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CASE REPORT Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 83-85
A case report and review of literature : Posterior mediastinal haemangioma


Govt. Medical College and Hospital, Nagpur, Maharashtra, India

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Keywords: Hemangioma, Posterior mediastinum

How to cite this article:
Taori K B, Mitra K R, Mohite A R, Bhawatkar A J, Siddique A Q. A case report and review of literature : Posterior mediastinal haemangioma. Indian J Radiol Imaging 2002;12:83-5

How to cite this URL:
Taori K B, Mitra K R, Mohite A R, Bhawatkar A J, Siddique A Q. A case report and review of literature : Posterior mediastinal haemangioma. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Aug 21];12:83-5. Available from: http://www.ijri.org/text.asp?2002/12/1/83/28424
We would like to report a rare case of Posterior mediastinal hemangioma in a young adult. The case is reported because of it's relative rarity and imaging features resembling a neurogenic tumour which is the commonest lesion of the posterior mediastinum.

A 25 year old man presented with a history of dull, continuous type of pain in the back on the right side since three months. Clinical examination was insignificant except for localized findings of mild scoliosis with convexity towards the left at T7-T8 level. There was no history of fever, cough or hemoptysis. Routine blood examination was within normal limits.

A penetrated plain roentgenogram of the chest was obtained which revealed an oval right paraspinal soft tissue density lesion with well defined margins in the mid thoracic region extending from T6 to T11. Few areas of amorphous calcification were also noted within the lesion. Scalloping of the adjacent vertebrae and scoliosis with convexity towards the side of the lesion was seen. Pleural effusion was seen on the left side. Lateral chest roentgenogram confirmed the posterior mediastinal location of the lesion.

Ultrasound through the right paraspinal approach revealed a heterogeneous mass with multiple calcific foci within it. No vascularity was seen on colour Doppler. Plain axial CT study of the thorax confirmed the above findings of a heterogeneous posterior mediastinal mass with multiple calcific foci in the right paraspinal region with dimensions of 9x6.3x7.4 cm. No area of fat or fluid density was identified. Scalloping of T6, T7 and T8 vertebral bodies was noted. However, the visualized neural foramen and vertebral canal appeared normal. Bilateral minimal pleural effusion was present. On contrast administration only mild inhomogeneous enhancement was seen.

A fine needle aspiration cytology performed under ultrasound guidance was non diagnostic. Thereafter, a right sided thoracotomy was performed which showed a well encapsulated, soft tissue mass, easily separable from the paraspinal soft tissues. Histopathology of the mass revealed a benign cavernous hemangioma with phleboliths. The postoperative course of the patient was uneventful.


   Discussion Top


Hemangiomas are rare tumours of the mediastinum with an incidence of less than 0.5% of mediastinal masses (1). Only about 125 cases have been reported in literature upto year 2000.

Mediastinal hemangiomas are usually incidentally detected on a routine chest radiograph in about half to one third of cases. Other presentations include nonspecific complaints like cough, chest pain, and dyspnoea or symptoms due to invasion of adjacent structures like dysphagia, superior vena cava syndrome and neurological symptoms secondary to intraspinal extension [1],[2],[3].

The age of presentation has a wide range with cases reported from 2 months to 76 years. However, maximum cases (approximately 75%) occurred in young adults before 35 years of age [2]. Our patient presented at 25 years of age consistent with the general observation. The size of the lesion varied form 1 cm to 16 cm (Mean 7.8 cm).

Posterior mediastinal location, as in the present case is relatively rare as compared to the more common anterior mediastinal location (68%). Isolated involvement of the middle mediastinum is very rare and when present is usually seen in contiguity [2].

Mediastinal hemangiomas may be associated with peripheral hemangiomas[3] or Rendu-Osler- Weber syndrome More Details[4].

Mediastinal hemangiomas are usually well encapsulated and heterogeneous in appearance. Only a few cases show homogenous density. Calcification on plain radiograph is reported to be seen in only 10% of cases [1],[2]. The pattern of enhancement varies from minimal heterogeneous enhancement to classical peripheral and central puddling of contrast as seen in hemangiomas elsewhere[3]. On MRI, Hemangiomas appear hypointense on T1W1 with few high signal foci due to methemoglobin formation and hyperintense on T2WI [5],[6]

The presence of phleboliths, heterogeneity and mild to moderate enhancement and intact intervertebral foramina are features which favour hemangiomas over the more common neurogenic tumours like neurofibroma and schwannoma.

 
   References Top

1.Cohen AJ: Mediastinal hemangiomas: Annals of Thoracic Surgery 1987:43(6):656-659  Back to cited text no. 1    
2.Davis JM: Benign Blood Vascular Tumours of the mediastinum: Radiology: 1978:126:581-587.  Back to cited text no. 2    
3.McAdams PH: Mediastinal hemangiomas: Radiographic and CT features in 14 patients: Radiology 1994: 193: 399-402.  Back to cited text no. 3    
4.Ginhardt TD: Cavernous hemangioma of the Superior mediastinum: am J Surg Pathol 1979:3:353-361.  Back to cited text no. 4    
5.Schurawitzki H: CT and MRI in Benign Mediastinal Hemangiomas: Clinical Radiology 1991: 43: 91-94  Back to cited text no. 5    
6.Seline TH: CT and MR imaging of Mediastinal Hemangiomas: Journal of Computer Assisted Tomography 1990:14(5):766-768.  Back to cited text no. 6    

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Correspondence Address:
K B Taori
Govt. Medical College and Hospital, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]

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