Cavernous Hemangioma of the Ilium Mimicking Aggressive Malignant Bone Tumor with Increased Activity on¹⁸F-FDG PET/CT

Abstract

Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (

Giant vertebral hemangioma masquerading as aggressive tumor: Tc-99m tagged RBC scan can help to solve the diagnostic conundrum!

“…F-18 FDG-PET/CT is increasingly used to differentiate osseous hemangiomas from malignant lesions based on the evidence that hemangiomas most frequently do not show increased radiotracer uptake [8], [9], [10]. However, some reports showed increased FDG uptake particularly in large hemangiomas [11], [12]. This may be attributed to internal hemorrhage and inflammation in such large lesions [11].…”

Benign osseous and articular abnormalities of the pelvis: a review of CT imaging findings

“…They account for 2% of all benign osseous lesions and 0.8% of all osseous lesions overall [50]. While vertebral hemangiomas demonstrate a pathognomonic "polka dot" pattern of calcifications on CT, hemangiomas of the bony pelvis exhibit a wider range of CT appearances [49]. Larger pelvic intraosseous hemangiomas are characterized by expansile low attenuation lesions with coarsened trabecula and scattered "polka dot" pattern calcifications (Fig.…”

“…Intraosseous hemangiomas are benign vascular neoplasms that are most frequently found in the skull and spine [49]. They account for 2% of all benign osseous lesions and 0.8% of all osseous lesions overall [50].…”

F-18 fluorodeoxyglucose positron emission tomography for differential diagnosis and prognosis prediction of vascular tumors

“…Regarding FDG-PET, there have been certain case reports describing incidental lesions with the presence or absence of FDG uptake ( 14 ). Additionally, the degree of FDG uptake in HEM ranges from mild to moderate across the literature ( 15 , 16 ).…”