Elbawab Hatem, Alreshaid Farouk, Hashem Tariq, Alnasser Asayil, Husain Raja, Aljehani Yasser
Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Division of General Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Int J Surg Case Rep. 2019;60:319-322. doi: 10.1016/j.ijscr.2019.06.026. Epub 2019 Jun 20.
Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence.
A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5×4×5.6cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma.
Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas.
Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence.
肋间血管瘤是一种极为罕见的疾病。将肋间血管瘤与其他胸壁肿瘤区分开来很困难。术前诊断的困难可能导致手术切除不完全，从而导致高复发率。
一名14岁男孩，右侧胸壁出现无症状肿块，无外伤史。采用了不同的影像学检查方法进行诊断，包括计算机断层扫描（CT）显示一个大小为6.5×4×5.6cm的软组织肿块，紧贴第5和第6肋骨。磁共振成像（MRI）显示在T1加权像上呈等信号，在T2加权像上呈高信号，高于右胸壁下外侧相邻肌肉的信号，这与肋间血管瘤相符。患者接受了肿块切除术。通过右后外侧开胸手术，发现一个边界清晰的肿块，紧贴第5和第6肋骨，占据右第5肋间间隙。组织病理学检查确诊为肋间血管瘤。
胸壁血管瘤并不常见，大多起源于胸廓外。血管瘤很少发生在肋间间隙，其中大多数起源于肋间肌肉（Agarwal等人，2006年）。Watson和McCarthy提出了两种血管瘤病因理论。得到更广泛支持的理论认为血管瘤是先天性起源。另一种理论提出血管瘤起源于创伤。
为防止复发，不应因胸壁缺损而影响手术完全切除。
