J Korean Soc Radiol.  2018 Feb;78(2):115-119. 10.3348/jksr.2018.78.2.115.

Ultrasound and MRI Findings of Intraneural Capillary Hemangioma of the Median Nerve Mimicking Traumatic Neuroma: A Case Report

• Song HB
• Lee YH
• Kang UR
• Lee SM
• Chae SB

• KMID: 2408261
• DOI: http://doi.org/10.3348/jksr.2018.78.2.115

Abstract

Intraneural hemangioma of the median nerve is extremely rare. Only a few cases have been reported in literature. The researchers present ultrasound (US) and MRI findings of a case of 38-year-old-man with intraneural capillary hemangioma of the median nerve. The patient had a small, palpable mass in the volar aspect of the wrist and symptoms of carpal tunnel syndrome. US showed an infiltrative intraneural mass, without significant blood flow despite a compression test. The researchers initially misdiagnosed this mass as an in-continuity neuroma. The mass showed heterogeneous, but predominantly high signal intensity on T2-weighted image, as well as heterogeneous enhancement. The MRI findings were helpful for correct diagnosis on the retrospective review.

MeSH Terms

Capillaries*
Carpal Tunnel Syndrome
Diagnosis
Hemangioma
Hemangioma, Capillary*
Humans
Magnetic Resonance Imaging*
Median Nerve*
Neuroma*
Peripheral Nervous System Neoplasms
Retrospective Studies
Ultrasonography*
Wrist

Figure

• 

  Fig. 1 A 38-year-old-man with intraneural hemangioma of median nerve. A. Long axis combined gray scale and short axis Doppler US images of the median nerve show an infiltrative hypoechoic mass (arrowheads) separating hypoechoic nerve fascicles (arrows). Doppler US image shows no detectable blood flow within the mass. B, C. Axial T2-weighted (B) and T1-weighted (C) show an intraneural mass (arrowheads) separating fascicles of the median nerve (arrows). T1-weighted MR images show a focus of high signal intensity (open arrow), which may represent hemorrhage within the mass. US = ultrasound D. On the sagittal T2-weighted image, the mass (arrowheads) shows heterogeneous but predominantly high signal intensity and has continuity with the long axis of the median nerve (arrows). E. Sagittal contrast-enhanced fat-saturated T1-weighted image shows well heterogeneous enhancement within the mass. F. Intraoperative photograph shows a blue fusiform mass (shown in blue on online figure) in the median nerve.

Reference

1. Vekris MD, Stafilas KS, Zacharis KX, Xenakis TA, Soucacos PN, Beris AE. Intrinsic haemangioma of the median nerve: report of a case and review of the literature. Microsurgery. 2008; 28:89–90.

2. Prosser AJ, Burke FD. Haemangioma of the median nerve associated with Raynaud’s phenomenon. J Hand Surg Br. 1987; 12:227–228.

3. Rousié M, Ledoux P. Intraneural hemangioma: a rare cause of intermittent carpal tunnel syndrome. Chir Main. 2015; 34:322–323.

4. Kerimoglu U, Uzumcugil A, Yilmaz G, Ayvaz M, Leblebicioglu G, Altinok G. Intraneural hemangioma of digital nerve diagnosed with MR imaging. Skeletal Radiol. 2007; 36:157–160.

5. Mestdagh H, Lecomte-Houcke M, Reyford H. Intraneural haemangioma of the posterior tibial nerve. J Bone Joint Surg Br. 1990; 72:323–324.

6. Brand C, Pedro MT, Schick M, Scheuerle A, Scheglmann K, Wirtz CR, et al. [Intraneural hemangioma of the ulnar nerve]. Nervenarzt. 2015; 86:197–201.

7. Woertler K. Tumors and tumor-like lesions of peripheral nerves. Semin Musculoskelet Radiol. 2010; 14:547–558.

8. Depaoli R, Coscia DR, Alessandrino F. In-continuity neuroma of the median nerve after surgical release for carpal tunnel syndrome: case report. J Ultrasound. 2014; 18:83–85.

9. Daoud A, Olivieri B, Feinberg D, Betancourt M, Bockelman B. Soft tissue hemangioma with osseous extension: a case report and review of the literature. Skeletal Radiol. 2015; 44:597–603.

10. Flors L, Leiva-Salinas C, Maged IM, Norton PT, Matsumoto AH, Angle JF, et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics. 2011; 31:1321–1340. discussion 1340-1341.