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Case 1

Mediastinal Hemangioma

The chest radiograph shows a large mass that involves the upper mediastinum at the level of the arch and continues caudally to the right cardiophrenic angle (Figs. 1A and 1B). Careful inspection reveals small rounded calcific densities within the mass, which are confirmed on unenhanced CT (Figs. 1C and 1D). The mass is contiguous with the mediastinum but shows no gross invasion of the mediastinal structures. The mass was resected, and pathology confirmed a mediastinal hemangioma containing numerous phleboliths.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —37-year-old man who presented with persistent dry cough and dyspnea. Posteroanterior (A) and lateral (B) chest radiographs show large mass in anterior mediastinum (arrows). Calcifications (phleboliths) are seen within mass (arrowheads).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —37-year-old man who presented with persistent dry cough and dyspnea. Posteroanterior (A) and lateral (B) chest radiographs show large mass in anterior mediastinum (arrows). Calcifications (phleboliths) are seen within mass (arrowheads).

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —37-year-old man who presented with persistent dry cough and dyspnea. Unenhanced (C) and enhanced (D) CT scans show heterogeneously attenuating mass in anterior mediastinum. Numerous rounded calcifications within mass are compatible with phleboliths.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D. —37-year-old man who presented with persistent dry cough and dyspnea. Unenhanced (C) and enhanced (D) CT scans show heterogeneously attenuating mass in anterior mediastinum. Numerous rounded calcifications within mass are compatible with phleboliths.

Benign vascular tumors are rarely encountered in the mediastinum, but the most common of these tumors are mediastinal hemangiomas. Hemangiomas account for approximately 0.5% of all mediastinal tumors [1,2,3]. They most commonly occur in the anterior mediastinum, with a few arising in the posterior mediastinum. The tumors are well circumscribed and unencapsulated, ranging from 2 to 20 cm in diameter [4]. Patients are usually asymptomatic but may present with cough, hoarseness, stridor, chest pain, or dyspnea as a result of the mass effect of the tumor. Mediastinal hemangiomas usually present in the first four decades of life, with a peak incidence in the first decade. Males and females are affected with equal frequency [1, 5].

Radiographically, mediastinal hemangiomas usually present as nonspecific masses. Phleboliths are seen on conventional radiographs in approximately 10% of these tumors but are more frequently seen on CT [1,2,3, 5]. Unless phleboliths are present, diagnosis of these tumors is difficult on conventional radiography. On CT, mediastinal hemangiomas are heterogeneous in attenuation, are round or lobulated, and have smooth margins. They frequently contain compartments and may encase or infiltrate adjacent structures. After the administration of IV contrast material, mediastinal hemangiomas usually enhance heterogeneously. They may show marked increased central enhancement, although peripheral enhancement and puddling of contrast material peripheral to the mass has been described [3].

In this case, the presence of phleboliths on the conventional radiographs is diagnostic of mediastinal hemangioma.

References

1. Davis JM, Mark GJ, Greene R. Benign blood vascular tumors of the mediastinum: report of four cases and review of the literature. Radiology 1978;126:581 -587[Abstract]
2. Eber CD, Stark P. Kernstine K. Subcarinal cavemous hemangioma: CT findings. Radiologe 1995;35:354 -355[Medline]
3. McAdams HP, Rosado-de-Christenson ML, Moran CA. Mediastinal hemangioma: radiographic and CT features in 14 patients. Radiology 1994;193:399 -402[Abstract/Free Full Text]
4. Moran CA, Suster S. Mediastinal hemangiomas: a study of 18 cases with emphasis on the spectrum of morphological features. Hum Pathol 1995;26:416 -421[Medline]
5. Buckner S, McAllister J, D'Altorio R. Case of the season: hemangioma of the middle mediastinum. Semin Roentgenol 1994;29:98 -99[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Klecker, R. J. Articles by King, M. A. Search for Related Content PubMed Articles by Klecker, R. J. Articles by King, M. A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?