대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 268 Date 2002-12-14

  • Courtesy of Jung Im Jung, M.D. / St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • Age/Sex 63 / M
  • Chief ComplaintIncidental chest radiograph abnormality. * CT number of the nodule - precontrast CT 24HU / enhanced CT 37 HU
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Sclerosing Hemangioma, Papillary Type
Radiologic Findings
There is an about 2.0x1.1cm sized, well-defined, nodule in left middle lung zone. Pre-contrast CT scan shows noncalcified, homogeneous soft tissue density nodule (24HU) in lingular segment of left upper lobe. After the contrast infusion, the nodule is mildly enhanced (37HU). On lung setting, the nodule is smoothly marginated.
Brief Review
Pulmonary sclerosing hemangiomas are benign neoplasm that usually, but not invariably, are solitary. Most patients are asymptomatic. In most series females outnumber males by nearly 4 to 1. The lesion is rare in patients under 20 years of age.
Lebow and Hybbell first described sclerosing hemangioma in 1956. It is a rare benign tumor, characterized microscopically by four major histologic components: solid, papillary, sclerotic, and hamngiomatous in varying proportions. There have been many investigations of the histogenesis of the tumor, but it is still uncertain whether its origin is endothelial or epithelial. However, recent immunohistochemical and ultrastructural data support the concept that sclerosing hemangioma is an epithelial neoplasm derived from type II pneumocytes and bronchiolar epithelial cells.
Radiographically, it is a mainly solitary, well-defined, benign-looking solitary pulmonary nodule. Rarely they contain areas of calcification. The air-meniscus sign, characterized by a crescentic radiolucency at the periphery of a lung nodule, has been reported in a few cases, corresponding to enlarged alveoli with septal destruction microscopically.
Im et al reported CT findings of eight patients with sclerosing hemangioma. It appeared as well defined, juxtapleural masses in all cases. The tumors enhanced by visual criteria in seven patients. However one patient with the smallest mass (2.0x1.5cm) is poorly enhanced by visual assessment. In our case the mass is mildly enhanced after contrast infusion (13HU) because of small size and papillary subtype.
References
1. Im JG, Kim WH, Han MC, Han YM, Chung JW, Ahn JM, Do YS. Sclerosing hemangiomas of the lung and interlobar fissures: CT findings. J Comput Assist Tomogr 1994; 18 : 34-38
2. Nam JE, Ryu YH, Cho SH, Lee Y, Kim HJ, Lee DY, Choe KO, Kim SJ. Air-trapping zone surrounding sclerosing hemangioma of the lung. J Comput Assist Tomogr 2002; 26: 358-361
3. Sugio K, Yokoyama H, Kaneko S, Ishida T, Sugimachi K. Sclerosing hemangioma of the lung: radiographic and pathological study. Ann Thorac Surg 1992; 53: 295-300
Keywords
Lung, Benign tumor, Sclerosing Hemangioma, Papillary Type

No. of Applicants : 21

▶ Correct Answer : 9/21,  42.9%
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - CHU Nancy-Brabois, France Denis Regent
  • - Ewha Womans University Hospital, Korea Ji Young Hwang
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - Korea University Anam Hospital, Korea Bo Kyung Je
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
▶ Semi-Correct Answer : 12/21,  57.1%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Centre d'imagerie J Callot, Nancy, France Lionel Cannard
  • - CHU Grenoble, France Mathieu Rodiere
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Gospel Hospital Kosin University, Korea Kyung Hwa Jung
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hospital of Leon, Spain Inmaculada Herraez
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Paik hospital, Inje University, Seoul, Korea Seung-Il Baek
  • - Pohang St. Mary's Hospital, Korea Taegwon Kim
  • - Taipei Municipal Jen-Ai Hospital, Taiwan Hui-Ju Tsai
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