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The aim of this article is show the neuroimaging, the pathological analysis and makes a brief review regarding to a giant cavernous haemangioma located in cavernous sinus in a 72 years old patient. A brief review was made in the literature searching for the key words "hemangioma" and "cavernous sinus" in the databases PubMed and Scielo for the last ten years. The images addressed were obtained by magnetic resonance imaging (MRI) in FLAIR, T1 and T1-weighted contrast-enhanced. The intracranial cavernous haemangiomas are rare conditions that comprise from 0,1 to 4% of intracranial vascular malformations. Diagnosis is made by MRI, when available SPECT (99mTc) is used to confirm and the treatment is done surgically with complement of radiotherapy and radiosurgery. The reported neuroimaging and pathological analysis show a giant cavernous hemangioma in cavernous sinus, a benign neoplasm involving the left internal carotid artery and maintaining contact with the contralateral internal carotid artery formed by abundant vascular structures, but without the presence of a muscular tunic.

Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used for diagnosis. Cavernous hemangioma is the most frequent type, but radiologists must be aware of other varieties. Conservative management is often adequate, but some cases necessitate targeted interventions. Although surgery was traditionally the main treatment, the evolution of minimally invasive procedures now often recommends transarterial chemoembolization as the treatment of choice.

Competing Interests: Conflict of interest None.

Small bowel hemangiomas are benign congenital vascular lesions that can be asymptomatic or cause anemia, gastrointestinal bleeding, obstruction, or intestinal perforation. We report the case of a 75-year-old woman who, after years of study for iron-deficiency anemia, was diagnosed with a cavernous hemangioma of the jejunum by capsule endoscopy, which was confirmed after surgical resection.

Hepatic Haemangioma is the most common benign liver tumour. There are two types of haemangiomas: capillary haemangioma and cavernous haemangiomas. The term"giant haemangioma"isreserved for lesionslarger than 5 cm. Given the abundance of vascular structures around the liver, SPECT/CT hybrid imaging with 99mTc labelled Red Blood Cells (RBCs) constitutes an excellent modality for localization and characterization of hepatic haemangiomas.

Hemangiomas, which originate in the sinonasal area, are not common among the various types of tumors from the head and neck region. Mechanisms for the formation of the tumor are yet to be discovered, and a few factors such as trauma, infection, oncogene, and some hormones are considered to take a role in the occurrence and growth of the tumor. Hemangiomas are classified for their histologic features as cavernous, capillary, and mixed types. There are a few reported cases of cavernous hemangiomas of the maxillary sinus, ethmoid sinus, middle and inferior nasal turbinate, and nasal septum. However, a case of cavernous hemangioma from the inferior nasal meatus, on the lateral wall to be precise, has never been reported. The authors are the first to report a case of a 69-year-old female patient who had cavernous hemangioma which was originated from the lateral wall of the inferior nasal meatus and successfully managed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Background: Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases., Case Presentation: We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed., Conclusion: Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports., (© 2023. The Author(s).)

Background: Preoperative identification of intramuscular hemangioma (IMH) subtypes (capillary hemangioma, cavernous hemangioma, and mixed hemangioma) is urgently necessary. Enhanced T2*-weighted angiography (ESWAN) is sensitive to vessels and metabolites and can be used to diagnose IMH subtypes., Purpose: To compare the diagnostic performances of ESWAN and conventional magnetic resonance imaging (MRI) for qualitative and quantitative diagnosis of IMH subtypes., Material and Methods: In total, 23 patients with IMHs were examined using conventional MRI and ESWAN. The signal intensity ratios (SIRs) of conventional MRI and ESWAN were measured., Results: There was no significant difference for volume among the three subtypes ( P  = 0.124, P  = 0.145). Various shapes and MRI signals were shown in the three subtypes of IMH. There was no significant difference for SIRs of conventional MRI ( P  = 0.558, P  = 0.259, P  = 0.385, P  = 0.347). However, there was a significant difference for SIRs of ESWAN parameters ( P  = 0.050, P  < 0.001, P  = 0.005, P  = 0.002). Capillary hemangiomas can be diagnosed when R2* SIR is <0.912 and intratumoral susceptibility signal (ITSS) percentage is <29.085%. Cavernous hemangiomas should be considered when R2* SIR is >0.912, ITSS percentage >35.226%, and phase SIR >2.536. In addition, mixed hemangiomas should be considered when T2* SIR is >0.662 and R2* SIR <1.618., Conclusion: Conventional MRI can only display the volume, shape, and signal of IMHs. 3D-MinIP imaging of ESWAN can show the veins and minor hemorrhage. SIRs of ESWAN parameters including T2* value, R2* value, phase value, and percentage of ITSS can be used to quantitatively diagnose capillary hemangiomas, cavernous hemangiomas, and mixed hemangiomas.

