Intramuscular Hemangiomas

Abstract

Context:Intramuscular hemangiomas are common in the general population and often present at medical and surgical clinics. Unfortunately, unfamiliarity with these lesions has led to a high percentage of misdiagnoses, inappropriate workup, and unnecessary referrals.Evidence Acquisition:A literature search was performed using Medline, Embase, PubMed, and Cochrane. The relevant articles and referenced sources were reviewed for additional articles that discussed the epidemiology, pathophysiology, investigation, and management of intramuscular hemangiomas. Clinical experience from experts in orthopaedics, musculoskeletal pathology, and musculoskeletal radiology was compared. The selected case studies are shared cases of the authors.Results and Conclusion:The pathophysiology of these lesions is not completely understood, but much can be implied from their underlying vascular nature. Isolated lesions are benign tumors that never metastasize but tend to enlarge and then involute over time. Magnetic resonance imaging is the imaging modality of choice. If a systemic disorder or malignancy is not suspected or has been ruled out, conservative management is the treatment of choice for most intramuscular hemangiomas.

Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report

“…In general, IH is rarely considered in the differential diagnosis of musculoskeletal pain. The average duration of symptoms at initial presentation is 13 months, and so chronic extremity pain should increase suspicion for the presence of IH (2,15). IH presenting with pathological fracture is extremely rare.…”

“…In addition, preoperative embolization is also performed for diffuse hemangiomas, when arteriography highlights tributary arteries of sufficient diameter (23). Additional treatments, such as corticosteroids, radiation and sclerotherapy, are available, but are rarely used due to side-effects and less successful long-term outcomes: Side-effects of corticosteroids include elevated blood pressure, changes to cholesterol levels, mood swings, acne and premature balding; side-effects of radiation include nausea, vomiting, inhibition of hematopoiesis and skin ulcers, and side-effects of sclerotherapy include tissue necrosis and pulmonary embolism (2,24). Surgical excision is occasionally impractical; not all patients are recommended for surgery, and complex high-risk infiltrating lesions exist.…”

“…A palpable tender mass is observed in the majority of IH cases. Large hemangiomas are identified by the detection of a vascular murmur or tremor upon palpation (2,12). Superficial vein dilation may also be observed with cutaneous extension, and the tumor is generally long-standing, large and slowly-growing (4).…”

“…IH frequently occurs in the extremities, particularly the lower limbs. Since the majority of lesions are small, isolated and asymptomatic, the true incidence of hemangioma is very difficwult to calculate (2). Chronic pain and novel mass development comprise the most common symptoms of IH and hemangioma in general (3).…”

Challenges of Preoperative Diagnosis and Management of Scalene Intramuscular Angioma

“…The head and neck location is uncommon representing 15% of intramuscular angioma, with subsites in a decreasing order of masseter muscle, trapezius, and others such as temporalis, periorbital muscles, mylohyoid, sternocleidomastoid and buccinators (Rossiter, Hendrix, Tom, & Potsic, 1993;Moumoulidis, Durvasula, & Jani, 2007;Wierzbicki, Henderson, Scarborough, Bush, Reith, & Clugston, 2013). Among the over 80 head and neck intramuscular angioma cases reported, there are only five located in scalene musculature and 80% (4/5) of them have not been suspected preoperatively (Van Abel, Carlson, Janus, Torres-Mora, Moore, Olsen, & Link, 2013;Ferlito & Gale, 1980;Scott, 1957;Cho, Cha, & Sung, 2015).…”