PULMONARY CAVERNOUS HEMANGIOMA
Hemangiomas account for 7% of all benign tumors and are among the most common neoplasms in infants and children, whereas their number in adults is much smaller. They are most commonly seen in the head and neck region and are usually classified based on their clinical appearance and the caliber of the vessels involved.
Cavernous hemangioma, a relatively uncommon variant, is histologically composed of dilated blood-filled spaces supported by scant connective tissue. Although it can occur throughout the body, it rarely occurs as a primary tumor of the lung. To date, approximately 26 cases of pulmonary cavernous hemangioma have been reported. The way in which cavernous hemangiomas present has varied significantly in reported cases. Most cases were identified incidentally on imaging studies for other indications. In the symptomatic cases, the most common symptom was hemoptysis or bloody sputum. Others presented clinically with respiratory distress or cyanosis. While most cavernous hemangiomas are clinically benign, complications such as massive bleeding make recognition of this lesion important in the differential diagnosis of pulmonary masses. These rare tumors can be associated with hereditary telengiectasia and arterio-venous malformations.
Surgery and/or close radiographic follow-up remain the treatment of choice for pulmonary cavernous hemangiomas. The preoperative diagnosis is difficult because pulmonary biopsy is often non-diagnostic as in our case. There is also a risk of bleeding after fine needle or bronchoscopic biopsy. If a tumor is diagnosed as such intraoperatively, wedge resection or enucleation is favored because of its benign behavior.
Other entities to consider in the differential diagnosis considering the patient's age, clinical history, and symptoms include the following.
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Contributed by Isil Z. Yildiz- Aktas, MD and Frank Schneider, MD