Korean J Radiol.  2012 Jun;13(3):350-354. 10.3348/kjr.2012.13.3.350.

Recurrent Pulmonary Capillary Hemangioma: Dynamic Contrast-Enhanced CT and Histopathologic Findings

• Kim EY
• Kim TS
• Han J
• Kim H
• Choi YS

• KMID: 1372856
• DOI: http://doi.org/10.3348/kjr.2012.13.3.350

Abstract

We report the dynamic contrast-enhanced CT and histopathologic findings of a rare case of recurrent pulmonary capillary hemangiomas. The findings consisted of peripheral nodular enhancement at the early arterial phase and a subsequent "central filling-in" enhancement pattern on the delayed scans, which was identical to the well-known enhancement pattern of hemangiomas of the liver. Although there was no evidence of histological malignancy, pulmonary capillary hemangiomas manifested as multiple nodular lesions and showed postoperative recurrence.

Keyword

Hemangioma; Lung neoplasms; Tomography; X-ray computed

MeSH Terms

Contrast Media/diagnostic use
Diagnosis, Differential
Female
Hemangioma, Capillary/pathology/*radiography/surgery
Humans
Iopamidol/diagnostic use
Lung/*blood supply
Lung Neoplasms/pathology/*radiography/surgery
Recurrence
Tomography, X-Ray Computed/*methods
Young Adult

Figure

• 

  Fig. 1 Pulmonary capillary hemangiomas in 22-year-old female. Initial multi-phase dymamic CT scan obtained at outside hospital shows two pulmonary nodules in left lung. Dynamic postcontrast CT scans (B-D) show peripheral nodular enhancement in early phase CT (B) and "central filling-in" enhancement pattern of theses nodules in subsequent delayed images (C, D), which are identical to well-known enhancement pattern of hepatic hemangiomas (A: precontrast image, B: obtained 1 minute after contrast enhancement, C: 2 minutes, D: 4 minutes). Wedge resection of these left pulmonary nodules was performed at outside hospital, and review of pathologic specimen revealed pulmonary capillary hemangiomas. Initial multi-phase dynamic CT scan obtained at outside hospital shows two pulmonary nodules in left lung. E. Fifty months after tumor removal, chest CT scan obtained from our institution shows 30-mm, recurrent pulmonary nodule in left lower lobe. Another smaller nodule is also detected in right lower lobe (not shown here). Nodule in left lower lobe shows prominent "peripheral nodular enhancement" pattern at this post-contrast CT image obtained 40 seconds after contrast administration, which is identical to previous CT finding. F. Scanning photograph of histopathologic specimen obtained from left lower lobectomy shows well-demarcated hemorrhagic nodule containing multiple dilated vascular spaces (arrows), many of which are compactly packed with red blood cells (H and E, ×1). G. Low-power photomicrograph shows that nodule is composed of anastomosing capillary vascular channels filled with red blood cells. These capillary lumina are divided by narrow trabeculae of hyaline stroma (H and E, ×40). These findings are compatible with capillary hemangiomas.

Reference

1. Bowyer JJ, Sheppard M. Capillary haemangioma presenting as a lung pseudocyst. Arch Dis Child. 1990. 65:1162–1164.

2. Galliani CA, Beatty JF, Grosfeld JL. Cavernous hemangioma of the lung in an infant. Pediatr Pathol. 1992. 12:105–111.

3. Abrahams NA, Colby TV, Pearl RH, Chipps BE, Juris AL, Leslie KO. Pulmonary hemangiomas of infancy and childhood: report of two cases and review of the literature. Pediatr Dev Pathol. 2002. 5:283–292.

4. Fugo K, Matsuno Y, Okamoto K, Kusumoto M, Maeshima A, Kaji M, et al. Solitary capillary hemangioma of the lung: report of 2 resected cases detected by high-resolution CT. Am J Surg Pathol. 2006. 30:750–753.

5. Capizzani TR, Patel H, Hines MH, Mott RT, Petty JK. A unique case of a giant congenital pulmonary hemangioma in a newborn. J Pediatr Surg. 2008. 43:574–578.

6. Dinehart SM, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg. 2001. 27:475–485.

7. Sienko A. Danis S, Zander , Farver CF, editors. Pulmonary processes of indeterminate malignant potential. Pulmonary pathology. 2008. Philadelphia, USA: Churchill Livingstone;636–648.

8. Flieder DB. Zander Danis S., Farver CF, editors. Benign Neoplasms of the Lungs. Pulmonary pathology. 2008. Philadelphia, USA: Churchill Livingstone;669–672.

9. Katzenstein AL, Gmelich JT, Carrington CB. Sclerosing hemangioma of the lung: a clinicopathologic study of 51 cases. Am J Surg Pathol. 1980. 4:343–356.

10. Chung MJ, Lee KS, Han J, Sung YM, Chong S, Kwon OJ. Pulmonary sclerosing hemangioma presenting as solitary pulmonary nodule: dynamic CT findings and histopathologic comparisons. AJR Am J Roentgenol. 2006. 187:430–437.