DOI:10.2214/AJR.05.0460
AJR 2006; 187:430-437
© American Roentgen Ray Society
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.
Received March 16, 2005;
accepted after revision May 2, 2005.
Supported by grant R11-2002-103 from the Korea Science and Engineering
Foundation.
Address correspondence to K. S. Lee
(kyungs.lee{at}samsung.com).
Abstract
OBJECTIVE. The purpose of this study was to describe the dynamic CT
findings of pulmonary sclerosing hemangioma presenting as a solitary pulmonary
nodule and to compare these findings with histopathologic findings.
CONCLUSION. On dynamic CT, sclerosing hemangioma has strong and
rapid enhancement attributed histopathologically to the presence of
hemangiomatous or papillary components in the tumor.
Keywords: CT • hemangioma • lung disease • lung neoplasm
Introduction
Sclerosing hemangioma is a rare benign neoplasm of the lung
[1], categorized as a
miscellaneous tumor in the new 1999 World Health Organization/International
Association for the Study of Lung Cancer classification. It is considered a
distinct entity characterized by the presence of vascular proliferation with a
marked tendency for sclerosis
[2]. Although initially
regarded as a variant of hemangioma on the basis of results of
immunohistochemical and genetic studies, sclerosing hemangioma is now
considered an epithelial tumor.
On chest radiographs, sclerosing hemangioma appears as a well-defined round
or oval mass. According to a report on the CT findings in eight cases, this
tumor presents as a well-defined juxtapleural mass with marked contrast
enhancement caused by its hemangiomatous component
[3]. Dynamic CT and MRI studies
have shown that sclerosing hemangioma has marked homogeneous enhancement
[4,
5]. Most sclerosing hemangiomas
grow slowly and can be cured by wedge resection or lobectomy. However,
sclerosing hemangioma can manifest as multiple tumors or as a tumor surrounded
by multiple daughter nodules in the same lobe; it also can be accompanied by
hilar lymph node metastasis [6,
7]. The purpose of this study
was to describe the dynamic CT findings of pulmonary sclerosing hemangioma
presenting as a solitary pulmonary nodule and to compare these findings with
the histopathologic findings.
Subjects and Methods
Patients and CT
Between March 2002 and October 2003, 318 patients with a solitary pulmonary
nodule at chest radiography underwent dynamic CT. Of these, 228 patients had
the final diagnosis of benign tumor or malignancy, and 116 (51%) of these
patients proved to have a benign nodule. Ten (9%) of the 116 patients had
surgically proven sclerosing hemangioma. Surgical intervention involved wedge
resection through open thoracotomy (n = 4) or video-assisted
thoracoscopic surgery (n = 6). Resection was performed because
percutaneous transthoracic fine-needle aspiration biopsy produced an
inconclusive diagnosis with features of well-differentiated adenocarcinoma or
carcinoid tumor (n = 6); the tumor showed high enhancement on
enhanced dynamic CT and interval growth on serial imaging (n = 3); or
percutaneous transthoracic fine-needle aspiration biopsy was technically
unfeasible (n = 1). All 10 patients were women 40-73 years old (mean
age, 52 years). Three of the 10 patients had no symptoms. In these patients,
tumors were identified incidentally as a solitary pulmonary nodule on chest
radiographs obtained at routine medical examinations. Seven patients had
nonspecific symptoms such as a mild cough with sputum (n = 4),
blood-tinged sputum (n = 2), or chest discomfort (n =
1).
