CT features of lobular capillary hemangioma of the nasal cavity

Abstract

Background and purpose: Lobular capillary hemangioma is a benign capillary proliferation of unknown etiology. To our knowledge, no comprehensive review of imaging findings of LCHNC has been presented. Thus, we investigated characteristic CT features of LCHNC.

Materials and methods: This retrospective study included 6 patients (2 men and 4 women; age range, 30-65 years; mean age, 49.2 years) with histologically proved LCHNC. We evaluated the size, site of origin, attenuation on NECT, degree and pattern of enhancement, and bony changes.

Results: The LCHNC lesion was 13.0-45.0 mm (average, 25.0 mm) in diameter. These lesions arose from the inferior turbinate in 5 (83.3%) patients and the anterior nasal septum in 1 (16.7%). Compared with the masticator muscles, the LCHNC lesion was hypoattenuating in 2 (33.3%) and isoattenuating on NECT in 4 (66.7%) patients. In 5 (83.3%) patients, the LCHNC lesion consisted of 2 distinct areas on CECT: a lobular intensely enhancing mass and an iso- or hypoattenuating cap of variable thickness around the intensely enhancing mass. Bony changes included erosion in 3 (50.0%) and displacement in 2 (33.3%) patients.

Conclusions: CT features of LCHNC consist of an intensely enhancing mass and an iso- or hypoattenuating cap on CECT. The inferior turbinate seems to be a common site of origin, and bony changes are not uncommon features of LCHNC. CT is useful not only in identifying the site of origin and assessing the extent but also in suggesting the nature of LCHNC.

Fig 1.

A 56-year-old woman with a lobular capillary hemangioma arising from the nasal septum. A, An axial NECT image shows a homogeneous hypoattenuating mass (asterisk) in the right anterior nasal cavity. The nasal septum is eroded (arrow), and the right middle turbinate is displaced laterally (small arrows). B, An axial CECT image reveals a lobular intensely enhancing mass (asterisk) arising from the nasal septum and a hypoattenuating cap (arrows). C, A Gd-enhanced SE T1WI (TR/TE, 700/19 ms) demonstrates only a lobular intensely enhancing mass (arrow), resulting from fill-in of Gd in the hypoattenuating cap of the CECT image. Note the tubular high-velocity SI voids (arrowheads) within the mass. D, A lateral view of the delayed phase of a carotid angiogram demonstrates a lobular capillary blush of the mass (arrows).

Fig 2.

A 53-year-old man with a lobular capillary hemangioma arising from the right inferior turbinate. A, A coronal NECT image shows a homogeneous isoattenuating mass (asterisk) in the right nasal cavity. B, A coronal CECT image reveals a lobular intensely enhancing mass (asterisk) arising from the right inferior turbinate and an isoattenuating cap (arrows) containing linear and spotty enhancing foci (arrowheads). C, A coronal NECT image of a bone algorithm demonstrates erosion of the medial wall of the right maxillary sinus and bony destruction of the right inferior turbinate (arrows). D, A lateral view of the delayed phase of a microcatheter angiogram of the right sphenopalatine artery demonstrates a lobular capillary blush of the mass (arrows).

Fig 3.

A 56-year-old man with a lobular capillary hemangioma arising from the left inferior turbinate. A, An axial NECT image shows a homogeneous isoattenuating mass arising from the destroyed left inferior turbinate (asterisk) with lateral displacement and erosion of the medial wall of the left maxillary sinus (arrow). B, An axial CECT image reveals a lobular intensely enhancing mass (asterisk) and a hypoattenuating area containing spotty enhancing foci (arrowheads). C, A SE T1WI (TR/TE, 600/11 ms) shows a hypointense LCHNC lesion (asterisk) compared with the masticator muscle. D, A dynamic Gd-enhanced SE T1WI (TR/TE, 350/11 ms) obtained at 1 minute after intravenous administration of Gd demonstrates a lobular intensely enhancing mass (asterisk) and a less intensely enhancing area containing tubular high-velocity SI voids (arrowheads). E, A dynamic Gd-enhanced SE T1WI (TR/TE, 350/11 ms) obtained at 4 minutes after intravenous administration of Gd reveals more homogeneous enhancement of the entire LCHNC lesion.

Fig 4.

A 35-year-old woman with a lobular capillary hemangioma arising from the posterior tip of the right inferior turbinate. A, An axial NECT image shows a homogeneous isoattenuating mass (asterisk) arising from the posterior tip of the right inferior turbinate near the posterior choana. B, An axial CECT image demonstrates an intensely enhancing mass (asterisk) and an isoattenuating cap (arrows).