Morkan Deniz B, Gauthier Jason M, Kreisel Daniel, Puri Varun, Nava Ruben G
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
AME Case Rep. 2021 Apr 25;5:13. doi: 10.21037/acr-20-144. eCollection 2021.
Rib hemangioma is a rare chest wall tumor for which few reports in the literature exist to help guide treatment. The clinical presentation, radiographic findings, and treatment strategies vary in the literature, with the majority of patients undergoing surgical resection to definitively rule out malignancy. Here, we report a 23-year-old woman with an incidentally discovered rib hemangioma, who had a history of migraines, during the workup of a severe headache refractory to medical treatment. Imaging revealed a solitary, expansile tumor arising from the posterior left third rib. Spinal magnetic resonance imaging (MRI) showed a fat-containing lesion with multiple vascular flow voids, non-enhancement, and high signal intensity on the T2-weighted series. It appeared to have a honeycomb core on chest computed tomography (CT). Imaging characteristics of the lesion were consistent with an intraosseous hemangioma. The tumor was managed with upfront surgical resection without a preoperative biopsy. The case was uneventful and no complications were encountered. The patient recovered well, denied any symptoms four weeks after surgery, and a follow-up chest X-ray was unremarkable. Following resection, the pathological diagnosis was concordant with the radiographic diagnosis of a rib hemangioma. Here, we review existing literature on the rare case of a rib hemangioma with a focus on the radiographic characteristics and management. Given that radiographic features of this lesion were consistent with prior reports and surgery did not change the diagnosis, we suggest that non-operative management be considered for similar lesions, as surgical resection does not appear to reveal occult malignancy in the majority of cases.
肋骨血管瘤是一种罕见的胸壁肿瘤，文献中鲜有报道可用于指导治疗。文献中该肿瘤的临床表现、影像学表现及治疗策略各不相同，大多数患者接受手术切除以明确排除恶性肿瘤。在此，我们报告一名23岁女性，因偏头痛病史在对药物治疗无效的严重头痛进行检查时偶然发现肋骨血管瘤。影像学检查显示一个孤立的、膨胀性肿瘤，起源于左后第三肋骨。脊柱磁共振成像（MRI）显示一个含脂肪的病变，有多个血管流空信号、无强化，在T2加权序列上呈高信号强度。胸部计算机断层扫描（CT）显示其似乎有一个蜂窝状核心。病变的影像学特征与骨内血管瘤一致。该肿瘤通过直接手术切除进行处理，未进行术前活检。手术过程顺利，未出现并发症。患者恢复良好，术后四周否认有任何症状，随访胸部X线检查未见异常。切除术后，病理诊断与肋骨血管瘤的影像学诊断一致。在此，我们回顾了关于肋骨血管瘤这一罕见病例的现有文献，重点关注影像学特征及处理方法。鉴于该病变的影像学特征与先前报道一致，且手术并未改变诊断，我们建议对于类似病变可考虑非手术治疗，因为在大多数情况下手术切除似乎并未发现隐匿性恶性肿瘤。