All 10 patients prospectively underwent enhanced dynamic CT with a 4-MDCT
scanner (LightSpeed QX/i, GE Healthcare) or a 16-MDCT scanner (LightSpeed 16,
GE Healthcare). Our institutional review board approved the study protocol,
and written informed consent was obtained from all patients. Before IV
injection of contrast medium, a series of 13 images were obtained throughout
each nodule, covering 30 mm along the z-axis with 2.5-mm collimation
at 120 kVp, 170 mA, 0.8-second gantry rotation time, and a table speed of 3.75
mm/s over 8 seconds. Thereafter, an additional series of nine images were
obtained at 20-second intervals after initiation of injection of contrast
material (3 mL/s, total of 120 mL of iomeprol [Iomeron 300, Bracco]) with a
power injector (MCT Plus, Medrad), according to the same parameters used for
the initial unenhanced series (total of 10 series of images). Image data were
reconstructed according to a standard algorithm with a thickness of 2.5 mm (13
images in each cluster; total number of dynamic images, 13 x 10 = 130
images). After the dynamic study, a helical scan (120 kVp, 50 mA, 5-mm
collimation, table speed of 15 mm/s) was obtained 5 minutes after contrast
injection from the lung apices to the level of the middle pole of both
kidneys.
View larger version (91K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (68K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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).
|
|
View larger version (86K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (163K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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)
|
|
View larger version (8K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (68K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (50K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (69K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (74K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (114K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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)
|
|
View larger version (83K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (37K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (94K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
View larger version (196K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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)
|
|
Image Analysis
All thin-section, dynamic CT, and conventional image data were directly
interfaced to our PACS system (Centricity 2.0, GE Healthcare Integrated
Imaging Solutions), which was used to display all image data on monitors (four
monitors, 1,536 x 2,048 image matrices, 8-bit viewable gray-scale, and
60-foot-lambert luminescence). On the monitors, both mediastinal (window
width, 400 H; window level, 20 H) and lung (window width, 1,500 H; window
level, -700 H) window images were viewed.
The morphologic features of nodules determined by analysis of unenhanced
thin-section CT scans included shape, margin characteristics, and presence of
calcification. The internal texture of the nodules also was evaluated on
unenhanced thin-section CT scans. The presence of hilar or mediastinal lymph
node enlargement was assessed by evaluation of enhanced scans covering the
entire thorax. Because a previous report suggested an intrafissural or
juxtapleural tumor location
[3], we also evaluated the
relation between the nodule and the fissure or the pleura. Nodular size was
defined as long-axis diameter on lung-window images. Nodular shapes were
classified as round, ovoid, or rectangular. Nodular margins were classified as
smooth, lobulated, or spiculated. Nodular texture was classified as
homogeneous or heterogeneous. Calcification was classified as stippled,
central nodular, laminated, or diffuse. When both sides of a nodule abutted
the fissure, the nodule was defined as located within the fissure. When it
abutted the chest wall at an obtuse angle, a nodule was defined as located in
the pleura. Otherwise, the nodule was defined as intrapulmonary.
On dynamic studies, we evaluated whether a nodule showed homogeneous or
inhomogeneous enhancement during or at the end of dynamic study. We also
measured nodule attenuation values and the attenuation values of the
descending thoracic aorta, when available, to ensure the adequacy of our
dynamic study. We measured the great branch when the aorta was not included in
the dynamic study. Nodule attenuation values, irrespective of the homogeneity
of attenuation, were measured in the same areas on selected images for each
series of images at each time. A circular region of interest was placed over a
nodule or the descending thoracic aorta. For a given nodule, we examined a
region of interest that covered approximately one half of the diameter of the
nodule at the equator. On the descending thoracic aorta or great vessels, we
also placed a region of interest that covered approximately one half of the
diameter of the aorta or great vessels. All attenuation measurements were
obtained from mediastinal-window images to ensure that partial volume
averaging was minimized. Two radiologists, one with 7 and the other with 14
years of experience in chest CT, selected images together and then one
radiologist measured the attenuation values. Two measurements obtained for
each nodule at each imaging phase were averaged. Several dynamic
characteristics of tumor enhancement were calculated from the time-attenuation
curves: baseline attenuation (AVBase), peak enhancement
(PE = attenuation at maximum), net enhancement (NE =
PE - AVBase), time to peak enhancement
(TPeak, time needed to reach peak enhancement),
acceleration index (AI = NE / TPeak),
attenuation value at 5-minute delay (AVDelay), and washout
value (attenuation difference between PE and
AVDelay, WV = PE -
AVDelay).