Background: Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs., Methods: A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management., Results: HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection., Conclusion: HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms., (© 2022. The Society for Surgery of the Alimentary Tract.)

Rationale: Female reproductive organ angiomas are rarely reported and are accidentally found during surgery. Angiomas arising from infundibulopelvic vessels presenting as adnexal masses are even rarer, and a few doctors have experience in their management., Patients Main Concerns and Important Clinical Findings: Herein, we report the case of a 40-year-old woman who was admitted after a physical examination revealed an ovarian mass. The physical examination revealed a palpable adnexal mass in the right pelvic cavity. Ultrasound showed a 4.5 × 4.0 × 5.0 cm space-occupying lesion close to the right ovary, which had many echogenic lines and calcifications in its cystic cavity., Primary Diagnosis: Right adnexal mass., Interventions: Laparoscopic surgery was performed in all the patients. During the surgery, the mass was found to be a retroperitoneal hemangioma with distorted and dilated vessels. We separated the right infundibulopelvic vessels and performed tumor resection with minimal blood loss., Outcomes: The patient recovered well, and no abnormalities were observed during the following 2 years. Pathological results showed that this adnexal mass was a type of cavernous hemangioma arising from the infundibulopelvic vessels., Lessons: Surgical removal of the affected tissues is an aggressive treatment of choice for cavernous hemangiomas. Laparoscopic resection of infundibulopelvic hemangioma is feasible, and gynecologists are qualified for this operation, as long as damage to the iliac vessels is avoided., Competing Interests: Conflict of interest: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Spinal hemangiomas are benign vascular tumors that most commonly originate from the osseous structures of the spinal column. Epidural spinal hemangiomas without osseous involvement are uncommon and are classified as pure epidural spinal hemangiomas. Extraosseous spinal epidural cavernous hemangiomas are rarely described and among available reports; most patients present with slowly progressive neurological symptoms. Herein, we present a novel case of acute neurological dysfunction from a pure spinal epidural hemangioma that was managed through surgical resection with good neurological recovery at follow-up., Case Presentation: A 45-year-old previously healthy man presented to the emergency room with sudden inability to ambulate and was found to have bilateral lower extremity weakness. Magnetic resonance imaging of the spine demonstrated an epidural mass extending out of the right T5/6 neural foramen. The mass enhanced heterogeneously, and the preoperative diagnosis favored an atypical schwannoma. The lesion was surgically removed en-bloc through a midline posterior decompression with instrumentation. Histopathologic examination confirmed cavernous hemangioma pathology. Within 6 weeks of the surgical intervention, the patient had regained full sensorimotor function and these effects were durable through long term follow-up., Discussion: Pure spinal epidural hemangiomas are rare and generally have an insidious clinical course. This case report highlights that these uncommon lesions may present with substantial and acute neurological dysfunction requiring urgent neurosurgical intervention. This should prompt clinicians to consider cavernous hemangioma in the differential diagnosis of patients presenting with acute neurological deterioration and an epidural spinal tumor., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)

Hepatic hemangiomas are benign liver tumors, and most of them progress asymptomatically. We report a case of hepatic hemangioma considered the cause of fever. A 53-year-old woman had a fever of 40°C for about 3 months without infection. Hepatic hemangiomas with internal bleeding of 10 cm in size on liver S8/7 and S3/2 were observed. These were resected laparoscopically for diagnostic treatment. She was afebrile after the operation. The pathological diagnosis was hematoma inside cavernous hemangioma. It should be noted that a bleeding hepatic hemangioma may cause fever of unknown origin and be indicated for resection.

