Intrasellar Cavernous Hemangioma: MRI Findings of a Very Rare Lesion
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Intrasellar cavernous hemangioma is an extremely rare lesion. It is usually confused with pituitary adenoma, both clinically and radiologically. It is important to differentiate intrasellar cavernous hemangioma from pituitary tumors because of the risk of severe hemorrhage during operation and the possible complications in the postoperative period. Magnetic resonance imaging characteristics of the lesion may be helpful in differential diagnosis. In this report, we present the magnetic resonance imaging findings of a cavernous hemangioma case, which is totally intrasellar located. J Med Cases. 2013;4(11):719-721 doi: https://doi.org/10.4021/jmc1485w: Uterine cavernous hemangioma is a rare vascular tumor that is more commonly reported as an acquired disease in pregnant women. Rarity of the case impeded the radiologist to be able to find characteristic imaging findings to diagnose the disease before surgery. We report a 40-year-old premenopausal woman with cavernous hemangioma of the uterus that was misdiagnosed as a low-grade sarcoma because of the non- typical imaging feature of this pathology that has not been reported before. The ultrasound exam of the patient only demonstrated global enlargement of the myometrium. Magnetic resonance imaging (MRI) showed diffuse myometrial edema with multiple linear low signal strands, without endometrial involvement and with mild restriction in diffusion-weighted imaging (DWI) that resulted in a lobulated border of uterine contour. MRI could be a helpful imaging modality for proper diagnosis of uterine hemangioma before surgery.
Myometrium
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Objective To investigate the value of CT and MRI in the diagnosis of intracranial cavernous hemangioma.Materials and Methods 22 cases of intracranial cavernous hemangioma confirmed with pathology were analyzed. 21 cases were intraaxial lesions, 1 case were dural cavernous hemangiomas in middle fossa. 10 cases were underwent with CT scan, 16 cases with MRI examination,13 cases with MRA examination.Results The lesion of intracerebral cavernous hemangioma could be located in every region of the brain, which single lesion was more often and most lesions had no or slightly edema without space-occupying effect. Slight hyperdensity mass were appeared in plain CT scan, and calcification were seen in 72.7% of the mass,the most of them were shown without enhancement. The characteristic MRI features were multiberry-like inhomogenous intensity with flocculent hypointensity ring. No enhencement could be seen. There were normal appearance in MRA. Extraaxial cavernous hemangioma were located in the middle fossa and parasellar, which had dumb-bell shape, and homogenous slight hypointensity on T 1WI and hyperintensity on T 2WI images with markedly enhancement.Conclusion The MRI findings of intracerebral cavernous hemangioma are specific, combined with CT and MRA could make a correct diagnosis. Misdiagnosis of dural cavernous hemangiomas is often to be done,so we should take the possible diagnosis of dural cavernous hemangiomas into account when the CT and MR image features of tumors are similar to meningioma which located in the middle fossa.
Middle cranial fossa
Cavernous hemangiomas
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Intracranial extra-axial cavernous hemangioma of the cavernous sinus is a very rare vascular malformation. It usually appears as a round non-encapsulated mass with well-defined borders, mimicking meningioma. We describe a case of cavernous hemangioma of the cavernous sinus, including the radiologic imaging findings, and also review the literature.
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Neuroradiology
Anterior mediastinum
Vascular Tumors
Vascular malformation
Angioma
Mediastinal tumor
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The authors reviewed nine orbital cavernous hemangioma patients and a retrospectively selected group of patients with simulating lesions. Most surgical procedures were performed because of either, decreased vision or proptosis. They have observed one bilateral orbital cavernous hemangioma. Neither MRI nor CT can correctly differentiate some simulating lesions from cavernous hemangioma.