Pathologic Comparisons
One lung pathologist with 11 years of experience in lung pathology
evaluated all surgical pathologic specimens unaware of CT findings.
Examinations focused on providing a histopathologic basis for the CT findings.
With routine light microscopy and H and E staining, the volume extents of the
four tumor components—papillary, sclerotic, solid, and
hemangiomatous—were estimated to the nearest 10% level, and the
predominant tumor component was determined. Extent of enhancement (peak
enhancement and net enhancement) was correlated with the determined tumor
component percentages.
Radiation Exposure
Radiation exposure doses to the lungs with our technique have been reported
previously [8]. Radiation
exposure to the breasts was measured with the same method as in the previous
study [8]. Breast exposure
doses were measured three times: first with the presumption that the nodule
was located in the upper lung zone, second with the presumption that the
nodule was located in the middle lung zone at a similar level to the breasts,
and third with the presumption that the nodule was located in the lower lung
zone.
Results
All sclerosing hemangiomas were located in the lungs. Seven tumors were in
the right lung and three in the left. Two hemangiomas were found in the upper
lobes, four in the right middle lobe or the lingular division of the left
upper lobe, and four in the lower lobes.
Mean tumor long-axis diameter was 18 ± 5 mm (SD; range, 10-24 mm).
Six tumors were round and four ovoid. All tumors had smooth margins (Figs.
1A,
1B,
1C,
1D,
1E,
2A,
2B,
2C,
2D,
2E,
3A,
3B,
3C, and
3D). The internal texture of
the tumors before contrast enhancement was homogeneous in all cases, but
during dynamic studies after contrast enhancement, four (40%) of the tumors
were homogeneous and six (60%) were heterogeneous. On 5-minute images, all
nodules were homogeneous. Three nodules (30%) contained an intratumoral
calcification, and all were stippled. Mediastinal or hilar lymph node
enlargement was not found in any case.
Enhanced dynamic CT study was feasible for all 10 patients. The dynamic CT
characteristics of the 10 cases are summarized in
Table 1. Mean baseline tumor
attenuation was 51 ± 11 H. The mean tumor peak enhancement value was
124 ± 14 H, and the mean net enhancement value was 74 ± 18 H.
The concurrently measured peak enhancement value of the thoracic aorta was 273
± 51 H. The mean time to peak enhancement was 57 ± 12 seconds
for tumors, whereas the mean time to peak enhancement for the aorta and great
vessels was 39 ± 6 seconds. The time difference between time to peak
enhancement of the aorta and that of the tumor was 18 ± 14 seconds. The
mean washout value for tumors after the 5-minute delay was 17 ± 7
H.
Five tumors had a predominantly papillary component, four were
hemangiomatous, and one was solid. In one case (patient 7,
Table 1) in which the
hemangiomatous and papillary components were equally included, the tumor was
classified as hemangiomatous. No tumor had a predominantly sclerotic
component. Dynamic CT characteristics correlated with the predominant tumor
components are summarized in Table
2. Except for the tumor with a predominantly solid component
(Figs. 3A,
3B,
3C, and
3D.), in which peak
enhancement (98 H) and net enhancement (33 H) were noticeably low, dynamic CT
parameters were similar in all tumors
(Table 2).
The measured total lung dose ranged from 186 to 192 mGy at nodule sites.
Organ dose ranged from 24 to 26 mGy elsewhere in the lung. The measured total
breast dose was 19-20 mGy when the nodule was in the upper lung zone, 233-241
mGy when the nodule was in the middle lung zone and on the same transaxial
plane as the breast, and 24-26 mGy when the nodule was in the lower lung
zone.