Hepatic cavernous haemangioma is a benign tumour of vascular origin found within the liver. Often incidentally diagnosed, the management of these vascular masses is frequently determined by the size of the mass and symptoms associated with its compression of adjacent structures. Tumours >10 cm are known as giant haemangiomas and are associated with increased risks of compression symptoms, coagulopathies and haemorrhage. Known to express hormone receptors for oestrogen, intervention for these masses remains controversial in the setting of pregnancy where concerns for tumour growth and life-threatening complications are increased. Here we present the case of a woman in her 30s recently diagnosed with a giant haemangioma who is found to be pregnant, their management and a review of the literature., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate and compare the CT and MRI features of hepatic sclerosed hemangioma (HSH) and sclerosing cavernous hemangioma (SCH)., Materials and Methods: Twelve HSH cases and 36 SCH cases were included, the imaging findings on CT (9 HSH and 34 SCH) and MRI (8 HSH and 10 SCH) were analyzed. Qualitative image analysis included the location, size, shape, capsular retraction, density, calcification, signal intensity on T 1 -weighted image (T 1 WI) and T 2 -weighted image (T 2 WI), presence of diffusion restriction, apparent diffusion coefficient (ADC) map, transient hepatic attenuation difference around the lesion, and the dynamic enhancement patterns., Results: The presence of liver cirrhosis in patients with HSH (3/12) was higher than SCH (1/36) (P = 0.043). The morphology appearance before enhancement showed no significant difference between HSH and SCH. Moreover, SCH had a stronger trend of centripetal enhancement patterns of cavernous hemangiomas (83.3%) compared to HSH (25%) (P < 0.001). Due to more frequent atypical enhancement features, containing rim-like enhancement, no enhancement, and peripheral heterogeneous enhancement, the misdiagnosis rate of HSH (75%) was significantly higher than that of SCH (16.7%) (P < 0.001). Furthermore, the ADC values of HSH and SCH were both higher than that of the surrounding liver parenchyma (P = 0.009, P = 0.002); however, there was no significant difference in ADC values between themselves (P = 0.613)., Conclusion: SCH showed the same trend of centripetal enhancement characteristics as typical hemangioma, while HSH exhibited atypical enhancement features due to complete sclerosis. Higher ADC values might contribute to the identification of atypical HSH and SCH from malignancies., (© 2021. The Author(s).)

Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: The authors analyzed the clinical characteristics and treatment results of capillary and cavernous hemangiomas in the nasal cavity., Patients and Methods: A total of 14 patients who underwent surgical treatment for sinonasal hemangiomas between January 2010 and May 2020 were analyzed. The study population was subdivided into capillary and cavernous hemangiomas groups., Results: The 14 patients with sinonasal hemangiomas involved 8 (57.1%) capillary hemangiomas and 6 (42.9%) cases of cavernous hemangioma. Clinical features, such as age, gender, medical condition, symptom, duration of symptom, size and site of sinonasal hemangiomas, surgery, anesthesia method, treatment outcomes, and recurrence of capillary and cavernous hemangiomas of nasal cavity showed no statistically significant difference (P > 0.05). A case of relapse involving a patient with cavernous hemangioma of vestibule was observed without recurrence after reoperation., Conclusion: The comparison of clinical features of capillary and cavernous hemangiomas of nasal cavity showed no statistical significance. Transnasal endoscopic tumor removal including the surrounding structure is a safe and effective procedure for sinonasal hemangiomas., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Background: Hepatic cavernous hemangioma is the most common type of benign liver tumor. Although ruptures and hemorrhages of hepatic hemangioma are rare complications, they are associated with high mortality. Most practitioners only pay more attention to abdominal hemorrhages caused by the rupture of hepatic hemangiomas. However, spontaneous intracapsular hemorrhages can often be neglected and poorly understood., Case Presentation: A 65-year-old man was referred to our institution with right upper quadrant pain, which had occurred suddenly and without a history of recent trauma. The blood test results were normal. Magnetic resonance imaging (MRI) of the abdomen showed a cystic mass in the right liver lobe. Considering the possibility of hepatic cystadenoma with hemorrhage, the patient underwent a right hepatic lobectomy. The pathological findings unexpectedly revealed intratumoral hemorrhage of hepatic hemangioma. The patient recovered well and was discharged eight days after surgery., Conclusions: Intracapsular hemorrhage of hepatic cavernous hemangioma is challenging to diagnose and has a high potential risk of rupture. MRI is beneficial for diagnosing subacute internal hemorrhage cases, and it is recommended to undergo surgery for patients with a definitive diagnosis.

