Gastrointestinal Hemangiomas
Imaging Findings with Pathologic Correlation in Pediatric and Adult Patients
Angela D. Levy1,2,
Robert M. Abbott2,3,
Charles A. Rohrmann, Jr.1,4,
Aletta Ann Frazier1,5 and
Amir Kende6
1
Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825
16th St. N.W., Bldg. 54, Rm. M-121, Washington, DC 20306-6000.
2
Department of Radiology and Nuclear Medicine, Uniformed Services University of
the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814.
3
Department of Radiology, Wilford Hall Medical Center, Lackland Air Force Base,
San Antonio, TX 78238.
4
Department of Radiology, University of Washington, 1959 NE Pacific, Seattle,
WA 98195-7115.
5
Department of Radiology, University of Maryland Medical System, 29 S. Greene
St., Baltimore, MD 21201-1544.
6
Department of Gastrointestinal Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306-6000.
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Fig. 1A. —Hemangioma growth patterns. Drawings depict solitary polypoid
growth of hemangioma in bowel lumen (A), multifocal polypoid
hemangiomas in bowel lumen (B), and infiltrative and annular growth of
hemangioma with intraluminal and extraserosal extension of tumor
(C).
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Fig. 1B. —Hemangioma growth patterns. Drawings depict solitary polypoid
growth of hemangioma in bowel lumen (A), multifocal polypoid
hemangiomas in bowel lumen (B), and infiltrative and annular growth of
hemangioma with intraluminal and extraserosal extension of tumor
(C).
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Fig. 1C. —Hemangioma growth patterns. Drawings depict solitary polypoid
growth of hemangioma in bowel lumen (A), multifocal polypoid
hemangiomas in bowel lumen (B), and infiltrative and annular growth of
hemangioma with intraluminal and extraserosal extension of tumor
(C).
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Fig. 2. —48-year-old man with melena and multiple cavernous
hemangiomas of small bowel. Photograph of resected cut specimen of small bowel
reveals multiple bluish polyps emanating from small-bowel mucosa.
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Fig. 3A. —62-year-old man with capillary hemangioma. Photomicrograph of
resected small intestinal hemangioma shows pedunculated polyp arising from
submucosa. Surface erosion of overlying mucosa covering polyp has occurred,
and focus of hemorrhage within polyp (arrow) is visible. (H and E,
x4)
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Fig. 3B. —62-year-old man with capillary hemangioma. Photomicrograph at
greater magnification than A shows numerous thin-walled capillaries
(arrows) lined with endothelial cells. Capillaries are separated by
stromal edema. (H and E, x80)
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Fig. 4A. —20-year-old man with cavernous hemangioma. Photomicrograph of
colonic resection shows proliferation of large blood-filled spaces in
submucosa and pericolonic soft tissue. (H and E, x4)
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Fig. 4B. —20-year-old man with cavernous hemangioma. Photomicrograph at
greater magnification than A shows blood-filled vessels throughout
submucosa. (H and E, x16)
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Fig. 5A. —Capillary hemangioma of duodenum in 7-week-old boy who
presented with vomiting and palpable right upper quadrant mass. Radiograph of
upper abdomen obtained with patient in supine position shows soft-tissue mass
displacing and obstructing duodenum. Artifacts from clothing are also
present.
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Fig. 5B. —Capillary hemangioma of duodenum in 7-week-old boy who
presented with vomiting and palpable right upper quadrant mass. Left posterior
oblique upper gastrointestinal series shows air-contrast image of duodenum
with obstructing intraluminal mass (arrows).
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Fig. 6A. —Cavernous hemangioma of ileum in 27-year-old woman with long
history of anemia and bloody stools. Contrast-enhanced CT scan of pelvis shows
intussusception involving distal small bowel (arrow).
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Fig. 6B. —Cavernous hemangioma of ileum in 27-year-old woman with long
history of anemia and bloody stools. Intraoperative photograph shows
blood-filled mass involving outer wall of ileum.
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Fig. 6C. —Cavernous hemangioma of ileum in 27-year-old woman with long
history of anemia and bloody stools. Photograph of resected cut specimen shows
intraluminal polypoid component of hemangioma.
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Fig. 7A. —62-year-old man with iron deficiency anemia due to polypoid
intraluminal small-bowel capillary hemangioma. Enteroclysis examination
reveals 3-cm polypoid mass in jejunum.
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Fig. 7B. —62-year-old man with iron deficiency anemia due to polypoid
intraluminal small-bowel capillary hemangioma. Photograph of resected specimen
shows 3-cm polypoid mass in lumen of jejunum.
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Fig. 8A. —Cavernous hemangioma of rectum in 20-year-old man with rectal
bleeding who was given diagnosis of hemorrhoids at age 5. Radiograph of pelvis
obtained with patient in supine position shows clusters of phleboliths.
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Fig. 8B. —Cavernous hemangioma of rectum in 20-year-old man with rectal
bleeding who was given diagnosis of hemorrhoids at age 5. Single-contrast
barium enema shows attenuation of rectal caliber and lobulated mass effect
containing phleboliths (arrows).
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Fig. 9A. —Cavernous hemangioma of descending colon in 62-year-old man
with 6-month history of rectal bleeding. Air-contrast barium enema shows
serpentine mass effect along lateral aspect of distal descending colon
(arrows).
