Intramuscular hemangioma within the biceps brachii causing the limitations of elbow extension and forearm pronation

Abstract

Rationale: Intramuscular hemangiomas are rare benign vascular neoplasms, merely accounting for 0.8% of all hemangiomas. Moreover, there are few case reports of intramuscular hemangiomas in the upper extremities. Patient concerns: A 24-year-old male patient presented with a 5-year history of intermittent pain of the right elbow joint. He had observed a swelling of the right cubital fossa over the past 2 years, leading to the limitations of elbow extension and forearm pronation. Diagnosis: The patient was diagnosed with intramuscular hemangioma of the biceps brachii. Interventions: Surgical excision of the tumor was performed for this patient and postoperative early functional exercises were permitted. Outcomes: The movements of the right elbow and forearm reached the normal range of motion at 5 weeks after surgery. There was no evidence of recurrence during the 5-month follow-up. Lessons: Optimal management of intramuscular hemangioma is critical, including precise evaluation, good microsurgical technique and early functional exercises, which may result in a satisfying outcome.

Hemangioma intramuscular: Uma causa rara de Omalgia

“…This intravascular procedure through the use of sclerosing agents that cause vascular thrombosis and endothelial damage, leading to endofibrosis and vascular obliteration, allow in many cases a complete regression of these tumors. 1,3,9,10 Another form of treatment consists in combining surgery with embolization 2 to 3 days before the surgical procedure, which is used in more complex, infiltrative and recurrent lesions. 5 Despite the low frequency of this clinical entity, it is important to place it as a diagnostic hypothesis in cases of chronic pain and limitation of limbs movements of in young patients with poor therapeutic response to antiinflammatory drugs and analgesia.…”

Intramuscular cavernous haemangioma of the triceps brachii: a rare tumour with good prognosis

“…2 Other differential diagnoses of intramuscular hemangiomata like arterio-venous vascular malformations and malignant intramuscular tumours such as sarcomas which can lead to diagnostic dilemmas can be reliably distinguished by MRI which is now considered to be the gold standard. 1,7,9,12 Additionally, MRI can also help in distinguishing these vascular tumours, cavernous hemangiomas can be seen as tumours with large cystic spaces, arteriovenous hemangiomas will show fast flow serpentine vessels, and venous hemangiomas will reveal slow flow serpentine vessels. MRI angiography can be considered if there are symptoms of neurovascular compression.…”

“…The indications for surgery are severe, unremitting pain, cosmetic deformities, distal neurovascular compression, local pressure effects leading skin necrosis, bony/muscular pain, restricted mobility and suspicion of malignancy. 7,12 Hence the treatment of choice for these tumours is surgery. 1,12 If the tumour is excised completely then chances of recurrence are minimal, sometimes complete excision may entail sacrifice of critical encased structures such as nerves, blood vessels or as in this case the lateral head of triceps had to be sacrificed, hence proper preoperative documentation, imaging work-up and patient consent before surgery is vital to avoid litigation.…”

“…2 For complex, high risk and infiltrative lesions, treatment modalities include -sclerotherapy, embolization followed by surgery, embolization alone, radiotherapy and corticosteroids. [11][12][13][14] Embolization is an effective treatment strategy, mainly used before surgery to decrease the vascularity of the tumour, hence decreasing blood loss and it can also be used to control pain and decrease the chances of recurrence following excision. However, for embolization to be effective, it must be combined with surgery, and the tumour is usually embolized 2-3 days before surgery.…”

“…However, for embolization to be effective, it must be combined with surgery, and the tumour is usually embolized 2-3 days before surgery. 1,[11][12][13][14] Other treatment options reported but not used frequently, include radium therapy, topical agents (carbon dioxide snow), cryosurgery, and arterial ligation, but these are fraught with uncertainties and recurrence is common following this modalities. 1…”