Cavernous hemangiomas
Orbit (dynamics)
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Extracerebral cavernous hemangioma typically occurs in cavernous sinus in middle cranial fossa,showing iso-or hypointensity on T1WI,obvious hyperintensity on T2WI,and evident enhancement after contrast administration during magnetic resonance imaging(MRI).In this article we report one case of atypical cavernous hemangioma of the trigeminal nerve,with atypical MRI findings including isotense or slight long T2 signal,dotty short T1 signal,and non-enhancement on T1WI.
Trigeminal Nerve
Middle cranial fossa
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A 55-year-old woman presented with multiple calvarial cavernous hemangiomas manifesting as right frontal swelling. Craniography and computed tomography showed an osteolytic lesion. Magnetic resonance imaging demonstrated multiple intraosseous lesions, and radioisotope bone scintigraphy identified even more numerous lesions. Total resection of the right frontal lesion and cranioplasty was performed. Histological examination confirmed the lesion as a cavernous hemangioma. Computed tomography of the abdomen revealed multiple hepatic lesions, which might be cavernous hemangiomas. Cavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. A patient with multiple cavernous hemangiomas should undergo systemic examination to look for latent lesions, and regular follow-up examinations.
Cavernous hemangiomas
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To analyze extracerebral cavernous malformation located in the cavernous sinus and correlate their magnetic resonance imaging (MRI) features to pathological findings.Nineteen patients (5 men and 14 women; mean age, 50.6 years; range, 32-71 years) with surgically verified cavernous malformations in the cavernous sinus were reviewed. MRI including T1-weighted, T2-weighted, and postcontrasted T1-weighted imaging was carried out in all instances with a 1.5-T superconductive system (Signa; General Electric Medical Systems, Milwaukee, WI).All these lesions measured from 2.5 cm to 6 cm (average, 4.3 cm) with 13 lesions located to the right side and 6 to the left side. Magnetic resonance images showed that 18 cases were hypointense to white matter on T1-weighted images with only one case showed mixed hypointensity and hyperintensity. On T2-weighted images, 17 cases showed marked homogeneous hyperintensity, 1 case showed marked hyperintensity with some signal void structures and 1 with mixed intensity. Marked homogeneous enhancement after contrast material administration was found in 7 cases, and the remaining 12 showed marked heterogeneous enhancement. Pathologically, these lesions can be classified as type A, type B, and type C. Type A was sponge-like with intact pseudocapsule; type B was mulberry-like with the pseudocapsule incomplete or absent; and type C was composed of both mulberry-like composition and sponge-like composition. Lesions with homogeneous contrast enhancement on MRI correlated with type A pathological findings, whereas those with heterogeneous enhancement correlated with type B and type C pathological findings. Asymmetrical dumbbell-shaped masses of 13 cases involving the sellar and round masses of 6 cases with 2 protruding into the sellar were found. All of the cavernous malformations displaced the adjacent temporal lobe without adjacent brain edema. The internal carotid arteries were displaced or encased in all cases.If a well-demarcated, homogeneous high signal intensity lesion on T2-weighted images with a dumbbell configuration involving both parasellar and sellar regions with marked heterogeneous or homogeneous enhancement is found, the diagnosis of cavernous sinus cavernous malformation should be entertained.
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Objective:To analyze the MR findings of intracranial cavernous hemangioma combined with pathologic features.Methods:53 cases of intracranial cavernous hemangioma were collected and studied.Among them,40 cases were intracerebral cavernous hemangiomas and 13 cases were extracerebral cavernous hemangioma.All the cases were examined by MRI.Results:Intracerebral cavernous hemangiomas generally showed popcorn-and mulberry-like mixed signals with ring-like low signal on MRI;Extracerebral cavernous hemangiomas showed homogenous low signal on T1WI and high intense signal on T2WI.After injecting contrast medium,the tumor signals were enhanced markedly.Conclusion:The different types intracranial cavernous hemangiomas have different pathologic features that result in different MR findings,leading to different operation plans and prognosis.As a result,the intracranial cavernous hemangioma can be diagnosed correctly by MR before operation which guides the operation plan.
Cavernous hemangiomas
Capillary hemangioma
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