Intramuscular hemangiomas

Abstract

Context: Intramuscular hemangiomas are common in the general population and often present at medical and surgical clinics. Unfortunately, unfamiliarity with these lesions has led to a high percentage of misdiagnoses, inappropriate workup, and unnecessary referrals.

Evidence acquisition: A literature search was performed using Medline, Embase, PubMed, and Cochrane. The relevant articles and referenced sources were reviewed for additional articles that discussed the epidemiology, pathophysiology, investigation, and management of intramuscular hemangiomas. Clinical experience from experts in orthopaedics, musculoskeletal pathology, and musculoskeletal radiology was compared. The selected case studies are shared cases of the authors.

Results and conclusion: The pathophysiology of these lesions is not completely understood, but much can be implied from their underlying vascular nature. Isolated lesions are benign tumors that never metastasize but tend to enlarge and then involute over time. Magnetic resonance imaging is the imaging modality of choice. If a systemic disorder or malignancy is not suspected or has been ruled out, conservative management is the treatment of choice for most intramuscular hemangiomas.

Keywords: hemangioma; intramuscular hemangioma; muscle lesions; vascular malformation.

Figure 1.

Lateral radiograph demonstrates a phlebolith (arrow) in a 31-year-old woman with an intramuscular hemangioma of the lateral triceps.

Figure 2.

Forty-five-year-old man with a hemangioma of the right biceps brachii. (a) A T1-weighted axial magnetic resonance image through the hemangioma is very slightly hyperintense to muscle and shows multiple interlacing vascular channels of the lesion, giving a “bag of worms” appearance. High-signal intralesional fat is abundant in many hemangiomas (asterisks). (b) A STIR axial image through the hemangioma at the same level shows the vascular component of the lesion to be markedly hyperintense to muscle.

Figure 3.

The 31-year-old man with a left proximal calf mass described in Case 1. (a) The lateral radiograph shows bony hyperostosis of the posterior cortex of the left proximal tibia (arrows) and an incidental enchondroma in the fibular shaft. (b) Axial T1 image shows a juxtacortical hemangioma of the left proximal calf.

Figure 4.

MRI of the calf demonstrating a region of high flow as signal voids with phase encoding artifact (arrows).

Figure 5.

The 17-year-old girl in Case 2. (a) Axial T1 postcontrast image showing increased signal throughout, with a small, round low-signal-intensity focus within the lesion. (b) Axial STIR image at the same level. (c) Axial T1 postcontrast image showing recurrence of the intramuscular hemangioma within the medial head of the gastrocnemius. (d) An axial STIR image at the same level again showing recurrence of the intramuscular hemangioma.