MyPACS.net: Radiology Teaching Files > Case 47672912

Never visited HEMANGIOMA OF THE SKULL
Contributed by: antonio aguiar, Radiologist, Real Hospital PortuguÍs De Pernambuco - Realimagem, Brazil.
History:

Patient 01: Adult woman, asymptomatic.

Patient 02: 83 - year - old woman.

Images:[small]larger

Fig. 1: Lateral skull projection - a lytic lesion in the calvaria, with a marginal thin sclerotic rim.

Fig. 2: Lateral skull projection - A well-defined skull lytic lesion, with thin trabeculaes inside it.

Fig. 3: CT scout view - a well-defined skull lytic lesion, with peripheral sclerosis.

Fig. 4: NECT - a well-defined diploic lytic lesion in the right parietal bone.

Fig. 5: NECT - a lytic lesion in the right parietal bone, with peripheral sclerosis.

Fig. 6: NECT - a diploic lytic lesion in the right parietal bone.

Fig. 7: CECT - an enhancing diploic lesion in the right parietal bone.
Findings:

Figure 01 (patient 01): lateral skull projection shows a lesion in the calvaria, which is primarily lytic (red arrows), with posterior trabeculaes (green arrow) and a marginal thin sclerotic rim.

Figure 02 (patient 01): lateral skull projection reveals a well-defined skull lytic lesion (red arrows), with thin trabeculaes inside it.

Figure 03 (patient 02): lateral CT scout view demonstrates a well-defined lytic lesion with peripheral sclerosis in the calvaria.

Figure 04 (patient 02): non enhanced computed tomography (NECT) shows a well-defined diploic lytic lesion in the right parietal bone (red arrows), with peripheral sclerosis.

Figure 05 (patient 02): NECT reveals a lytic lesion in the right parietal bone, with peripheral sclerosis.

Figure 06 (patient 02): NECT demonstrates a diploic lesion in the right parietal bone (red arrow).

Figure 07 (patient 02): contrast enhanced computed tomography (CECT) shows an enhancing diploic lytic lesion in the parietal bone (red arrow).

Diagnosis: Hemangioma of the skull.
Discussion:

Bone hemangiomas are benign malformed vascular lesions, overall constituing less than 1% of primary bone neoplasms. They occur most frequently in the vertebral column (30% - 50%) and skull (20%), whereas involvement of other sites, including long bones, short tubular bones and ribs is rare. The osseous hemangioma is a true neoplastic mass composed of blood-filled endothelium-lined spaces and interspaced bone trabeculaes.

Hemangiomas may have a spectrum of histologic findings. They can be divided into capillary (small vessels), cavernous (large vessels), and mixed type. Most hemangiomas of bone are cavernous type, although they may be mixed.

Hemangiomas of bone may be discovered at any age, but they are more commonly found in the fourth to sixth decade of life. They are twice as common among women as among men, suggesting hormonal influence. Bone hemangiomas are asymptomatic lesions discovered incidentally on imaging or postmorten examination. Occasionally, they may cause pain and swelling.

Hemangiomas of the skull, like the other osseous hemangiomas, are often asymptomatic lesions. Hemangiomas account for 10% of benign skull tumors.

The plain film and the CT findings in hemangioma of the skull can be quite specific. Calvarial hemangiomas are usually solitary, round, osteolytic lesion that may demonstrate the characteristic sunburst, radiating spoke-wheel, and or weblike or honeycomb pattern of trabecular thickening, with a sclerotic rim. In some cases, the lesion may be expansile, enlarging the diploic space.

Computed tomography (CT) after contrast infusion will demonstrate enhancement of the hemangiomas as the blood-filled spaces opacify. In magnetic resonance (MR) studies of hemangiomas, signal is usually increased on T1 and T2, with gadolinium enhancement owing to the vascularity of these lesions.

Angiography may occasionally be perfomed in conjunction with embolization of symptomatic hemangiomas prior to surgery.

Mostly, skull hemangiomas usually remains asymptomatic, require no treatment, and have no signficant sequelae.

 

References:

1. Reeder, MM; Felson B. Gamuts in Radiology. 1st ed. Audiovisual Radiology of Cincinnati, Inc. Cincinnati, Ohio. 1975.

2. Putman, CE. Textbook of Diagnostic Imaging. 1st ed. W. B. Saunders Company. Philadelphia, PA. 1998.

3. Osborn, AG. Diagnostic Neuroradiology. 1st ed. Mosby - Year Book, Inc. St. Louis, MO. 1994.

4. Katz, DA; Damron, TA. Hemangioma. http://emedicine.medscape.com/article/1255694   . Nov 17, 2008.

5. Chasi, I; Hide, G. Bone Hemangioma Imaging. http://emedicine.medscape.com/article/390293   . Jun 24, 2009.

6. Jichic, D. Benign Skul Tumors. http://emedicine.medscape.com/article/1155917   . Oct 13, 2009.

Comments:
No comments posted.
Additional Details:

Case Number: 47672912Last Updated: 10-16-2010
Anatomy: Cranium and Contents   Pathology: Neoplasm
Modality: CT, Conventional RadiographAccess Level: Readable by all users
Keywords: hemangioma of the skullACR: 11.3141

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.