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Calvarial hemangioma

Case contributed by Mark Pringle
Diagnosis certain

Presentation

Left forehead lump. Present for two years.

Patient Data

Age: 30 years
Gender: Female
ct

Expansile lucent lesion of left frontal bone with 'sunburst' trabecular thickening with extension beyond the external plate of the calvarium - concerning for 'hair-on-end' periosteal reaction. No other bony lesion.

Soft tissue window of the brain (not shown) is unremarkable.

mri

The left frontal bone lesion has heterogenous signal characteristics but is largely:

  • T2: hyperintense

  • T2: FLAIR hyperintense

  • T1: hypointense with speckled foci of signal hyperintensity (likely to represent fat)

  • T1 C+: avid contrast enhancement following gadolinium

Unremarkable brain and CSF spaces. No other lesion.

Pathology

Bone with large dilated vascular spaces within the marrow spaces. The appearances are of a cavernous hemangioma of bone.

Case Discussion

Intraosseous hemangiomas are benign vascular lesions. They have a relatively indolent clinical course however can present with lumps. Imaging appearances can be concerning, particularly the pseudo 'hair-on-end' appearance. This lesion underwent open biopsy and pathology confirmed benign hemangioma.

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