대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1278 Date 2022-04-18

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  • Courtesy of Sowon Jang / Bundang Seoul National University Hospital
  • Age/Sex 60 / M
  • Chief ComplaintWeight loss (-5kg/6months) Occupation: tiler
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Hemangioma
Radiologic Findings
Fig 1. Chest PA shows small radiopaque nodular lesions (phleboliths) in the right upper abdomen area.
Fig 2-5. CT scans reveal a large soft-tissue mass in the right lower back region, mainly involving the subcutaneous fat between the paraspinal muscles and the abdominal wall muscles. The mass extended cranially along the ribs, intercostal space, and pleura. The mass contains several round calcifications that represent phleboliths.
Fig 6. PET CT scan shows a mild hypermetabolic mass involving the right pleura and right lower back region.
Fig 7. Fat suppression T2-weighted MR image reveals a predominantly hyperintense lobulated mass with tortuous tubular hypointense structures. T1-weighted image shows the mass with the interspersed area of high signal intensity representing fatty septa.
Brief Review
Soft-tissue hemangiomas are benign vascular neoplasms that are thought by most physicians to be congenital in origin, although some authors have theorized that they represent a proliferation of vascular elements resultant from prior trauma. Soft-tissue hemangiomas that originate within skeletal muscle (intramuscular hemangiomas) are relatively uncommon and account for only 0.7% of all reported hemangiomas. Even less common are hemangiomas that occur in the chest wall.
The imaging of soft-tissue hemangiomas typically begins with conventional radiography. Phleboliths are the only conventional radiographic finding helpful in diagnosing soft-tissue hemangioma. CT can demonstrate the characteristic fatty appearance of the tumor and occasionally reveal a phlebolith, which is specific to soft-tissue hemangiomas. Soft-tissue hemangiomas have a characteristic MR appearance. Typically, T1-weighted MR images demonstrate a soft-tissue mass of intermediate signal intensity with interspersed areas of high signal intensity that can appear lacy and correspond to areas of fatty proliferation. T2-weighted images typically demonstrate a predominantly hyperintense mass with interspersed areas of low to the intermediate signal intensity that is representative of hemosiderin deposition, fibrous septa, and/or smooth muscle. Small, round areas of low signal intensity depicted with any sequence may represent phleboliths or areas of signal void secondary to high-velocity blood flow within the vascular channels. Contrast material enhances numerous vascular channels throughout the vascular lesion.
References
1. Ly, Justin Q., and Timothy G. Sanders. Case 65: hemangioma of the chest wall. Radiology 229.3 (2003): 726-729.
Keywords
hemangioma,

No. of Applicants : 109

▶ Correct Answer : 28/109,  25.7%
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Chonbuk National University Hospital , Korea (South) HYUNSOO BAE
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) CHAEHUN LIM
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Seoul National University Bundang Hospital , Korea (South) SUNYOUNG PARK
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - TAKANA HAYASHI
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - , Korea (South) HM PARK
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
▶ Correct Answer as Differential Diagnosis : 21/109,  19.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Chonnam National University Hospital , Korea (South) ARA A CHO
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - , Korea (South) SUNHYANG LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , United States HIROAKI TAKAHASHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 9/109,  8.3%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - , Japan CHIAKI SATO
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Chungnam National University Hospital , Korea (South) HYUN JAE LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
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Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

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