Soft tissue hemangioma: intramuscular, leg

Case contributed by Dr Domenico Nicoletti


Nodular, painless bulge in medial calf.

Patient Data

Age: 60 years
Gender: Female

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.


MRI left leg

In the 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, skin, subcutaneous tissue and synovial tissue.
Histologic varieties include capillary, cavernous, arteriovenous, venous and mixed.
Calcification is common.

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Case information

rID: 57449
Published: 27th Dec 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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