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  • Capillary hemangioma
  • Cavernous hemangioma
  • Arteriovenous hemangioma
  • Venous hemangioma
  • Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia)
  • Pyogenic granuloma (granulation tissue type capillary hemangioma)
  • Intramuscular hemangioma
  • Synovial hemangioma
  • Hemangioma of peripheral nerve (perineural hemangioma)
  • Angiomatosis


  • The most common tumor of childhood


  • 7% of all benign tumors, the most common tumor in infancy and childhood; may present as a painless mass, variation in size
  • 60% of synovial hemangiomas occur in the knee
    • Swelling and joint pain
    • Limitation of motion reported in hip location
    • Spontaneous hemarthrosis/monarthritis in children and adolescents
  • Overlying skin discoloration may be present
  • May become clinically apparent during pregnancy
  • Pulsatile or audible bruit rarely
  • Tender, spongy mass that may decrease in size with palpation or elevation
  • Contractures have been reported
  • Bilateral 1st dorsal compartment hemangiomas reported causing bilateral deQuervain's stenosing tenosynovitis
  • Locking of a MCPJ by a volar plate hemangioma reported
  • Neuropathies have been reported: PIN, ulnar nerve at the cubital tunnel
    • FDP flexor sheath location reported as a cause of CTS
  • Unusual location


  • Mineralization types
  • Phleboliths (49%) (on radiographs or CT)
  • Nonspecific amorphous or curvilinear
  • Metaplastic ossification
  • ± cortical erosions or sclerosis in long-standing lesions
  • LLD has been reported
  • MRIreveals worrisome indistinct margins; MRA diagnostic
    • T1-weighted images reveal poorly marginated mass isointense with muscle
      • Some areas isointense with fat can be seen
    • T2-weighted images show marked ? signal
    • Serpiginous regions
    • Robust contrast enhancement
    • ± effusion in joint locations
  • High flow signal, vascular channels
  • The combination of lobulation, septation, and central low-signal-intensity dots (not seen on gadolinium-enhanced images) on MRI specific for hemangioma


  • Tortuous blood vessels within subcutaneous or muscular tissues


  • Depends on type, but with a myriad of dilatedvessels with plump nuclei within the cells
    • Cavernous
    • Lobular capillary
    • Arteriovenous
    • Venous
  • EM:
    • Weibel-Palade bodies


  • Soft tissue sarcomas, esp angiosarcoma
  • Vascular malformation
  • Intravascular papillary endothelial hyperplasia
  • Hemangioendothelioma
  • Hemangiopericytoma
  • Kaposi's sarcoma
  • PVNS or synovial chondromatosis in the joint location
  • Synovial sarcoma


  • Observation in asymptomatic pts after adequate bx
  • Intramuscular hemangiomas must be suspected prior to bx or bleeding may be a problem
  • Large unresectable hemangioma tx is controversial
  • Percutaneous embolization may require several txs
  • LR often because of incomplete excision





    • Thrombocytopenia purpura associated usually with a cavernous hemangioma of an extremity and trauma such as a femoral fx
    • Surgery can be complicated by bleeding due to platelet consumption from sequestration in sinusoids, secondary fibrinolysis, hypofibrinogenemia, ? fibrin split products, and DIC
    • Resuscitation includes FFP, cryoprecipitate, platelets
    • Right posterior triangle kaposiform hemangiomaextending to skull base resulting in respiratory compromise and spinal cord compression in an infant reported
      • Corticosteroids, medical managment, embolization and vincristine reported 
    • Hematology consultation!

    • Multiple hemangiomas and enchondromas with a high rate of malignant degeneration of either type lesion

    • Gigantism (bone and soft tissue hypertrophy with LLD), massive cavernous hemangiomas and varicosities (laterally in a 'lumbar-to-foot' pattern)
    • (Also at risk for Wilms' tumor)
    • High output cardiac failure can occur necessitating tx
    • Total circulatory arrest in infants for surgical resection has been described
    • May require amputation for functional or cosmetic reasons (pre-prosthetic consultations)
    • Thrombophlebitis, DVT/PE
    • 95% LE, 85% unilateral

    • Pure epidural lesion rare
    • Low to intermediate signal on T1-weighted and high signal on T2-weighted and proton density images
    • Laminectomy and microsurgical resection when symptomatically indicated


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