Soft tissue venous malformations, commonly known as soft tissue haemangiomas, are a location-dependent benign vascular soft tissue tumour.
They are the most common angiomatous lesion and represent up to 7% of all benign soft-tissue tumours 2.
It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'soft tissue hemangioma' and 'soft tissue venous malformation' interchangeably.
There may be an greater female predilection.In the paediatric population, heamangiomas tends to be the most frequently diagnosed soft-tissue neoplasm.
Soft tissue haemangiomas may be classified in to five histological subtypes.
This classification is dependent on the predominant type of vascular channel identified within them:
- capillary-commonest type and tend to predominate in the paediatric population.
They can arise in various anatomic locations, including striated muscle, skin, subcutaneous tissue, and synovial tissue (synovial haemangioma).
Small lesions may be occult of plain film which large lesions may show evidence of a focal soft tissue swelling +/- associated phleboliths.
Can have a variable appearance. Typically seen as an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces within. On Colour Doppler, there may be no detectable signal or only weak colour Doppler signal 13.
On unenhanced CT, it may appear as an ill-defined mass of similar attenuation to muscle may be identified. CT may also identify the presence of associated phleboliths.
Haemangiomas are typically well-defined, lobulated and heterogeneous with no features of local invasion.
While many sequences show a rather heterogeneous signal mass certain signal characteristics tend to dominate.
- overall signal is often intermediate to slightly high signal (relative to skeletal muscle) 6
- some focal high signal areas may be present in a large proportion of lesions (up to 70% 5,9)
- T2: high signal intensity tends to dominate on T2-weighted images
- gradient echo: the presence of pheboliths may show blooming artefact 10
- T1 C+ (Gd): lesions show marked signal enhancement in parts of the areas, which were both of high and low T2 8
Some intramuscular hemangiomas may also associated atrophic changes in muscles
Vascular tumours and malformations
vascular malformations and tumours
- vascular tumours
- tufted angioma (with or without Kasabach Merritt syndrome)
- Kaposiform hemangioendothelioma (with or without Kasabach Merritt syndrome)
- spindle cell hemangioendothelioma
- other, rare hemangioendotheliomas
- dermatologic acquired vascular tumors
- slow flow vascular malformations
- capillary malformation (CM)
- venous malformation (VM)
- common sporadic venous malformation
cavernous venous malformation (cavernoma or cavernous haemangioma)
- cerebral cavernous venous malformation
- orbital cavernous venous malformation
- hepatic cavernous venous malformation (hepatic haemangioma)
- splenic cavernous venous malformation (splenic haemangioma)
- breast venous malformation (breast haemangioma)
- retroperitoneal venous malformation
- soft tissue venous malformation
- primary intraosseous venous malformation
- cardiac venous malformations
- cavernous venous malformation (cavernoma or cavernous haemangioma)
- Bean syndrome
- familial cutaneous and mucosal venous malformation
- glomuvenous malformation (glomangioma)
- Maffucci syndrome
- common sporadic venous malformation
- lymphatic malformation (LM)
- fast flow vascular malformations
- arterial malformation
- arterial malformation
- arteriovenous fistulae (with one or more shunts)
- arteriovenous malformations (with a nidus of multiple shunts)
- 1. Kaplan PA, Williams SM. Mucocutaneous and peripheral soft-tissue hemangiomas: MR imaging. Radiology. 1987;163 (1): 163-6. Radiology (abstract) - Pubmed citation
- 2. Olsen KI, Stacy GS, Montag A. Soft-tissue cavernous hemangioma. Radiographics. 24 (3): 849-54. doi:10.1148/rg.243035165 - Pubmed citation
- 3. Greenspan A, Mcgahan JP, Vogelsang P et-al. Imaging strategies in the evaluation of soft-tissue hemangiomas of the extremities: correlation of the findings of plain radiography, angiography, CT, MRI, and ultrasonography in 12 histologically proven cases. Skeletal Radiol. 1992;21 (1): 11-8. - Pubmed citation
- 4. Nelson MC, Stull MA, Teitelbaum GP et-al. Magnetic resonance imaging of peripheral soft tissue hemangiomas. Skeletal Radiol. 1990;19 (7): 477-82. - Pubmed citation
- 5. Suh JS, Hwang G, Hahn SB. Soft tissue hemangiomas: MR manifestations in 23 patients. Skeletal Radiol. 1994;23 (8): 621-5. - Pubmed citation
- 6. Memis A, Arkun R, Ustun EE et-al. Magnetic resonance imaging of intramuscular haemangiomas with emphasis on contrast enhancement patterns. Clin Radiol. 1996;51 (3): 198-204. - Pubmed citation
- 7. Dubois J, Patriquin HB, Garel L et-al. Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR Am J Roentgenol. 1998;171 (1): 247-52. AJR Am J Roentgenol (abstract) - Pubmed citation
- 8. Jenner G, Söderlund V, Bauer HF et-al. MR imaging of skeletal muscle hemangiomas. A report of 16 cases. Acta Radiol. 1996;37 (2): 140-4. - Pubmed citation
- 9. Griffin N, Khan N, Thomas JM et-al. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol. 2007;36 (11): 1051-9. doi:10.1007/s00256-007-0375-6 - Pubmed citation
- 10. Teo EL, Strouse PJ, Hernandez RJ. MR imaging differentiation of soft-tissue hemangiomas from malignant soft-tissue masses. AJR Am J Roentgenol. 2000;174 (6): 1623-8. AJR Am J Roentgenol (full text) - Pubmed citation
- 11. Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253 (2): 297-316. doi:10.1148/radiol.2532081199 - Pubmed citation
- 12. Paltiel HJ, Burrows PE, Kozakewich HP et-al. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology. 2000;214 (3): 747-54. doi:10.1148/radiology.214.3.r00mr21747 - Pubmed citation
- 13. Keng C, Lan H, Chen C et-al. Journal of Medical Ultrasound. 2008;16 (3): . doi:10.1016/S0929-6441(08)60051-X
- 14. Toprak H, Kiliç E, Serter A et-al. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci. 2014;4 (1): 12. doi:10.4103/2156-7514.127965 - Free text at pubmed - Pubmed citation