대한흉부영상의학회 Weekly Chest Cases

Case No : 1062 Date 2018-03-05

Courtesy of Kum Ju Chae, Gong Yong Jin / Chonbuk National University College of Medicine
Age/Sex 20 / M
Chief ComplaintIncidental radiologic abnormality

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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,

No. of Applicants : 119

▶ Correct Answer : 33/119, 27.7%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Niigata University , Japan ATSUSHI UEHARA
- Chonbuk National University Medical School , Korea (South) HYEJIN YANG
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- Chonbuk National University Hospital , Korea (South) EUN HA JUNG
- Chonbuk National University Hospital , Korea (South) JAEYEONG JEONG
- Other , Korea (South) HEE SEOK CHOI
- Other , Korea (South) SEONGSU KANG
- Asan Medical Center , Korea (South) HYUN JUNG KOO
- Freelance resident in Reunion Island , Reunion Fabien HO
- Chungbuk National University Hospital , Korea (South) CHANGHOON OH
- Chonbuk National University Hospital , Korea (South) SANGJIN PARK
- university of montreal , Canada Andrei Bogdan Gorgos I
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Asan Medical Center , Korea (South) JIHYE KWON
- Asan Medical Center , Korea (South) JOOAE CHOE
- Gifu University Hospital , Japan Yo Kaneko
- Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
- CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
- Other , Korea (South) HAYEON LEE
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Multimagem Diagn泥sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
- VENKATESHWAR HOSPITAL NEW DELHI , India RAKESH BHATIA
- MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
- Chonbuk National University Hospital , Korea (South) SOL KI KIM
- , Australia SANKAR MONDAL
- Teikyo University Hospital , Japan KAORU SUMIDA
- , Korea (South) TAE SUN KANG
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE

▶ Correct Answer as Differential Diagnosis : 16/119, 13.4%

- NIMS, HYDERABAD , India BHASKAR K
- Ondokuz Mayis University , Turkey CETIN CELENK
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Azienda Ospedaliera Universitaria Integrata di Verona , Italy GIAN ALBERTO SOARDI
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- VDC, HYDERABAD , India KARTHIK RAYASAM
- Chonnam National University Hospital , Korea (South) SOYEON KI
- Medicheck health care , Korea (South) Chae hun Lim
- University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
- Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
- TB centre kasaragod. , India rikhy krishnan
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
- Private sector , Greece VASILIOS TZILAS
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Chungbuk National University Hospital , Korea (South) HYEONMI RYU
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 2/119, 1.7%

- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Samsung Medical Center , Korea (South) HYUN JUNG YOON

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1062 Date 2018-03-05

Discussion

No. of Applicants : 119