate diagnosis may be important to exclude conditions that need treatment, (or to avoid an unnecessarily risky percutaneous biopsy). Although blood pool scintigraphy using planar gamma camera imaging is a reliable examination for the diagnosis of liver hemangiomas, it may fail to depict small, deeply seated lesions, and hence miss the diagnosis. Two cases are reported in which SPECT demonstrated delayed pooling in small, deep, space-occupying lesions, which were poorly seen on planar images, and therefore made a cavernous hemangioma the most likely diagnosis.

Patients with arteriovenous malformations of the bowel may have multiple symptoms secondary to chronic blood loss. A case of ileal cavernous hemangioma detected by Tc-99m labeled red blood cell imaging in the absence of active gastrointestinal bleeding is presented.

Hemangioma is the most common benign tumor of the liver. An accurate diagnosis of such tumor is essential for proper management of patients with hepatic cavernous hemangioma (HCH). Noninvasive diagnosis of HCH can be made using sequential Tc-99m RBC scintigraphy by demonstrating a "perfusion-blood pool mismatch." In addition, a case of HCH was observed which demonstrated peripheral enhancement with subsequent central enhancement on a sequential Tc-99m RBC blood pool scintigraphy. It is felt that this scintigraphic finding is pathognomonic for HCH.

The unique information provided by radionuclide techniques allows the noninvasive characterization of primary tumors and tumor-like conditions of the liver. A thorough knowledge of the mechanisms of radiopharmaceutical localization and the histologic abnormalities present in each condition is required to optimally use these techniques. A review of this subject is presented.

Perfusion defect in the dynamic study and slow filling of the lesion by a blood pool agent were observed in three cases with large cavernous hemangiomas of the liver. This finding is explained by the low perfusion and the large blood volume of cavernous hemangiomas. When such a lesion is suspected a late blood pool study should be performed in order to demonstrate the true vascularity of the lesion.

As the most common benign hepatic tumor, hepatic hemangioma may be misinterpreted during radiographic cancer staging, inadvertently biopsied, or pursued surgically as a solitary malignancy. Two cases of hepatic hemangiomas discovered during hepatobiliary scintigraphy are presented: the first involving multiple anechoic lesions by ultrasound and the second involving a solitary echogenic lesion by ultrasound. Whereas the former patient eventuated in surgery solely for the evaluation of a space-occupying lesion, the latter was totally obstructed at the common bile duct; both patients' hemangiomas were documented surgically.

Peripheral filling at dynamic CT occurs frequently with cavernous hemangiomas, yet this phenomenon is a rare finding on Tc-99m RBC imaging. A case of peripheral filling of a cavernous hemangioma with scintigraphy is reported and the rationale for its infrequent occurrence is discussed.

A cavernous hemangioma of the liver presented as an area of increased activity on an isotope bone scan. A review of the literature fails to reveal any previous reports of this phenomenon.