Hepatic sclerosed hemangioma is a rare benign liver tumor that originated from hepatic cavernous hemangioma; however, the process of its formation has been unclear. We herein present the patient of a histologically proven hepatic sclerosed hemangioma that showed drastic changes in diagnostic images in a short period. A 56-year-old man was referred to our hospital for the treatment of suspicious hepatocellular carcinoma with hepatitis C, approximately 2 cm in diameter in liver segment 8. Initially, the tumor manifested as early entire enhancement with mildly delayed washout in contrast-enhanced ultrasonography; however, it manifested as continuous peripheral enhancement with the central non-enhanced area after 1 month in various diagnostic images. He completely quit drinking and smoking 1 month preoperatively. No special symptoms and signs were found to suggest tumor ischemia. Anatomical resection of segment 8 was completed. Histological examination confirmed the final diagnosis of common type hepatic sclerosed hemangioma, derived from atypically enhancing cavernous hemangioma. No signs of impaired blood flow were observed in both diagnostic images and histological examination. Sclerosing changes in hepatic cavernous hemangioma may be completed in a relatively short time with no apparent reason.

This video shows the technical nuances of microsurgical resection of recurrent cavernous sinus (CS) hemangioma by superior and lateral approach.  A 77-yr-old woman presented with headache and difficulty in vision in right eye for 6 mo. She had previously undergone attempted resection of a right CS tumor in another hospital with partial removal, and the tumor had grown significantly. Neurological examination revealed proptosis, cranial nerve 3 palsy, and loss of vision in right eye (20/200). Left side visual acuity was 20/20.  Brain magnetic resonance imaging (MRI) demonstrated a large CS mass with homogeneous enhancement, measuring 3.3 × 3.3 × 2.6 cm, extending into the suprasellar cistern with mass effect on the right optic nerve. It extended anteriorly to the region of the right orbital apex and abuted the basilar artery posteriorly.  She underwent right frontotemporal craniotomy, posterolateral orbitotomy and anterior clinoidectomy as well as optic nerve decompression, and the CS tumor was removed by superior and lateral approach. An incision was made into the superior wall of the CS medial to the third nerve. On lateral aspect the tumor had extended outside the CS through the Parkinson's triangle. Posteriorly it extended through the clival dura. Anteriorly tumor encased the carotid artery and it was gradually dissected away. At the end of the operation, all of the cranial nerves were intact.  Postoperative MRI showed near complete tumor resection with preservation of the internal carotid artery. At 6 mo follow-up her modified Rankin Scale was 1 and vision in left eye was normal.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides., (Copyright © 2019 by the Congress of Neurological Surgeons.)

Adrenal cavernous hemangiomas are a rare, benign, and non-functional tumor. We report a case of a 62-year-old male who presented with right upper quadrant and flank pain. Physical examination revealed a fullness of the right upper quadrant. Both computed tomography and magnetic resonance imaging suggested a hemangioma originating from the liver. During angiography with the intent of embolization, it was discovered that the vascular supply was consistent with an adrenal mass rather than a hepatic origin. The patient was referred to Urology and underwent curative right open adrenalectomy and nephrectomy. Histopathology confirmed the diagnosis of an adrenal cavernous hemangioma.

A cardiac cavernous hemangioma is an extremely rare primary benign cardiac tumor. Herein, we report a case of cavernous hemangioma in the right atrium and close to the coronary sinus of an asymptomatic 56-year-old male who underwent multimodality imaging and successful resection of the cavernous hemangioma. Our case highlights that multimodality imaging plays an important role in characterizing cardiac hemangiomas and determining the surgical plan., (© 2020 Wiley Periodicals, Inc.)

