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Weekly Chest CasesArchive of Old Cases

Case No : 730 Date 2011-10-25

  • Courtesy of Jeung Sook Kim / Dongguk University Ilsan Hospital
  • Age/Sex 42 / F
  • Chief ComplaintIncidental findings on chest radiographs
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Sclerosing hemangioma
Radiologic Findings
Chest radiographs show well-defined round nodule in right middle lung zone. Pre-enhanced CT scan demonstrate well-defined round nodule in inferior portion of right upper lobe. There is no evidence of calcification or fat density within nodule. On enhanced CT scan, the nodule reveals homogenous dense enhancement (87HU).
Brief Review
Sclerosing hemangioma is a rare benign tumor, characterized microscopically by four major histologic components: solid, papillary, sclerotic, and hemngiomatous in varying proportions. 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. 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. 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 also 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.
The experience using FDG-PET scan in sclerosing hemangioma is limited, and only slightly elevated uptake with an SUV of 1.8 has been recorded. In contrast, in two patients examined by Hsu et al. (7), the masses demonstrated SUV of 2.72 and 3.93, which were above the cut-off value of 2.5, suggestive of malignancy.
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. Sugio K, Yokoyama H, Kaneko S, Ishida T, Sugimachi K. Sclerosing hemangioma of the lung: radiographic and pathological study. Ann Thorac Surg 1992; 53: 295-30
3. 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.
4. Hsu PK, Cheng HF, Yeh YC, Wu YC, Hsu WH. Pulmonary sclerosing haemangioma mimicking lung cancer on PET scan. Resp 2009; 14: 903-912
Keywords
lung, benign tumor,

No. of Applicants : 110

▶ Correct Answer : 49/110,  44.5%
  • - Okayama University , Japan Akihiro Tada
  • - shanghai zhoupu hospital , China wei wang
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - CHRU lille , France manuel toledano
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - UWO , Canada S Lee
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Kangdong Sacred Heart Hospital , Korea (South) Soo Jeong Yoon
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - GRMC (Gajra raja medical college), deptt. of radiodiagnosis gwalior , India SHAILESH GUPTA
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - Severance hospital , Korea (South) Beomseok Sohn
  • - HSC , Brazil Diogo Pinheiro
  • - PRINCESS MARGARET HOSPITAL , Bahamas SHUJAUDDIN RAHIMI
  • - Jaseng Oriental Hospital , Korea (South) Byung-June Jo
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Chaeil Clinic , Korea (South) Sunkyung Lim
  • - University of British Columbia , Canada Amr Ajlan
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - university of Iowa , United States leandro leite
  • - All India Institute of medical sciences , India Justin Moses
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Iwate Med.Univ , Japan kikuchi koyo
  • - Okayama university, Department of Pathology , Japan Junya Itakura
  • - Gangnam severance hospital , Korea (South) Sejin Nam
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - radiologist, aditya imaging centre , India vivek patel
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Asan medical center , Korea (South) sang young oh
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Chungnam National University hospital , Korea (South) sunkyoung you
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - Private sector , Greece Vasilios Tzilas
  • - Severance hospital , Korea (South) Saerom Hong
▶ Correct Answer as Differential Diagnosis : 20/110,  18.2%
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Fr Mullers Medical College , India Deepu Thomas
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - NMC, sunder lal jain hospital , India sanjeev vachher
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - chp st martin , France Mariotte benoit
  • - IRSA , France jean-luc BIGOT
  • - NASA SCANS , India RAKESH BHATIA
  • - Seoul St Mary Hospital , Korea (South) Chaehun Lim
  • - CNUH , Korea (South) Hyedoo Jung
  • - Okayama university , Japan Mayu Uka
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