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Pulmonary sclerosing haemangioma

Pulmonary sclerosing haemangiomas (PSH), also known as pneumocytomas of the lung, are rare benign neoplasms of the lung.

Epidemiology

Typically presents in middle age (30-50 years of age). There is a recognised female predilection. 

Clinical presentation 

Most patients are asymptomatic. Symptoms if present will include haemoptysis, cough, chest pain, dyspnea, and pleurisy.

Pathology

It is a rare benign tumor which is microscopically characterized by four main histological components (solid, papillary, sclerotic, and haemangiomatous) in varying proportions. A thin fibrous pseudocapsule separates it from the adjacent compressed lung parenchyma.

Radiographic features

There can be significant size variability where the lesions range from under 1 cm to ~8 cm in diameter, although most are < 3.5 cm.

Chest radiograph
  • they usually tend to present as a solitary, well-defined nodular lesion (oval to rounded shadow). 
  • they occasionally contain areas of calcification
  • may show an air-meniscus sign 4: crescentic radiolucency at the periphery of a lung nodule  
CT chest 
  • often seen as a well defined intraparechymal nodular mass (often juxta-pleural)
  • areas of calcification may be present
  • may show a radiolucent zone around the lesion 5
  • shows significant but inhomogeneous enhancement 2,8

History and etymology

It was first described by A A Leibow and D S Hubell et.al in 1956 3.


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