Objective: The objective of this study was to evaluate the imaging features of a hepatic sclerosed hemangioma by comparing them with those of a cavernous hemangioma using magnetic resonance imaging with gadoxetic acid enhancement., Methods: Nine patients with hepatic sclerosed hemangiomas and 36 patients with cavernous hemangiomas (control group) who underwent gadoxetic acid-enhanced magnetic resonance imaging were included. Qualitative values (imaging findings and enhancement pattern [typical vs atypical enhancement]) and quantitative values (apparent diffusion coefficient) were evaluated., Results: Patients with sclerosed hemangiomas showed significantly more irregular tumor margin on hepatobiliary phase images, peritumoral arterial enhancement, and a lower proportion of hyperintensity on heavily T2-weighted images compared with controls (all P values <0.05). In addition, the sclerosed hemangioma group had significantly more frequent atypical enhancement patterns than did the control group (88.9% vs 33.3%; P = 0.006). However, the mean apparent diffusion coefficient value of hemangiomas was not significantly different between the 2 groups (P = 0.639)., Conclusions: Gadoxetic acid-enhanced magnetic resonance images can help in differentiating between hepatic sclerosed hemangiomas and cavernous hemangiomas.

Background: An unusual case of cavernous hemangioma coexisting with venous angioma in the ipsilateral orbit is described., Case: A 67-year-old woman had a mass in the lower eyelid of her right eye and proptosis. Imaging examinations showed two masses connected to each other in the extraconal space of the right orbit., Observations: Anterior orbitotomy was performed to remove the tumors. Histopathological evaluation of the anteriorly located tumor revealed cavernous hemangioma. The posteriorly located tumor was found to be a venous angioma. Endothelial cells in both tumors showed positive immunostaining for factor VIII-related antigen and smooth muscle actin. Immunoreactivity of smooth muscle actin was more prominent in the interstitium of the posteriorly located tumor., Conclusion: Coexistence of cavernous hemangioma and venous angioma in the same area suggests that they are a continuum and of the same origin., (Copyright Japanese Ophthalmological Society 2004)

Purpose: The relative utility of various preoperative diagnostic imaging modalities for the evaluation of hemangioma of the extremities, including positron emission tomography (PET) (using 18F-fluoro-2-deoxy-D-glucose [FDG] and fluorine-18 alpha-methyltyrosine [FMT]), computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA), was investigated., Methods: Imaging findings in 16 patients with 16 histopathologically documented hemangiomas of the extremities were retrospectively reviewed. Preoperative imaging included: FDG-PET (n = 16), FMT-PET (n = 12), MRI (n =16), CT (n =11), and DSA (n =14)., Results: All 16 lesions examined by PET with FDG and/or FMT showed accumulation. The standardized uptake values (SUVs) for FDG-PET for the 16 examined tumors ranged from 0.7 to 1.67; for FMT-PET, they ranged from 0.14 to 1.00. The SUVs with both tracers indicated the benign nature of the tumor. Computed tomography demonstrated variable attenuation and phleboliths in two patients. The MRI signal characteristics were relatively consistent: heterogeneous signals were slightly higher than those of skeletal muscle on T1-weighted images and brighter than those of subcutaneous fat on T2-weighted images. The pooling and cotton-wool staining depicted in DSA was found to be significantly correlated with FDG accumulation, suggesting that localized blood retention-induced ischemia may accelerate anaerobic glycolysis, which leads to high FDG uptake., Conclusion: Although plain radiography, CT, MRI, and angiography may provide anatomic extent and be pathognomonic, FDG-PET and FMT-PET may be the most reliable among the studied imaging modalities for differentiating benign hemangiomas from other soft tissue tumors, especially malignant neoplasms.

Intramuscular hemangiomas are rare benign tumors, making up 0.8% of all hemangiomas. They are of interest to the surgeon because their location may present considerable therapeutic challenge since radiographic work-up of the soft- tissue mass by magnetic resonance imaging (MRI) may be suspicious for malignancy. The definitive diagnosis is made by histological study of the surgical and/or biopsy specimen. Patients with intramuscular hemangiomas may have soft-tissue complaints, such as pain and swelling, present for years. The gross and microscopic appearance of intramuscular hemangiomas is variable. Grossly, the capillary type is nonvascular and spongy in appearance, whereas the cavernous type is composed of large, thin-walled, dilated vessels lined by flattened endothelial cells. In general, wide excision is the treatment of choice to prevent local recurrence, but every patient with intramuscular hemangioma should be treated individually after evaluating the tumor location, accessibility, and depth of invasion, the patient's age, and cosmetic considerations. From October 1, 1989, to June 30, 1997, 11 patients underwent surgical treatment with the definitive histological diagnosis of intramuscular hemangioma. Pain upon activity but also at rest as well as swelling were the major symptoms. The average duration of symptoms was 13 months (range 1 month to 5 years). After a mean follow- up of 3 years and 4 months (range 12 months to 9 years), one of the patients has developed a recurrence; all remaining patients enjoy pain relief without any recurrence.

