Intramuscular haemangioma is a rare entity accounting for 0.8% of all haemangiomas

2. Hemangioma
• The term “haemangioma” is commonly misused to
describe any type of vascular abnormality, including
vascular malformation.
• Hassanein et al. revealed in a study that the term was
incorrectly used in 71.3% of publications on the
PubMed database.
• Haemangiomas are hamartomas or developmental
anomalies in which natural cells (in contrast to
neoplasms) are present in abnormal numbers.

3. Definition
A benign skin lesion consisting of dense, usually
elevated masses of dilated blood vessels.

4. The most common benign soft tissue tumour of
infancy and childhood comprising 7% of all soft
tissue tumours.
The etiology is unclear but possibly congenital in
origin

5. • Blood vessels are tubes of endothelial cells
surrounded by layers of smooth muscle cells
and connective tissue proteins, which develop
as a result of biochemical signals between the
two.
• Sometimes this communication fails and
abnormal blood vessels form
Blood Vessel Formation

6. Types of Hemangiomas
• Strawberry Hemangioma
• Cavernous (Deep) Hemangioma
• Compound Hemangioma

7. Strawberry Hemangioma
• strawberry red mark
found on 1 out of 10
babies
• consists of small
closely packed blood
vessels
• 95% disappear by the
time the child is 10
years old

8. Cavernous (Deep) Hemangioma
• deeply situated red-blue
spongy mass of tissue
filled with blood
• grows rapidly in the first
six months of age
• composed of larger, more
mature vascular
elements
• some of these lesions
disappear on their own

9. Consider Treatment
• Treatment should be
considered if the
hemangioma….
• ulcerates
• bleeds
• causes functional impairment
• causes infection
• grows rapidly and
uncontrollably
• causes psychological problems

10. Treatments of Hemangiomas
Medical
• steroid injection
• interferon alfa-2a
Surgical
• resection
• laser

11. Intramuscular haemangioma

12. Demography
 Intramuscular haemangioma is a rare entity
accounting for 0.8% of all haemangiomas.
 85% of cases having occurred under the age of 30
years,
 30% are seen in lower extremities with quadriceps
being the most common muscle involved.
 Females are slightly more affected

13. Etiology
 Often linked to trauma but much data exists
suggesting a congenital origin.
 90% of these lesions are misdiagnosed
- often deep seated
- extremely variable in size and
consistency.
 progressively enlarge but never metastasize

14. Clinical Features
 Swelling and pain,
 History of trauma (17%)
 Noncompressible mass without bruit
 Bluish discoloration of overlying skin and superficial
dilated veins.
 Restriction of joint motion.
 Aspiration of the mass yields blood (confused with
hematoma in the presence of history of trauma)

15. Complications of the haemangioma
Functional impairment,
Skin necrosis of the overlying skin,
Bone erosion,
Entrapment of vessels and nerves,
Cardiac failure,
Thrombocytopenia, and
Consumptive coagulopathy (Kasabach-Merritt syndrome)

16. Investigation

17. Plain radiographs
May appear only as a non-specific soft tissue mass
Shows phlebolith in 25–30% of cases.
Periosteal reaction adjacent to the haemangioma
may mimic osteomylitis or bone tumour.
Ultrasonograms
reveal complex hypoechoic mass and if
phleboliths are present,
acoustic shadowing may also be documented.

18. MRI
- is very promising investigation
- helps in diagnosing and defining the location and extent.
Angiography if MRI has not provided sufficient information
about the relationship between the tumour and a neurovascular
bundle.

19. Treatment

20. I. Complete surgical excision of the tumor with a
surrounding margin of the normal muscle.
17–20% of local recurrence rate reported in the literature which is due to
inadequate primary surgical excision rather than histological subtype.
II. Compression sclerotherapy using sclerosing
agents- ethanol, polidocanol, hypertonic saline, and sodium
morrhuate
III. Radiotherapy
IV. Embolization,
V. Laser ablation

21. Literature Review

23. • Abstract
• Haemangiomas are one of the most common soft tissue tumours comprising
7% of all benign tumours. Vascular malformations are often confused with
haemangiomas. The etiology is unknown. They are common in infancy and
childhood and females are more commonly affected. These tumours may be
superficial or deep, and deeply seated lesions, are difficult to diagnose
clinically and hence require radiographic assessment. Deep-seated
haemangiomas are usually intramuscular, although intra-articular synovial
haemangiomas also occur. The commonest anatomic site is the lower limb.
• Despite their vascular origin, haemangiomas do not metastasize or undergo
malignant transformation. Many treatment modalities for the symptomatic
haemangioma are available but surgical excision is the preferred treatment.
We present an unusual case of a dumb-bell intramuscular haemangioma
involving the triceps and extending into the cubital tunnel of the elbow,
distinguish between haemangiomas and vascular malformations and
emphasize the importance of surgical technique in ensuring ulnar nerve
safety.
• Keywords: Cavernous haemangioma, Haemangioma, Triceps, Intramuscular
haemangioma

25. • Abstract
• Haemangioma is a common benign soft tissue tumour. Intramuscular
haemangiomas may present as a perceived sporting injury. Magnetic resonance
imaging is the investigation of choice. Intramuscular haemangioma should be
considered in the differential diagnosis of unexplained pain and swelling in a
muscle.
• Haemangiomas are common benign soft tissue tumours, comprising 7–10% of all
soft tissue tumours.1 Cutaneous haemangiomas, the most common,1 are usually
found in childhood. Intramuscular haemangiomas may present later in life as a
cause of persistent symptoms and may present as a perceived sporting injury.
Diagnostic ultrasound is an appropriate initial imaging modality for suspected
haemangioma, although magnetic resonance imaging is the investigation of
choice. Intramuscular haemangioma should be considered in the differential
diagnosis of unexplained pain and swelling in a muscle.

27. • Abstract
• Skeletal muscle haemangiomas are uncommon soft tissue tumors; more
than 90% are misdiagnosed initially. They present as chronic pain and
swelling in a muscle with or without a history of trauma. Plain X-rays, bone
scans, computerized tomography (CT) studies, and angiography studies may
not always be specific for this tumor. Diagnostic ultrasound is an appropriate
initial imaging modality for suspected haemangioma, although magnetic
resonance imaging is the investigation of choice. Many treatment modalities
for the symptomatic haemangiomas are available of which surgical excision is
the most preferred.
• We present an unusual case of pain, swelling, and restriction of movements in
the right knee following an episode of trauma in a 12-year-old boy who was
being followed for 1 year by a general practioner and later referred to us. The
patient was diagnosed to have intramuscular cavernous haemangioma in the
vastus medialis by us for which he was treated by surgical excision and
followed for 1 year and found to have no recurrence. The clinical features,
radiological picture, pathological histology, diagnostic tools, and treatment
options have been discussed.

29. • Intramuscular haemangioma is a rare entity.
• Differential diagnosis of pain and swelling in a
muscle includes intramuscular haemangioma
• Ultrasound can diagnose the lesion but may not be
able to delineate its extent
• The treatment of choice is total excision
• Sclerotherapy has a role in the management of
intramuscular haemangioma when excision is not
possible.

30. Thank you