Intraosseous hemangioma - calvarial

Case contributed by Dr Abeer Ahmed Alhelali


History of non-tender forehead swelling which grew over the last 2 months. No history of trauma.

Patient Data

Age: 25 years
Gender: Male

Well-defined expansive lytic lesion is seen affecting the right frontal bone with typical coarsened trabeculation and characteristic sunburst pattern radiating from the center.

The erosive changes of the external skull table seen. An overlying focal galeal contour bulge was noted.

No intraparenchymal component could be depicted.  No soft tissue component could be seen.

No other similar lesions could be seen.

Case Discussion

Intraosseous hemangioma accounts for about 0.7% of all bone tumors. It is considered as a rare bone tumor. It can present at any age; however, it is commonly seen between fourth and fifth decades. 1 The cause is unknown; it could be congenital or traumatic. 2

Patients may present with slow-growing palpable hard mass as in our case with mild tenderness. Neurological deficit is uncommon as mass grows externally rather than internally. 3

Radiologically interosseous hemangioma presents as an osteolytic lesion. CT is the modality of choice to check interosseous extent and soft tissue involvement; however, it is difficult to make definitive diagnosis radiologically only, as many differential diagnoses may be raised like Langerhans cell histiocytosis, osteoma and fibrous dysplasia. 4

In CT fibrous dysplasia will show ground glass appearance which may help to differentiate between it and interosseous hemangioma which will show thickened trabeculae with a sunburst pattern.

Treatment of choice is en bloc resection with a safe margin of normal bone. Other therapies like embolization, curettage and radiotherapy may help.4

Special thanks to Dr Tamer Ibrahim ElHoliby.

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