Diagnosis: Sclerosing Hemangioma of the Lung

 

Radiologic Findings

Chest radiograph shows a well-defined, ovoid mass in the right lower lung field. Right diaphragm and cardiac borders are partially obscured. The density of the mass is homogeneous. Pre-enhanced CT scan shows a well-circumscribed soft tissue density mass with probably central, tiny radioopaque density. Contrast-enhanced CT scan shows homogeneous enhancement of the mass, measuring about 100 HU. It abutted to the pericardial fat pad in the subpleural region.

 

Brief Review

Sclerosing hemangioma is a rare benign tumor of the lung with controversial histogenesis and first described by Liebow and Hubbell in 1956. There is a female-to-male predominance of approximately 4 to 5:1, a gender difference that may be related to the presence of estrogen receptors in some tumors. Most lesions are discovered in patients between 30 and 50 years of age. The lesion was more common on the right side. One case was located entirely in the interlobar fissure, and in two it derived from either the right or left upper lobe and extended into the interlobar fissure. Some cases were multiple in both lung fields. Most cases were asymptomatic, but some presented with hemoptysis, cough, chest pain, dyspnea, and pleurisy. The lesions range from 0.8 to 8.2 cm in diameter, but most are less than 3.5 cm in diameter. They are usually well-defined, circumscribed, hemorrhagic nodules. The tumor is often subpleural, and a thin fibrous pseudocapsule separates it from the adjacent compressed lung parenchyma. Four pathologic patterns are recognized: solid, hemorrhagic, papillary, and sclerotic. There were a mixture of at least three of these patterns, and a solid area was present in all cases. On CT, sclerosing hemangioma appeared as well defined juxtapleural masses in all cases. The tumors enhanced by visual criteria in all but one patient with the smallest mass. The CT density of the enhancing mass ranged from 96 to 157 HU. Some patients had calcifications and a few had well defined areas of low attenuation, corresponding with angiomatous, solid and sclerotic, and cystic areas, retrospectively. MRI findings were reported: They had mixed areas of high and low signal intensity on both T1- and T2- weighted images and were totally enhanced on postcontrast enhanced T1-weighted images. The T1 high signal intensity areas corresponded to those including abundant clear cells, and the T2-weighted low signal intensity areas corresponded to the fibrotic or hemorrhagic areas in the tumors.

 

References

1.      Im JG, Kim WH, Han MC et al. Sclerosing hemangioma of the lung and interlobar fissures: CT findings. Journal of Comput Assist Tomogr 1994; 18(1):34-38. 2.      Armstrong 3.      Spencer's lung 4.      Fujiyoshi F, Ichinari N, Fukukura Y, et al. Sclerosing hemangioma of the lung: MR findings and correlation with pathologic features. Journal of Comput Assist Tomogr 1998; 22(6):1006-1008.

A Useful Comment from France on Case 142  sclerosing hemangioma of the lung
 
With the complementary data you gave us after our first answer, our young fellow Mrs Valerie  Laurent - Croise found in the  book of a french thoracic radiologist J Frija "Tumeurs du poumon de l'adulte "1997 Paris Masson ed ,a paragraph devoted to this quite very rare entity in western countries . The author gave three references in this book:

    .DAIL.D.H. Uncommon tumors in pulmonary pathology. Dail DH, Hammar SP. Springer Verlag Ed., New York, 1988,847-972
 
    .WOJCIK E.M., SNEIGE N., LAWRENCE D.D., ORDONEZ ;N.G. Fine needle aspiration cytology of sclerosing hemangioma of the lung: case report with immunohistochemical study. Diagn. Cytopathol. 1993 , 9 , 304-309.
 
    .DAWSON W.B, MULLER N.L., MILLER R.R. Pulmonary sclerosing hemangioma: unusual cause of a solitary pulmonary nodule. J. Canad. Assoc. Radiol., 1990, 41 ,272-374
 
I would like to take this opportunity to congratulate you for your beautiful thoracic radiology teaching file .We only discovered it for 2 weeks and as general radiologist mainly devoted to vascular and GI tract imaging in our daily practice, we are very satisfied to learn more about thorax  in a so pleasant way.
 
 
Denis Regent
CHU Nancy-Brabois
Service de Radiologie Adultes
54017 Vandoeuvre les Nancy cedex
France

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