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Fig. 9B. —Cavernous hemangioma of descending colon in 62-year-old man
with 6-month history of rectal bleeding. Photograph of descending colon
outside of the abdomen during surgery shows blood-filled masses along serosal
surface of colon (arrows).
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Fig. 10. —29-year-old man with history since birth of multiple
hemangiomas involving left lower extremity, scrotum, and rectum. Air-contrast
barium enema shows hemangioma that has lobulated mass effect along entire
sigmoid colon.
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Fig. 11A. —Cavernous hemangioma of colon in 9-month-old girl who
presented with blood-filled diaper. Single-contrast barium enema shows 6-cm
annular mass of hepatic flexure with lacelike barium-filled crevices. Air
bubbles are also present in lumen of proximal transverse colon.
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Fig. 11B. —Cavernous hemangioma of colon in 9-month-old girl who
presented with blood-filled diaper. Contrast-enhanced CT scan shows
circumferential infiltration of colon (arrows) by soft-tissue
attenuation mass.
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Fig. 11C. —Cavernous hemangioma of colon in 9-month-old girl who
presented with blood-filled diaper. Intraoperative photograph shows
circumferential mass composed of large blood-filled spaces.
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Fig. 12A. —Cavernous hemangioma of stomach in 84-year-old woman with
abdominal pain and black, tarry stools. Radiograph of upper abdomen obtained
with patient in supine position shows cluster of large phleboliths in left
upper quadrant. Residual contrast material is present in colon. Reprinted with
permission from [2].
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Fig. 12B. —Cavernous hemangioma of stomach in 84-year-old woman with
abdominal pain and black, tarry stools. Left posterior oblique air-contrast
upper gastrointestinal series shows circumferential mass effect in body of
stomach containing phleboliths (arrows).
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Fig. 12C. —Cavernous hemangioma of stomach in 84-year-old woman with
abdominal pain and black, tarry stools. Photograph of portion of resected
specimen shows blood-filled cavities (arrows) beneath mucosa and
phlebolith in vascular space (curved arrow).
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Fig. 13A. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Barium esophagram shows masslike
impression and subtle varicoid fold thickening in distal esophagus. Several
phleboliths are located to left of esophagus (arrow).
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Fig. 13B. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Contrast-enhanced CT scan shows diffuse
esophageal-wall thickening with phleboliths (arrows).
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Fig. 13C. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Sagittal T1-weighted MR image shows
low-signal-intensity irregular thickening of esophageal wall with compressed
esophageal lumen (arrow).
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Fig. 13D. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Axial T2-weighted MR image shows
high-signal-intensity wall thickening. Signal void is present at site of
phlebolith (arrow).
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Fig. 13E. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Posterior chest view from
99mTC-labeled RBC scan shows radiotracer uptake along right and
left lateral aspects of spine (arrows).
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Fig. 13F. —Cavernous hemangioma of esophagus in 60-year-old man with
1-year history of worsening dysphagia. Endoscopic image of esophagus shows
bulging intraluminal mass (asterisk) containing prominent
vessels.
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Fig. 14A. —Hemangiomatosis of the rectosigmoid in 20-year-old man with
Proteus syndrome. Radiograph of abdomen obtained with patient in supine
position shows innumerable phleboliths scattered throughout abdomen.
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Fig. 14B. —Hemangiomatosis of the rectosigmoid in 20-year-old man with
Proteus syndrome. Single-contrast barium enema shows infiltrating submucosal
mass involving rectosigmoid and descending colon. Portions of mass contain
phleboliths (arrow).
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Fig. 14C. —Hemangiomatosis of the rectosigmoid in 20-year-old man with
Proteus syndrome. CT scan through upper pelvis shows phleboliths in mass that
diffusely thickens sigmoid and descending colon.
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Fig. 15A. —Infantile hemangiomatosis in 3-month-old boy who subsequently
died. At autopsy, hemangiomas were found that involved liver, spleen, upper
gastrointestinal tract, pancreas, retroperitoneum, kidneys, mediastinum, lung,
thyroid, and skin. Radiograph obtained with patient in supine position shows
phleboliths in abdomen and lung base (arrows).
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Fig. 15B. —Infantile hemangiomatosis in 3-month-old boy who subsequently
died. At autopsy, hemangiomas were found that involved liver, spleen, upper
gastrointestinal tract, pancreas, retroperitoneum, kidneys, mediastinum, lung,
thyroid, and skin. Upper gastrointestinal series shows displacement of
gastroesophageal junction and numerous nodular filling defects in small
bowel.
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Fig. 15C. —Infantile hemangiomatosis in 3-month-old boy who subsequently
died. At autopsy, hemangiomas were found that involved liver, spleen, upper
gastrointestinal tract, pancreas, retroperitoneum, kidneys, mediastinum, lung,
thyroid, and skin. Unenhanced CT scan of upper abdomen shows large soft-tissue
mass (asterisk), containing phleboliths, that displaces stomach,
liver masses with phleboliths, and splenic mass.
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Fig. 15D. —Infantile hemangiomatosis in 3-month-old boy who subsequently
died. At autopsy, hemangiomas were found that involved liver, spleen, upper
gastrointestinal tract, pancreas, retroperitoneum, kidneys, mediastinum, lung,
thyroid, and skin. Autopsy photograph of cut section of small bowel shows
numerous hemorrhagic nodules.
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Copyright © 2001 by the American Roentgen Ray Society.