Unlabelled: We investigated the sensitivity and specificity of perfusion and blood-pool scintigraphy in the detection of head and neck hemangiomas and evaluated their histopathologic types., Methods: Perfusion and blood-pool scintigraphy with 99mTc-red blood cells (RBCs) or 99mTc-human serum albumin combined with DTPA (HSA-D) were used to evaluate 51 head and neck lesions clinically suspected of being hemangiomas in 48 patients. Thirty-three of the 51 lesions were subsequently histologically confirmed to be hemangiomas, whereas the remaining 18 were histologically diagnosed as other lesions., Results: Perfusion and blood-pool scintigraphy correctly diagnosed 30 of 33 hemangiomas as being hemangiomas but could not detect the remaining 3 hemangiomas. Perfusion and blood-pool scintigraphy correctly diagnosed 12 of 18 lesions as nonhemangiomas, but the remaining 6 lesions were misdiagnosed as hemangiomas. Thus, the sensitivity for detecting hemangiomas was 91%, with a specificity and accuracy of 67% and 82%, respectively. Twenty-five (89%) of 28 cavernous or venous hemangiomas demonstrated normal activity on the perfusion images and increased activity on the delayed blood-pool images, whereas the remaining 3 (11%) showed normal activity on both perfusion and blood-pool images. Finally, 5 of 5 (100%) capillary or recemose hemangiomas showed increased activity on the perfusion and blood-pool images., Conclusion: Perfusion and blood-pool scintigraphy demonstrated sufficiently high sensitivity but relatively low specificity for detecting head and neck hemangiomas. Additionally, perfusion and blood-pool scintigraphy can clearly differentiate between cavernous and venous hemangiomas and capillary and recemose hemangiomas and are extremely useful for the detection and evaluation of head and neck hemangiomas.

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.

The natural history and appropriate treatment of giant liver haemangioma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered into a follow-up programme consisting of clinical assessment and abdominal ultrasonography every 6 months. Resection was considered only for symptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean follow-up was 36 months for the resected patients and 55 months for the observed group. Surgery permanently relieved symptoms. No recurrence of haemangioma was observed. Some 32 of 36 unresected lesions followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a further indication for resection and justifies strict imaging follow-up. The pattern of growth, rather than absolute size, of a lesion is suggested for selection of asymptomatic patients who might benefit from preventive surgical excision. When feasible, the authors prefer enucleation to remove giant haemangiomas.

Fifteen patients with intramuscular haemangiomas were evaluated with magnetic resonance imaging (MRI). Phleboliths were demonstrated by plain films or CT in six cases, which are characteristic for haemangioma. MRI showed intermediate or slightly high signal intensity on T1-weighted spin-echo images, and overall extremely bright signal on T2-weighted images. Twelve patients had a heterogeneous signal intensity and serpentine pattern on all sequences. A draining vessel was identified in a patient with histologically confirmed diagnosis of arteriovenous type of hemangioma. In three cases with localized small lesions, the MR appearance on T1 and T2-weighted conventional spin-echo sequences was homogenous. Two of the three showed a serpentine pattern on contrast enhanced images. In a patient with a soft tissue mass suspected of representing a haemangioma, MRI may provide more specific information, regarding the characteristics and extent of the lesion than other imaging techniques. In small localized lesions, contrast enhanced MRI may also offer significant advantage, making the identification of serpentine pattern possible which is a characteristic morphological feature of haemangioma.

