Three-dimensional image simulation of primary diaphragmatic hemangioma: A case report

Abstract

Background: Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional (3D) simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.

Case summary: A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.

Conclusion: In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.

Keywords: Case report; Diaphragmatic tumor; Hemangioma; Thoracoscopy; Three-dimensional image simulation; Video-assisted thoracic surgery.

Figure 1

Contrast-enhanced chest computed tomography images illustrating a poorly-enhanced lesion (arrow) in the right basal lung, abutting the right diaphragm. A: Axial view; B: Coronal view.

Figure 2

Pathologic image showing a vascular lesion composed of dilated cavernous vascular spaces separated by irregular vascular walls microscopically. The pathologic findings (hematoxylin and eosin staining; magnification, 100×) are compatible with those of cavernous hemangioma.

Figure 3

Three-dimension reconstruction image illustrating the relationship of the tumor and neighboring organs. We mark the right uppeer lobe in lavender color, the right middle lobe in yellow, and the diaphrgam in purple. The right lower lobe is transparent to see the black lesion clearly. The three-dimension reconstruction image reveals a diaphragmatic lesion, without lung parenchyma involvement. A: Right lateral view of the right lung; B: Posterior view of the right lung.

Figure 4

Intraoperative image of a red papillary tumor arising from the right diaphragm. The resected tumor measured 3.5 cm × 1.5 cm × 1.3 cm in size, was brown in color, and had a soft consistency.