Discussion
Sclerosing hemangioma is composed of two types of cells: cuboidal cells
that line papillary structures and round to polygonal cells that form solid
sheets. The neoplasm has four possible histologic components: papillary,
sclerotic, solid, and hemorrhagic. Most tumors have at least three of these
components, and a minority have only two. In the large series reported to
date, no tumor has shown a single component
[9].
In our study, sclerosing hemangioma had several morphologic characteristics
on unenhanced CT images: a round or ovoid shape (100% of cases), a smooth
margin (100%), homogeneous attenuation (100%), and calcification (30%). These
morphologic features are characteristic enough for differentiation of
sclerosing hemangioma from malignant nodules, because malignant nodules have a
lobulated and spiculated margin with occasional calcification
[9]. However, these morphologic
features of sclerosing hemangioma can overlap with the CT findings of other
benign nodules such as hamartoma. In such situations, dynamic studies showing
characteristic strong and early enhancement may allow the differential
diagnosis of sclerosing hemangioma and other benign pulmonary tumors.
Strong enhancement of sclerosing hemangioma suggests the possibility that
the nodule is malignant [8,
10]. According to a study by
Yi et al. [8], who used the
same dynamic study protocol that are used to evaluate solitary pulmonary
nodules, malignant nodules had higher mean peak enhancement (98 ± 17 H
vs 78 ± 30 H, p < 0.001) and mean net enhancement (53
± 15 H vs 35 ± 26 H, p < 0.001) values and lower
mean time to peak enhancement (103 ± 43 seconds vs 119 ± 45
seconds, p = 0.03) than benign nodules. In our study, however,
sclerosing hemangioma had even more rapid (time to peak enhancement, 57
± 12 seconds) and stronger (peak enhancement, 124 ± 14 H; net
enhancement, 74 ± 18 H) enhancement than malignant nodules. These
dynamic study results integrated with morphologic CT findings (i.e., round or
ovoid shape, smooth margin, and homogeneous attenuation) allow differentiation
of sclerosing hemangioma and malignant nodules. However, because lung cancer
also has well-defined margins and similar strong and rapid enhancement, we
cannot completely exclude the possibility of lung cancer on the basis of
results of CT morphologic analysis and enhanced dynamic CT.
Benign tumors that resemble sclerosing hemangioma in terms of morphologic
and dynamic features include leiomyoma and a small percentage of highly
vascular hamartomas. However, differentiation of these tumors is clinically
insignificant because of the common prognostic implications. Highly vascular
solitary metastatic cancers, such as pulmonary metastatic renal cell
carcinoma, have morphologic and dynamic CT features similar to those of
sclerosing hemangioma.
Sclerosing hemangioma has been described as a benign tumor with strong
enhancement after IV administration of contrast medium
[3]. It has been reported that
sclerosing hemangioma shows homogeneous enhancement, maximum CT values ranging
from 90 to 110 H [5]. In our
dynamic study, nine of 10 tumors had more than 60-H net enhancement. The mean
peak enhancement value of 10 sclerosing hemangiomas was 124 H, and the mean
net enhancement value was 74 H. The mean time to peak enhancement was 57
seconds, which is similar to the rapid enhancement shown by hypervascular
tumors of the liver and kidneys
[11]. Our pathologic study
showed that the single case of a compact solid-type tumor had slow and
persistent enhancement with little washout. Moreover, this slow and persistent
enhancement was found in the lower-attenuation area on the time-attenuation
curve when the tumors showed heterogeneous enhancement (one part strong
enhancement and the other part less enhancement, as in Figs.
1A,
1B,
1C,
1D, and
1E) during the dynamic study.
It therefore appears that the dynamic characteristics of sclerosing hemangioma
depend on the levels of hemangiomatous or papillary (early and strong
enhancement component) and solid or sclerotic (slow and persistent enhancement
and little washout) components present.
