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Osseous Change Adjacent to Soft-Tissue Hemangiomas of the Extremities: Correlation with Lesion Size and Proximity to Bone

Justin Q. Ly1, Timothy G. Sanders1, John P. Mulloy1, Gregory M. Soares1, Douglas P. Beall1, Theodore W. Parsons2 and Mark A. Slabaugh2

1 Department of Radiology, Wilford Hall USAF Medical Center, 759th MDTS/MTRD, Ste. 1, 2200 Bergquist Dr., Lackland AFB, TX 78236-5300.
2 Department of Orthopedic Surgery, Wilford Hall USAF Medical Center, 759th MSGS/MCSO, Lackland AFB, TX 78236-5300.



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  		Fig. 1A. —61-year-old man with history of palpable mass in anterior portion of right lower leg. Radiograph of right lower leg shows smooth periosteal reaction along posterolateral aspect of mid diaphyseal region of tibia (long arrow) and fibula (short arrow).

 


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  		Fig. 1B. —61-year-old man with history of palpable mass in anterior portion of right lower leg. Axial T2-weighted fat-suppressed MR image (TR/TE, 3116/85) reveals predominately hyperintense mass (long arrow) adjacent to anterolateral aspect of fibula (short arrow), representing portion of soft-tissue hemangioma in direct contact with fibula. Note abnormal increased marrow signal in fibula. Soft-tissue hemangioma was extensive in this patient, and on other images (not shown) was noted to contact bones posteriorly and laterally adjacent to areas of periosteal reaction like those seen on radiograph (A).

 


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  		Fig. 2A. —64-year-old man with several-year history of forearm swelling. Radiograph of forearm reveals minimal aggressive irregular periosteal reaction (open arrow) along medial aspect of distal radius. Note also subtle linear lucencies or permeative pattern (long arrows) present throughout mid and distal diaphyseal regions of both ulna and radius.

 


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  		Fig. 2B. —64-year-old man with several-year history of forearm swelling. Axial T1-weighted MR image (TR/TE, 500/15) obtained through level of mid forearm reveals signal abnormality (arrow) in posterior cortex of radius immediately adjacent to soft-tissue hemangioma, representing cortical destruction.

 


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  		Fig. 2C. —64-year-old man with several-year history of forearm swelling. Axial STIR MR image (4566/45) distal to B reveals diffuse marrow signal abnormality (arrows) in both ulna and radius at level of adjacent soft-tissue hemangioma. Bone biopsy was not performed, and it is therefore unknown if signal change represents red marrow conversion or angiomatous involvement of bone.

 


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  		Fig. 3A. —24-year-old woman with history of palpable mass in mid portion of right thigh. Radiograph reveals smooth cortical thickening (arrow) along medial aspect of mid shaft of right femur.

 


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  		Fig. 3B. —24-year-old woman with history of palpable mass in mid portion of right thigh. Coronal T1-weighted MR image (TR/TE, 400/14) reveals smooth cortical thickening (arrow) involving medial aspect of mid diaphysis of femur.

 


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  		Fig. 3C. —24-year-old woman with history of palpable mass in mid portion of right thigh. Coronal T2-weighted fat-suppressed MR image (3300/70) also reveals smooth cortical thickening (long arrow) of medial aspect of femur with small adjacent hyperintense soft-tissue mass (short arrow) representing hemangioma.

 


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  		Fig. 4A. —27-year-old woman with long history of left upper arm swelling. Radiograph of left humerus reveals large soft-tissue mass (long arrow) laterally with numerous phleboliths (curved arrow) and extensive cortical change (short arrow) of adjacent humerus.

 


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  		Fig. 4B. —27-year-old woman with long history of left upper arm swelling. Magnified radiograph of humerus reveals both cortical scalloping (white arrows) and linear lucencies (black arrows) in cortex, representing tunneling.

 


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  		Fig. 4C. —27-year-old woman with long history of left upper arm swelling. Sagittal T1-weighted MR image (TR/TE, 550/16) of left upper arm reveals large soft-tissue hemangioma (black arrows) in direct contact with mid diaphysis of humerus. Note extensive cortical abnormalities (white arrows).

 


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  		Fig. 4D. —27-year-old woman with long history of left upper arm swelling. Sagittal T2-weighted fat-saturated MR image (4000/108) again reveals large soft-tissue hemangioma (long arrows) in direct contact with humerus. Note diffuse marrow signal change (short arrows) throughout diaphysis of humerus.

 

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