대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Mediastinal hemangioma

Radiologic Findings

Fig 1. Chest PA shows a bulging contour on the right side of the heart.
Fig 2-4. Mediastinal window setting of the chest CT scan shows a well-defined mass at the right side of the heart, with heterogeneous nodular enhancement, punctate/curvilinear calcification, and internal focal fat density

Brief Review

Mediastinal hemangiomas are uncommon benign vascular tumors that account for less than 0.5% of all mediastinal masses. At histologic examination, these tumors are composed of large, interconnecting vascular spaces interposed with various stromal elements such as fat, myxoid and fibrous tissues. They are categorized as capillary, cavernous, or venous hemangiomas based on the size of the vascular spaces. Most mediastinal hemangiomas are found in the anterior mediastinum; however, a few arise in the posterior mediastinum.
Phleboliths, multiple enhanced vessels, and peripheral puddling of contrast enhancement may be potential diagnostic features. Punctate calcification is more common and needs to be differentiated from the calcification seen in patients with teratoma or cartilaginous tumors. The pattern of contrast enhancement varies, including central, mixed central and peripheral, peripheral, and nonspecific increased attenuation. Gradually increasing and persistent enhancement has been seen on dynamic contrast-enhanced CT. In our case, the hemangioma showed punctate/curvilinear calcifications, consistent with phleboliths. A confounding feature in this case was fat in the mediastinal mass. This has been described in patients with hemangiomas, however, it is seen more commonly in teratomas.

References

1. 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(5):276-8.
2. McAdams HP, Rosado-de-Christenson ML, Moran CA. Mediastinal hemangioma: radiographic and CT features in 14 patients. Radiology. 1994;193(2):399-402.
3. Sakurai K, Hara M, Ozawa Y, Nakagawa M, Shibamoto Y. Thoracic hemangiomas: imaging via CT, MR, and PET along with pathologic correlation. J Thorac Imaging. 2008;23(2):114-20.
4. Prachi P., Hean M., Frederic R. Case130: Mediastinal Hemangioma. Radiology 2008; 246:634-637

Keywords