J Korean Med Sci.  2007 Jun;22(3):580-582. 10.3346/jkms.2007.22.3.580.

Intramuscular Hemangioma Mimicking Myofascial Pain Syndrome: A Case Report

• Kim DH
• Hwang M
• Kang YK
• Kim IJ
• Park YK

• KMID: 1778377
• DOI: http://doi.org/10.3346/jkms.2007.22.3.580

Abstract

Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.

Keyword

Hemangioma; Intramuscular; Calf; Pain; Myofacial Pain Syndrome

MeSH Terms

Adult
Diagnosis, Differential
Female
Hemangioma/*diagnosis
Humans
Magnetic Resonance Imaging/methods
Muscle, Skeletal/anatomy & histology/pathology
Muscular Diseases/*diagnosis
Myofascial Pain Syndromes/*diagnosis
Pain
Radiography/methods
Time Factors

Figure

• 

  Fig. 1 Pain drawing shows a referred pain pattern of medial gastrocnemius or soleus muscle.

• 

  Fig. 2 (A) Plain radiography of the left leg shows several focal round calcifications within the muscles. (B) Femoral angiography reveals faint tissue staining and puddlings with early venous drainage that suggest vascular malformation on the left calf. (C, D) Sagittal and axial views of magnetic resonance image shows findings consistent with an intramuscular hemangioma involving the medial potion of the soleus muscle.

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  Fig. 3 Photomicrograph of specimen shows dilated thin-walled blood vessels (arrowhead) and an adipocytic component (arrow) (H&E, ×100).

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