대한흉부영상의학회 Weekly Chest Cases

Case No : 832 Date 2013-10-07

Courtesy of Bong Wan Noh, Kyung Hee Lee / Inha University Hospital
Age/Sex 52 / F
Chief ComplaintAbnormal chest radiography

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Diagnosis With Brief Discussion

Diagnosis: Mediastinal cavernous hemangioma
Radiologic Findings: Chest radiograph shows bulging contour of left upper mediastinum.
CT scans show a lobulating mass with internal curvilinear calcifications and central nodular enhancing lesions in left anterior mediastinum.
After mass excision, the mass was diagnosed as cavernous hemangioma.
Brief Review: Hemangiomas are rare benign vascular tumors, accounting for less than 0.5% of mediastinal masses. They are composed of large interconnecting vascular channels with regions of thrombosis and varying amounts of interposed stroma, such as fat and fibrous tissue. Tumors are categorized according to the size and nature of their vascular spaces as capillary, cavernous, or venous; cavernous hemangiomas make up about 75% of cases. They are well defined and rarely are invasive.
Mediastinal hemangiomas are most common in young patients; about 75% present before the age of 35. One third to one half of cases are asymptomatic, but some patients present with symptoms of compression of mediastinal structures. Occasional cases are associated with peripheral hemangiomas or Osler-Weber-Rendu syndrome.
On CT, tumors are often heterogeneous in attenuation on unenhanced scans, and fat is occasionally seen within them. Heterogeneous enhancement is typical following contrast infusion but is not always present. Enhancement may be dense, multifocal, or diffuse, and central or peripheral. Opacified vascular channels can be seen within the mass, with rapid enhancement similar to that of normal mediastinal vessels. Phleboliths, thought to be pathognomonic, are visible in up to 10% of cases on plain radiographs. On CT, punctuate calcifications or phleboliths are visible in 10% to 20%. Dilated mediastinal vessels may be associated with the mass.
Please refer to
References: W. Richard Webb. The mediastinum: mediastinal masses. Thoracic imaging. 2nd ed. Lippincott Williams & Wilkins 2011: 269
Keywords: mediastinum, benign tumor,

No. of Applicants : 76

▶ Correct Answer : 14/76, 18.4%

- Niigata City General Hospital , Japan Takao Kiguchi
- University of British Columbia , Canada Amr Ajlan
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Asan medical center , Korea (South) Hyun Joo Lee
- Asan medical center , Korea (South) Sang Young Oh
- Asan medical center , Korea (South) yoonyoung choi
- Niigata University , Japan Atsushi Uehara
- 異⑸ , Korea (South) sooncheul baek
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- 異⑸ , China ZHANG YING
- chungbuk national university hospital , Korea (South) soojung lee
- Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio

▶ Correct Answer as Differential Diagnosis : 11/76, 14.5%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- , Korea (South) Chan Park
- Saint Malo , France jean-baptiste Noel
- AMC , Korea (South) park jong chun
- NASA SCANS , India RAKESH BHATIA
- Chungbuk univertisy hospital , Korea (South) Soohyun Lee
- Kizawa Memorial Hospital , Japan Yo Kaneko
- IRSA La Rochelle , France Denis Chabassiere
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- All India Institute of medical sciences , India Justin Moses

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 832 Date 2013-10-07

Discussion

No. of Applicants : 76