Thoracoscopic resection of a mediastinal venous hemangioma: Report of a case

Abstract

Mediastinal hemangioma is a rare tumor, accounting for 0.5% or fewer of all mediastinal tumors in most reports. We herein report a case of thoracoscopic resection of venous hemangioma in the middle mediastinum. A 48-year-old man was referred to our hospital for dysphagia. A chest computed tomography scan showed the mass to have a smooth surface and heterogeneous contents. Magnetic resonance imaging demonstrated the morphology of the vascular tumor to be a hyperintense mass on a T2-weighted image. Using thoracoscopic surgery, the tumor was completely extirpated and confirmed histologically to be a venous hemangioma. In this case, thoracoscopic surgery provided a satisfactory view and facilitated correct handling for the mediastinal venous hemangioma.

Surgical Approaches to Non-thyrogenic and Non-thymic Mediastinal Tumors of the Thoracic Inlet

“…In most cases of hemangioma, a definitive preoperative diagnosis is difficult, and because there are no characteristic imaging findings, they may easily be misdiagnosed as neurogenic tumors. 17 In the present series, the patient with the nonresectable hemangioma had a preoperative contrast-enhanced CT scan that showed a smooth, well-demarcated mass with heterogeneous contents (►Fig. 5), and the mass could not be definitively diagnosed as hemangioma until the thoracoscopic examination.…”

About a challenging mediastinal tumor

“…It is often difficult to diagnose hemangioma preoperatively because the lesion manifests as a nonspecific mediastinal mass. 3 Two of our patients were suspected to have a neurinoma preoperatively. This was due to localization in the posterior mediastinum, radiologic features, and to a past history of neurinoma in one patient.…”

“…The presence of calcification poses a challenge in the diagnosis of mediastinal lymphoma, teratoma, and hemangioma. 3 Surgical resection is the mainstay of treatment. Total resection is recommended when possible.…”

“…Computed tomography (CT) was performed in 3 patients (nos. 3,4,5) and revealed a mediastinal mass in all cases, which was adherent to the right atrial cavity in case no. 3, with extension to the sixth dorsal vertebra in case no.…”

Venous hemangioma of the anterior mediastinum

“…Because symptoms and radiological findings are usually nonspecific, preoperative precise diagnosis of mediastinal hemangiomas is difficult. Although computed tomography scan and magnetic resonance imaging of the thorax may be useful for diagnosis, characteristic findings of them are poor . It was reported that preoperative diagnosis was correct in only 2 of 61 cases .…”