A Rare Clinical Report of Intramuscular Hemangioma of the Middle Scalene Muscle

Intramuscular hemangioma (IMH) is an uncommon benign vascular lesion, which develops in skeletal muscles and it accounts for <1% of all hemangiomas. The accurate diagnosis is often difficult because the clinical and radiological findings are not specific. The gold standard treatment of IMH is surgical resection. We present a rare clinical report of IMH of the middle scalene muscle that was treated successfully with preoparative embolization and surgicalexcision.

A 26-year-old man was referred to our ear, nose, and throat (ENT) department with a 4-year history of a right-sided growing neck mass. This mass was firstly observed in childhood. It started growing up suddenly after intense weight training 4 years ago. The mass was treated with a partial excision which was performed in another hospital. There were no preoperative radiological images and there was no clinical suspicion of IMH. The mass was partially resected due to the bleeding, which was controlled by bipolar diathermy. The histopathological diagnosis was IMH. The patient had a family history of hemangiomas, from his mother’s side. When the patient presented to our department, he had functional disabilities, such as difficulty in head movements and swallowing. Moreover, the mass was huge, painless, mobile and was located in the posterior cervical triangle. No other hemangioma was revealed at any other location in patient’s body from the clinical examination.Magnetic resonance imaging (MRI) revealed a hypervascular mass (12.4 cm × 9.6 cm × 8.9 cm), with hypointense signal void on T1-weighted images and hyperintense signal void on T2-weighted images, with close relationship with the middle scalene muscle fibers Computed tomography angiography (CTA) demonstrated that the mass was fed by branches of the right thyrocervical and costocervical trunks. Digital subtraction angiography (DSA) and tumor embolization were performed 2 days before the complete surgical resection Ιntraoperatively, the tumor was found that was arising from the middle scalene muscle. The postoperative and the 5-month follow-up period were without complications or recurrence of IMH. Histopathological examination confirmed the diagnosis of IMH

Author(s): Konstantinos Garefis

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