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Pulmonary Sclerosing Hemangioma Presenting as Solitary Pulmonary Nodule: Dynamic CT Findings and Histopathologic Comparisons

Myung Jin Chung1, Kyung Soo Lee1, Joungho Han2, Yon Mi Sung1, Semin Chong1 and O Jung Kwon3

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
2 Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.


Figure 1
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  		Fig. 1A —47-year-old woman (patient 10) with sclerosing hemangioma with predominantly hemangiomatous and solid components. Mediastinal window of unenhanced CT scan (2.5-mm collimation) obtained at level of left upper lobar bronchus shows well-defined ovoid nodule in left upper lobe. Nodule has smooth margin and homogeneous internal attenuation.

 

Figure 2
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  		Fig. 1B —47-year-old woman (patient 10) with sclerosing hemangioma with predominantly hemangiomatous and solid components. Dynamic CT scan obtained 60 seconds after IV administration of contrast medium shows strong enhancement in right half of nodule (arrows) and less enhancement in left half (arrowheads).

 

Figure 3
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  		Fig. 1C —47-year-old woman (patient 10) with sclerosing hemangioma with predominantly hemangiomatous and solid components. CT scan 5 minutes after contrast injection shows washout (arrows) of initial strong enhancement in right half, delayed enhancement (arrowheads) in left half (solid and sclerotic area), and therefore homogeneous attenuation in entire nodule.

 

Figure 4
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  		Fig. 1D —47-year-old woman (patient 10) with sclerosing hemangioma with predominantly hemangiomatous and solid components. Low-magnification photomicrograph shows kidney-shaped nodule consisting of hemorrhagic hemangiomatous component (arrows) in right half of nodule and mixed hypercellular solid and sclerotic component (arrowheads) in left half. (H and E, x40)

 

Figure 5
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  		Fig. 1E —47-year-old woman (patient 10) with sclerosing hemangioma with predominantly hemangiomatous and solid components. Time-attenuation curve obtained at descending aorta (diamonds), strongly enhancing right component (squares), and weaker-enhancing left component (triangles) of nodule shows rapid and strong enhancement and washout in right half of hemangiomatous component and slow and weak but persistent enhancement in left half of solid and sclerotic component of nodule. In this patient, two types of nodular time-attenuation curve were plotted because nodule had two distinctive enhancement patterns.

 

Figure 6
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  		Fig. 2A —40-year-old woman (patient 8) with sclerosing hemangioma having mixed papillary and sclerotic components. Mediastinal window of unenhanced CT scan (2.5-mm collimation) obtained at level of distal bronchus intermedius shows well-defined ovoid nodule (arrows) in right middle lobe. Smooth margins and homogeneous internal attenuation are evident.

 

Figure 7
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  		Fig. 2B —40-year-old woman (patient 8) with sclerosing hemangioma having mixed papillary and sclerotic components. Dynamic CT scan 60 seconds after IV administration of contrast medium shows spotty enhancement (arrows) within nodule compared with strong enhancement in pulmonary and systemic arteries.

 

Figure 8
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  		Fig. 2C —40-year-old woman (patient 8) with sclerosing hemangioma having mixed papillary and sclerotic components. CT scan 90 seconds after contrast injection shows permeant enhancement (arrows) within nodule.

 

Figure 9
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  		Fig. 2D —40-year-old woman (patient 8) with sclerosing hemangioma having mixed papillary and sclerotic components. CT scan 5 minutes after injection shows homogeneous attenuation of entire nodule.

 

Figure 10
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  		Fig. 2E —40-year-old woman (patient 8) with sclerosing hemangioma having mixed papillary and sclerotic components. Low-magnification photomicrograph shows ovoid nodule with predominantly papillary component (straight arrows). Hemangiomatous (arrowheads) and sclerotic (curved arrows) components of tumor are evident. (H and E, x40)

 

Figure 11
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  		Fig. 3A —57-year-old woman (patient 9) with sclerosing hemangioma having predominantly solid and sclerotic components. Mediastinal window of unenhanced CT scan (2.5-mm collimation) at level of proximal left pulmonary artery shows small round nodule in superior segment of left lower lobe. Attenuation of nodule (65 H) is similar to that of chest wall muscle.

 

Figure 12
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  		Fig. 3B —57-year-old woman (patient 9) with sclerosing hemangioma having predominantly solid and sclerotic components. Dynamic CT scan 60 seconds after IV contrast administration shows enhancement (net enhancement, 33 H) similar to that of chest wall muscle. Curvilinear enhancement (arrows) is evident in periphery of nodule.

 

Figure 13
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  		Fig. 3C —57-year-old woman (patient 9) with sclerosing hemangioma having predominantly solid and sclerotic components. CT scan 5 minutes after contrast injection shows homogeneous attenuation of nodule.

 

Figure 14
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  		Fig. 3D —57-year-old woman (patient 9) with sclerosing hemangioma having predominantly solid and sclerotic components. Low-magnification photomicrograph shows round nodule with predominantly solid (large arrows) and some sclerotic (arrowhead) components. Hemangiomatous component (curved arrows) is evident in periphery. Cystlike features (small arrows) in nodule are caused by tissue distortion during freezing of pathologic specimen. (H and E, x40)

 

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