A Rare Clinical Report of Intramuscular Hemangioma of the Middle Scalene Muscle

Management of a rapidly enlarging supraclavicular mass of unknown aetiology

Intramuscular haemangiomas are benign tumours showing an extremely rare occurrence and making up less than 1% of all haemangiomas. The goal of this case report is to share our experience in treating a patient with an extremely rare intramuscular haemangioma, which occurred in the supraclavicular region VB level of the neck and extended towards the infraclavicular space, localised within and inferior to the trapezius muscle. The lesion was diagnosed by using multimodal imaging and a wide excision was performed with intraoperative feeding vessel ligation and a good postoperative result. The main difficulties regarding diagnosis and treatment include a lack of evidence-based guidelines, due to limited publications on this topic, the nature of the lesion frequently showing obscure anatomic localisation deep within muscles and unclear delineation, various anatomic origin requiring an individual treatment approach, inconclusive radiologic signs as well as non-specific symptoms.

Intramuscular Hemangioma of the Triceps Brachii Muscle: A Case Report

Introduction

Intramuscular hemangioma (IMH) is a rare type of benign tumor that represents less than 1% of all hemangiomas. Chronic pain and a palpable mass are the most common symptoms. Due to the atypical clinical characteristics of the disease, accurate diagnosis is difficult. Misdiagnosis of IMH as malignancy can occur due to similarities in imaging features between IMH and malignancy. To diagnose IMH accurately, multiple imaging modalities, including X-ray, MRI, CT, and 18F-FDG PET/CT, can be used. However, the final diagnosis of IMH is confirmed through histopathological examination.

Case

This case reports a 16-year-old girl diagnosed with IMH in the triceps brachii muscle. Seek medical attention due to pain and discomfort in the left shoulder. Initial imaging with contrast-enhanced MRI and CT suggested synovial sarcomata. The moderate uptake of FDG on positron emission tomography/computed tomography (PET/CT) also raised suspicions of malignancy. The pathological findings revealed an intramuscular hemangioma with thrombosis and thrombus organization.

Conclusion

The accurate diagnosis of IMH can be challenging due to the absence of distinct clinical symptoms and imaging findings. When evaluating periarticular intramuscular lesions, IMH should be considered if the MRI shows mixed signals with heterogeneous enhancement. Despite the moderate uptake of FDG seen in some IMH cases, it should not automatically rule out the possibility of IMH. Hence, a combination of imaging modalities and histopathological examination is crucial in ensuring a correct diagnosis of IMH.

An intramuscular hemangioma of the semispinalis muscle: A case report

Intramuscular hemangiomas are uncommon benign endotheliomas that typically occur in the trunk and limbs. Head and neck involvement is relatively infrequent, with the masseter muscle being the most commonly affected site. We present a rare case of intramuscular hemangiomas arising from the semispinalis muscle. A 31-year-old male presented with a painless swelling in the left upper neck region, gradually increasing in size over the past year. Imaging studies revealed a well-defined mass originating from the semispinalis muscle. Surgical excision was performed successfully, and histological examination confirmed the diagnosis of a mixed intramuscular hemangioma. The patient remained recurrence-free during the 2-year follow-up period. Intramuscular hemangiomas in the posterior neck muscles are rare, with only a few reported cases. Wide surgical resection with control of feeding vessels is the optimal treatment, and follow-up is recommended to monitor for local recurrence. This case report highlights the clinical presentation, diagnostic challenges, and successful surgical management of intramuscular hemangiomas in a unique location, emphasizing the importance of accurate diagnosis and appropriate treatment of this rare tumor.