Intramuscular haemangioma treated by endovascular embolisation and subsequent resection

Case contributed by Yves Leonard Voss

Presentation

Known intramuscular haemangioma of the left sternocleidomastoid muscle. Firm mass palpable on 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
Gender: Male

MRI shows a hypervascularized lesion of the left sternocleidomastoid muscle.

Differential diagnoses should include hypervascular tumour, AVM (arteriovenous malformation), haemangioma, etc.

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

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

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

No arteriovenous shunts can be seen.

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

Post-interventional MRI of the lesion.

Case Discussion

Recurrent intramuscular haemangioma refractive to surgical treatment shown by transfemoral angiography and treated by direct punct and embolisation using OnyxTM as a preparation for repeat surgery.

Postoperative histology confirmed intramuscular cavernous haemangioma.

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

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Case information

rID: 50113
Case created: 19th Dec 2016
Last edited: 13th Sep 2017
Inclusion in quiz mode: Excluded

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