Intraosseous hemangioma - calvarial

Discussion:

Intraosseous hemangioma accounts for about 0.7% of all bone tumors. It is considered as a rare bone tumor. It can present at any age; however, it is commonly seen between fourth and fifth decades. 1 The cause is unknown; it could be congenital or traumatic. 2

Patients may present with slow-growing palpable hard mass as in our case with mild tenderness. Neurological deficit is uncommon as mass grows externally rather than internally. 3

Radiologically interosseous hemangioma presents as an osteolytic lesion. CT is the modality of choice to check interosseous extent and soft tissue involvement; however, it is difficult to make definitive diagnosis radiologically only, as many differential diagnoses may be raised like Langerhans cell histiocytosis, osteoma and fibrous dysplasia. 4

In CT fibrous dysplasia will show ground glass appearance which may help to differentiate between it and interosseous hemangioma which will show thickened trabeculae with a sunburst pattern.

Treatment of choice is en bloc resection with a safe margin of normal bone. Other therapies like embolization, curettage and radiotherapy may help.4

Special thanks to Dr Tamer Ibrahim ElHoliby.

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