Unusual manifestations of sclerosing hemangioma include mediastinal mass
[12], tumor with a cystic
appearance [13,
14], air trapping around the
tumor
[15-18],
and tumor within an extralobar pulmonary sequestration. When it presents with
a cystic appearance, sclerosing hemangioma should be differentiated from clear
cell tumor, intrapulmonary thymoma, pleuropulmonary blastoma type 1, and
alveolar adenoma [14]. Given
the limited number of patients enrolled, we did not have the opportunity to
see such unusual cases. When sclerosing hemangioma manifests atypical
morphologic characteristics during imaging studies or at pathologic
examination, a wide range of differential diagnostic techniques may be needed.
Immunohistochemical analysis can help differentiate sclerosing hemangioma
(epithelial origin, type 2 pneumocyte) from other tumors (mesothelial or
submesothelial origin) on the basis of tumor origin. The presence of
antibodies of thyroid transcription factor 1, surfactant protein B, vimentin,
and cytokeratin L is helpful in differentiating sclerosing hemangioma.
In cystic tumors, the tumor is composed of a cystic wall (fibrous and
partly hyalinized), tumor cells have various histologic patterns, and red
blood cells accumulate within the cavity
[13]. The mechanism of
formation of the air-trapping zone surrounding the tumor at CT and the air
meniscus sign on chest radiographs has been suggested as being peritumoral
hemorrhage followed by clearance through the airway creating a peritumoral air
space.
Although generally regarded as benign, sclerosing hemangioma can appear
with hilar or mediastinal nodes or lung-to-lung metastasis, especially when
the tumor is large [19,
20]. Sclerosing hemangioma is
considered to originate from a primitive respiratory epithelium
[21]. Therefore, nodal or
lung-to-lung metastasis is not exceptional. In our study, however, neither
nodal nor pulmonary metastasis was identified.
Our study had several limitations. First, there was selection bias because
we included histopathologically proven cases only. Although the tumors were
found to have mainly papillary and hemangiomatous components, we do not know
precisely which components are actually predominant. Second, the high level of
radiation exposure used in the dynamic study was a shortcoming. Measured lung
radiation dose at the nodule location was 186-192 mGy, five times higher than
the 38-40 mGy with standard MDCT
[8]. Moreover, the measured
breast dose was 233-241 mGy for nodules in the middle lung zone and on the
same transaxial plane as the breasts. A low-dose technique with reduced
radiation risk or truncation of the dynamic CT technique (30- or 60-second
intervals rather than 20-second intervals) would have been more advisable for
the dynamic study. Third, because we did not perform a blinded prospective
study comparing the series of sclerosing hemangiomas with malignant nodules,
we do not know how accurate the given morphologic and dynamic CT features are
for differentiating sclerosing hemangioma from malignant nodules.
In conclusion, sclerosing hemangioma appears morphologically as a small,
round, or oval homogeneous nodule with a smooth margin that on dynamic CT has
strong and rapid enhancement caused primarily by hemangiomatous or papillary
components.
References
- Nagata N, Dairaku M, Sueishi K, Tanaka K. Sclerosing hemangioma of
the lung: an epithelial tumor composed of immunohistochemically heterogeneous
cells. Am J Clin Pathol 1987;88
: 552-559[Medline]
- Travis W. Histological typing of lung and pleural
tumors. Berlin, Germany: Springer, 1999
- Im JG, Kim WH, Han MC, et al. Sclerosing hemangiomas of the lung
and interlobar fissures: CT findings. J Comput Assist
Tomogr 1994; 18:34
-38[Medline]
- Nakanishi K, Kohzaki S, Fujimoto S, Horita Y, Hayashi K. Pulmonary
sclerosing hemangioma: report of a case with emphasis on dynamic MR imaging
findings. Radiat Med 1997;15
: 117-119[Medline]
- Xie RM, Zhou XH, Lu PX, He W. Diagnosis of pulmonary sclerosing
hemangioma with incremental dynamic CT: analysis of 20 cases [in Chinese].