Objective: This study was undertaken to describe the imaging characteristics of synovial hemangioma, with the goal of improving the disappointing rate (22%) of clinical diagnosis of this condition. A review of the literature and the differential diagnosis of intra-articular lesions, including synovial osteochondromatosis and pigmented villonodular synovitis, are also presented., Patients: The subjects of the study were 8 patients (4 males, 4 females; age range: 5-47 years; mean age: 19 years) with histologically confirmed synovial hemangioma involving the knee (n = 7) or wrist (n = 1). We retrospectively examined the imaging studies performed in these patients, including plain radiography (n = 8), magnetic resonance imaging (MRI; n = 4), angiography (n = 3), arthrography (n = 2), and contrast-enhanced computed tomography (CT; n = 2)., Results: Plain radiographs showed a soft tissue density suggesting either joint effusion or a mass in all patients. Phleboliths and bone erosions on plain films in four patients with extra-articular soft tissue involvement pointed to the correct diagnosis. Angiography, showing fine-caliber, smooth-walled vessels, contrast pooling in dilated vascular spaces, and early visualization of venous structures, was diagnostic in two patients. Neither arthrography nor CT yielded specific enough findings. MRI was consistently effective in allowing the correct diagnosis to be made preoperatively, showing an intra-articular or juxta-articular mass of intermediate signal intensity on T1-weighted images and of high signal intensity of T2- or T2*-weighted images with low-signal channels or septa within it. A fluid-fluid level was found in two patients with a cavernous-type lesion., Conclusion: Despite the limited nature of this study, it shows clearly that MRI is the procedure of choice whenever an intra-articular vascular lesion such as synovial hemangioma is suspected. Nonetheless, phleboliths and evidence of extra-articular extension of plain radiographs point to angiography as an effective procedure of first resort because it can be combined with embolotherapy.

There is considerable confusion in the literature regarding the pathological substrates of angiographically occult vascular malformations (AOVMs) of the brain and their clinical significance. We retrospectively reviewed the cases of 34 consecutive patients with AOVMs undergoing surgical excision at a single institution during a 10-year period. Pathological specimens were reexamined, and the lesions were classified according to strict histopathological criteria. There were 21 cavernous malformations, 3 arteriovenous malformations, 3 venous malformations, 2 capillary malformations, and 5 mixed (pathologically heterogeneous) lesions. The initial pathological diagnostic report had been imprecise or had misidentified the lesion type in 18 of the 34 cases (53%), most commonly labeling a cavernous malformation as an arteriovenous malformation or not recognizing mixed features within the same lesion. Clinical presentation (including hemorrhage) and outcome were not significantly different among the various lesion types. Preoperative diagnostic imaging included a variety of modalities that were introduced or evolved during the period of the study and generally suggested a suspected vascular malformation but did not predict pathological subtypes. Acute hematomas in this surgical series made the identification of underlying vascular malformations highly speculative. We conclude that the majority of AOVMs requiring surgical intervention are cavernous malformations, although there was a notable pathological heterogeneity of the remaining lesions. Histopathological subtypes of AOVMs are not associated with unique clinical or radiographic features.

A retrospective analysis of the morphology and signal behaviour of T1, proton and T2-weighted spin-echo sequences has been carried out on 21 haemangiomas and 2 lymphangiomas of the peripheral soft tissues which had been examined by MRT. In 11 cases the diagnosis was confirmed histologically and in 12 by angiography. The majority of haemangiomas (19 cases) and both lymphangiomas showed hyperintense signals on T2-weighted spin-echo sequences; 2 lesions did not conform to this behaviour. MRT was a sensitive method for demonstrating vessels with high flow velocities so that it was possible to distinguish high flow haemangiomas by MRT. Apart from one thrombosed haemangioma, all 9 haemangiomas examined with iv Gd-DTPA showed homogeneous contrast uptake except for vessels with high flow velocities. One lymphangioma examined with iv Gd-DTPA was characterised by non-homogeneous contrast uptake.

