J Korean Soc Radiol.  2015 Dec;73(6):403-407. 10.3348/jksr.2015.73.6.403.

Epiphyseal Hemangioma of the Humeral Head: Imaging Findings and Literature Review

• Yang WJ
• Jin W
• Chun YS
• Kim GY
• Park SY
• Park JS
• Ryu KN

• KMID: 2130947
• DOI: http://doi.org/10.3348/jksr.2015.73.6.403

Abstract

We describe a case of an epiphyseal hemangioma in the humeral head of a 20-year-old man. On plain radiographs, the lesion showed no gross abnormality. The computed tomography images demonstrated the presence of an irregular and lobulating osteolytic lesion with a peripheral sclerotic rim and focal cortical defects. The magnetic resonance images showed an ill-defined low signal intensity on T1-weighted images and mixed low and high signal intensities on T2-weighted images. Additionally, ill-defined marrow enhancement with inner low signal lines was noted in this lesion. The patient was treated with curettage and a bone chip graft. The present case is instructive in the differential diagnosis of epiphyseal bone tumors; furthermore, the possibility of an intraosseous hemangioma should also be considered.

MeSH Terms

Bone Marrow
Curettage
Diagnosis, Differential
Epiphyses
Hemangioma*
Humans
Humeral Head*
Humerus
Magnetic Resonance Imaging
Transplants
Young Adult

Figure

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  Fig. 1 An anteroposterior radiograph of the right shoulder shows no gross abnormalities in the humeral head.

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  Fig. 2 CT scans show an irregular and lobulating osteolytic lesion with a peripheral sclerotic rim and thickened internal trabeculae (arrow). On coronal reformatted images, a focal cortical defect (arrow) is suggested.

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  Fig. 3 Magnetic resonance images show irregular low signal intensity on T1-weighted images (A, arrow; T1WI; axial plane; TR/TE, 600/20 ms), mixed low and high signal intensities on T2-weighted images (B, arrow; T2WI; coronal plane; TR/TE, 4400/80 ms) and inhomogeneous enhancement on gadolinium-enhanced fat-suppressed T1WI (C, arrow; CE-FS T1WI; axial plane; TR/TE, 670/20 ms). In addition, inner and peripheral low signal lines in this lesion are demonstrated on all MR sequences. CE-FS = contrast-enhanced fat-suppressed, TE = echo time, TR = repetition time

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  Fig. 4 A photomicrograph (A) of an intraosseous hemangioma reveals numerous vascular channels (arrows) of various sizes and shapes. The irregular architecture of the thickened bony trabeculae (T) is noted (hematoxylin and eosin staining, original magnification, × 40). Immunostaining for factor VIII (B) shows vascular channels of a variety of shapes and sizes (arrows), lined by endothelial cells (polymer method; original magnification, × 200).

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