Zhonghua Jie He He Hu Xi Za Zhi 2003;26
: 7-9[Medline]
- Lee ST, Lee YC, Hsu CY, Lin CC. Bilateral multiple sclerosing
hemangiomas of the lung. Chest 1992;101
: 572-573[Abstract/Free Full Text]
- Shimosato Y. Lung tumors of uncertain histogenesis.
Semin Diagn Pathol 1995;12
: 185-192[Medline]
- Yi CA, Lee KS, Kim EA, et al. Solitary pulmonary nodules: dynamic
enhanced multi-detector row CT study and comparison with vascular endothelial
growth factor and microvessel density. Radiology2004; 233:191
-199[Abstract/Free Full Text]
- Kim GY, Kim J, Choi YS, Kim HJ, Ahn G, Han J. Sixteen cases of
sclerosing hemangioma of the lung including unusual presentations.
J Korean Med Sci 2004;19
: 352-358[Medline]
- Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement
at CT: multicenter study. Radiology 2000;214
: 73-80[Abstract/Free Full Text]
- Lee KH, Choi BI, Han JK, Jang HJ, Kim TK, Han MC. Nodular
hepatocellular carcinoma: variation of tumor conspicuity on single-level
dynamic scan and optimization of fixed delay times for two-phase helical CT.
J Comput Assist Tomogr 2000;24
: 212-218[CrossRef][Medline]
- Sakamoto K, Okita M, Kumagiri H, Kawamura S, Takeuchi K, Mikami R.
Sclerosing hemangioma isolated to the mediastinum. Ann Thorac
Surg 2003; 75:1021
-1023[Abstract/Free Full Text]
- Kitagawa H, Goto A, Minami M, Nakajima J, Niki T, Fukayama M.
Sclerosing hemangioma of the lung with cystic appearance. Jpn J
Clin Oncol 2003; 33:360
-363[Abstract/Free Full Text]
- Khoury JD, Shephard MN, Moran CA. Cystic sclerosing haemangioma of
the lung. Histopathology 2003;43
: 239-243[CrossRef][Medline]
- Nam JE, Ryu YH, Cho SH, et al. Air-trapping zone surrounding
sclerosing hemangioma of the lung. J Comput Assist
Tomogr 2002; 26:358
-361[CrossRef][Medline]
- Matsuyama W, Hirotsu Y, Mizoguchi A, Iwami F, Kawabata M, Osame M.
Pulmonary sclerosing hemangioma with specific CT findings [in Japanese].
Nihon Kokyuki Gakkai Zasshi 1998;36
: 564-567[Medline]
- Sagara Y, Hayashi K, Shiraishi Y, et al. The pulmonary air meniscus
sign in a case of sclerosing hemangioma [in Japanese]. Nihon Kyobu
Shikkan Gakkai Zasshi 1994;32
: 774-777[Medline]
- Bahk YW, Shinn KS, Choi BS. The air meniscus sign in sclerosing
hemangioma of the lung. Radiology 1978;128
: 27-29[Abstract]
- Yano M, Yamakawa Y, Kiriyama M, Hara M, Murase T. Sclerosing
hemangioma with metastases to multiple nodal stations. Ann Thorac
Surg 2002; 73:981
-983[Abstract/Free Full Text]
- Kim KH, Sul HJ, Kang DY. Sclerosing hemangioma with lymph node
metastasis. Yonsei Med J 2003;44
: 150-154[Medline]
- Wang E, Lin D, Wang Y, Wu G, Yuan X. Immunohistochemical and
ultrastructural markers suggest different origins for cuboidal and polygonal
cells in pulmonary sclerosing hemangioma. Hum Pathol2004; 35:503
-508[CrossRef][Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
K. S. Lee, C. A. Yi, S. Y. Jeong, Y. J. Jeong, S. Kim, M. J. Chung, H. Y. Kim, Y. K. Kim, and K. H. Lee
Solid or Partly Solid Solitary Pulmonary Nodules: Their Characterization Using Contrast Wash-In and Morphologic Features at Helical CT
Chest,
May 1, 2007;
131(5):
1516 - 1525.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Introduction
