Presentation
Nodular, painless bulge in medial calf.
Patient Data
XR left leg
In the medial part of the calf, there is a heterogeneous soft tissue mass which contains numerous small spherical calcifications characteristic of phleboliths.
The bones appear normal.
In the left medial gastrocnemius muscle, all sequences show a heterogeneous mass.
T1-weighted images show an increase in fat around the circumference of the lesion and multiple interlacing vascular channels in the lesion, giving a “bag of worms” appearance.
STIR axial images through the hemangioma at the same level show the vascular component of the lesion to be markedly hyperintense to muscle.
On T2-weighted images, the central portion of the mass shows high signal intensity. (High-signal intralesional fat is abundant in many hemangiomas.)
Axial T1 post-contrast images show enhancement of the lesion, which is composed of a cluster of tubular structures that represent discrete vessels.
Case Discussion
Hemangiomas are common, benign soft-tissue tumors (7% of all benign soft tissue tumors).
They can arise from skeletal muscle and are then termed intramuscular hemangiomas or from the skin, subcutaneous tissue and synovial tissue. Histologic varieties include capillary, cavernous, arteriovenous, venous and mixed. Calcification is common.
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