Intramuscular hemangioma treated by endovascular embolization and subsequent resection

Case contributed by Yves Leonard Voss
Diagnosis certain


Known intramuscular hemangioma of the left sternocleidomastoid muscle. Firm mass palpable on physical exam. Within the last two years, the patient already underwent surgical resection of the malformation twice with rapid recurrence of the lesion.

Patient Data

Age: 50 years
Gender: Male

MRI shows a hypervascularized lesion of the left sternocleidomastoid muscle.

Differential diagnoses should include hypervascular tumor, AVM (arteriovenous malformation), hemangioma, etc.

A diagnostic angiography revealed absent augmented venous drainage rendering an AVM improbable and showed typical signs of a hemangioma.

Right femoral arterial access (5F) demonstrating the subclavian, vertebral and common carotid arteries with the subclavian and carotid branches supplying the hemangioma.

Dominant branches of the external carotid artery, as well as proximal subclavian branches, are shown to mainly supply the hemangioma.

No arteriovenous shunts can be seen.

Direct puncture of the hemangioma in its medial and lateral compartment, complete occlusion using OnyxTM.

Post-interventional MRI of the lesion.

Case Discussion

Recurrent intramuscular hemangioma is refractive to surgical treatment shown by transfemoral angiography and treated by direct puncture and embolization using OnyxTM as preparation for repeat surgery.

Postoperative histology confirmed intramuscular cavernous hemangioma.

Case courtesy of Prof. Rene Chapot and Dr. Hannes Nordmeyer (Alfried-Krupp-Krankenhaus, Essen, Germany).

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