Discussion
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
Case 245, Case 469, -
- References
- W. Richard Webb. The mediastinum: mediastinal masses. Thoracic imaging. 2nd ed. Lippincott Williams & Wilkins 2011: 269
- Keywords
- mediastinum, benign tumor,