Background and Purpose: Using multitracer positron emission tomography, I investigated regional hemodynamic and metabolic changes in both perifocal and remote tissues of cerebral angiomas, with special reference to steal phenomena., Methods: In 22 patients (14 with arteriovenous malformations and eight with cavernomas) cerebral blood flow, cerebral blood volume, mean vascular transit time, cerebral metabolic rate for oxygen, oxygen extraction fraction, cerebral metabolic rate for glucose, and glucose extraction fraction were measured using standard positron emission tomographic methods. Twelve patients also had their cerebral glucose metabolism assessed during psychophysical activation. Regions of interest representing the angioma, perifocal and remote tissues, contralateral mirror regions, and standard brain regions were analyzed., Results: There were no significant changes in hemodynamic variables or oxygen metabolism in the ipsilateral cerebral hemisphere, but ipsilateral glucose metabolism was reduced both at rest (p less than 0.01) and during activation (p less than 0.05). Glucose (p less than 0.001) and oxygen (p less than 0.001) metabolism in regions of perifocal tissue with low blood flow were decreased, with substrate extraction fractions showing no increase to compensate for insufficient blood flow. Functional recruitment of the cortex overlying the angioma beyond its periphery and supplied by the same arterial branches was subnormal (p less than 0.05) despite relatively unchanged hemodynamics in this tissue compartment., Conclusions: These data suggest that dysfunction of the cortex supplied by arterial branches also feeding the vascular malformation is related to neuronal deafferentation, while the proportionate decrease in blood flow and metabolism of perifocal tissue may be ascribed to neuronal loss in chronically hypoperfused areas, rather than to persistent hemodynamic steal effects.

Two patients with osseous hemangioma of the orbit, and with typical features on plain radiography and computed tomography, are reported. The typical features of osseous hemangioma of the orbit on computerised tomography (CT) are: expansile bony lesion limited by a thin sclerotic rim, bony trabeculae radiating from the centre to the periphery of the lesion, and absence of an associated extra-tumoral soft tissue mass. To the best of our knowledge this is the first report of osseous hemangioma of the orbit evaluated by CT.

In contrast to angiography, MRI not only allows the diagnosis of DVA (developmental venous anomaly, so-called venous angioma), but also shows up cavernomas and other angiographically occult vascular malformations. It also differentiates between DVAs and occult true malformations. This has completely changed the pathological assessment of DVAs. In a retrospective study on 31 patients with angiographically proven DVAs neighbouring cavernoma was a frequent finding (15 patients, 48% group I). Symptoms caused by cavernoma were present in 6 (40%) of these 15 patients. The following associations were also found: cerebral arterial aneurysm (2), spinal arterio-venous dural fistula (1), dermal haemangioma (1), Klippel-Trénauny syndrome (1). Only 16 (52%) of the 31 cases with DVA were free of associated cavernoma (group II). Only 3 (19%) of these patients with a solitary DVA were symptomatic. In our series we have seen no case of bleeding from a DVA. A DVA is a vascular anomaly characterized, like other anomalies, by reduced resistance and limited capacity for regulation and adaptation. In rare cases this can result in haemodynamic disturbances, thrombosis and ischaemia. Wall rupture with bleeding does not occur in DVA. It must be assumed that bleeding reported in patients with DVAs before the availability of MRI resulted from an associated true vascular malformation in most cases.

Embolization of the proximal part of the hepatic artery was carried out in three patients with hemangioma of the liver who did not meet the criteria for radical surgery. Metal spirals were used for this purpose. Response was observed in all the cases. Patients were followed for 9-36 months. The data obtained suggest that embolization of the hepatic artery is effective and may be used for the treatment of inoperable vascular tumors of the liver.

Four cases of renal hemangioma are presented. Renal hemangioma is difficult to detect because this benign vascular tumor never demonstrates any abnormalities on renal arteriography. Computed tomography in two resected cases of cavernous hemangioma revealed a low-density mass without any enhance effect, while the others diagnosed by the selective renal arteriography demonstrated no abnormality on computed tomography. We postulate that both angiographic and computed tomographic appearances of the renal hemangioma could depend on its vascular components. Related reports are also reviewed.

Angiographic findings in seventy cases of maxillofacial hemangioma are reported. The tumors have been divided into four types: (1) plexiform hemangioma, (2) cavernous hemangioma with venous drainage, (3) cavernous hemangioma without venous drainage, and (4) the so-called "diffuse type" of cavernous hemangioma. The angiographic features of the four types are described, and clinical application is evaluated. The angiograms demonstrate the location, extent, blood supply, and drainage of the tumors and show whether they communicate intracranially, thus providing valuable criteria for planning and determining the mode of treatment.

In a 32-year-old man with a right-sided retinal cavernous hemangioma and cutaneous angiomas, computed tomography and nuclear magnetic resonance imaging confirmed the presence of cerebrovascular lesions. This supports the inclusion of cavernous hemangioma of the retina in the established group of neuro-oculo-cutaneous phacomatoses.