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Weekly Chest CasesArchive of Old Cases

Case No : 1034 Date 2017-08-21

  • Courtesy of Sung Hee Shin, Kyung Min Shin / KyungPook National University ChilGok Hospital
  • Age/Sex 62 / M
  • Chief ComplaintIncidental findings on screening CT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Hemangioma with organizing thrombi
Radiologic Findings
Fig 1-3. Mediastinal window setting of the chest CT scan shows a 19-mm-sized nodular lesion in the anterior mediastinum, which closely abuts the body of the sternum. On precontrast CT scan, the nodule shows homogeneous attenuation and lobulated margin without calcification. After contrast administration, the nodule shows marked enhancement (190 HU) mainly in the central portion, which is comparable to those of adjacent vessels. Fig 4. Integrated F-18 FDG-PET/CT scan shows faint FDG uptake (maximum standardized uptake value of 1.8) in the nodule.
Brief Review
Hemangioma is a rare, benign vascular tumor that counts for less than 0.5% of all mediastinal masses. It has been speculated that they represent either true neoplasm or developmental vascular anomalies. At histologic examination, 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 fibrinous tissues. Most mediastinal hemangiomas are found in the anterior mediastinum.
Preoperative diagnosis may be difficult because the tumors usually manifest as mediastinal masses with nonspecific image findings. Phleboliths, a potentially diagnostic finding, are seen in only 10% of conventional radiographs. Calcification is more readily identifiable on CT scans. Punctate calcification is seen more commonly and needs to be differentiated from the calcification seen in patients with teratoma or cartilaginous tumor.
Hemangiomas commonly appear as well-circumscribed, heterogeneous soft-tissue masses on unenhanced CT scans. Their appearance depends on the stromal content and degree of thrombosed vascular channels. Contrast enhancement is most often heterogeneous and central. Gradually increasing and persistent enhancement has been seen on dynamic contrast-enhanced CT scans.
References
1. Prachi P., Hean M., Frederic R. Case130: Mediastinal Hemangioma. Radiology 2008; 246:634-637
2. H. Page, Melissa L., Cesar A. Mediastinal Hemangioma: Radiographic and CT Features in 14 Patients. Radiology 1994; 193:399-402
3. Sakurai K., Hara M., Ozawa Y et al., Thoracic hemangiomas: imaging via CT, MR, and PET along with pathologic correlation. J Thorac Imaging 2008;23(2):114-120
Please refer to
Case 1009 Case 832 Case 469 Case 245
Keywords
Hemangioma, Mediastinal Hemangioma, anterior mediastinum,

No. of Applicants : 104

▶ Correct Answer : 45/104,  43.3%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - the First Affiliated Hospital of NanJing Medical University , China AIPING CHEN
  • - Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
  • - Other , Korea (South) SEONG SU KANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - National Taiwan University Hospital , Taiwan LI-TA KENG
  • - 怨„紐… , Korea (South) jin young kim
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - University of New South Wales , Australia RASHID HASHMI
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
▶ Correct Answer as Differential Diagnosis : 18/104,  17.3%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - Korea University Guro Hospital , Korea (South) TAE SEOP CHOI
  • - Ajou University School of Medicine , Korea (South) YOOLIM BAEK
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Yeungnam University Medical Center , Korea (South) MINJUNG RYU
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ibaraki-gazou-shindan , Japan SHOICHI KATOH
  • - Private sector , Greece VASILIOS TZILAS
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 2/104,  1.9%
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
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