Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Mediastinal cavernous hemangioma
- Radiologic Findings
- Fig 1. Chest PA shows bulging contour of left anterior mediastinum with tracheal deviation to the right side.
Fig 2-6. Enhanced chest CT images demonstrate a lobulated contour mass with mild enhancement with punctate calcification in left anterior mediastinum.
- Brief Review
- Hemangiomas are uncommon benign vascular tumors that account for less than 0.5% of mediastinal masses. Mediastinal hemangiomas usually occur in young patients, before age of 35 years. It has been speculated that they represent either true neoplasm or developmental vascular anomalies. Most mediastinal hemangiomas are found in the anterior mediastinum, however, a few arise in the posterior mediastinum. At histologic analysis, these tumors consist of large interconnecting vascular spaces lined by flattened cuboidal epithelium along with a varying amount of interspersed stromal elements, such as fat, myxoid, and fibrous tissues. They are categorized as capillary, cavernous, or venous hemangiomas and more than 90% are capillary or cavernous.
Hemangiomas commonly appear as heterogeneous lesions on unenhanced CT scans, and contrast enhancement is most often heterogeneous and central. Gradually increasing and persistent enhancement has been seen on dynamic contrast-enhancement CT scans. Large draining veins have also been seen on delayed images. Phleboliths, thought to be pathognomonic, are visible in up to 10% of cases on plain radiographs. In our imaging, a dilated vein draining into the left innominate vein was seen. And also, tiny punctate calcification which consistent with a phlebolith is a diagnostic of hemangioma.
The differential diagnosis includes mediastinal lymphoma, lymphangioma and teratoma. Mediastinal lymphoma can appear as a heterogeneous mediastinal mass but calcification is exceedingly rare. Lymphangiomas usually are cystic lesions that typically do not enhance. Dilated vein is a feature suggestive of hemangioma rather than teratoma.
- References
- 1. Agarwal P, Seely J et al. Mediastinal hemangioma. Radiology 2018; 246: 634-637
2. W. Richard Webb. The mediastinum: mediastinal masses. Thoracic imaging. 2nd ed. Lippincott Williams & Wilkins 2011: 269
3. Cheung YC, Ng SH, Wan YL, Tan CF, Wong HF, Ng KK. Dynamic CT features of mediastinal hemangioma: more information for evaluation. Clin Imaging 2000;24:276 –278.
- Keywords
- Mediastinum, anterior mediastinum, Mediastinum, Benign neoplasm, Vascular malformation,