Case Diagnosis: Upper limb intramuscular hemangioma
Case 1: A 13-year-old boy presented with swelling on the volar aspect of his right forearm and pain during physical activities. Ultrasound evaluation showed well-marginated cavernosal and easily compressible echotexture inside the mid-belly of flexor digitorum superficialis muscle with mildly positive power Doppler signal. The suspected diagnosis of intramuscular hemangioma (IH) was confirmed by magnetic resonance imaging (MRI). The embolization of the hemangioma was performed and provided satisfactory results.
Case 2: A 38-year-old woman presented with pain in her left thenar area lasting more than 10 years, exaggerated while working on PC. Ultrasound evaluation showed a well-marginated cavernosal echotexture with calcifications within the flexor pollicis brevis muscle belly. The suspected diagnosis of IH in the flexor pollicis brevis muscle belly was confirmed on MRI. Excision of the mass was performed and thepatient reported pain relief thereafter
Intramuscular hemangiomas (IHs) are benign soft tissue tumors and their occurrence in the upper limb is rare. Their diagnosis can be difficult because of pertinent nonspecific symptoms. They are often treated as tendinitis or as muscle strain. Herein, it is noteworthy that ultrasound imaging would be helpful in those clinical conditions.
We present two cases of IHs, one in the flexor pollicis brevis muscle belly and the other one in the flexor digitorum superficialis muscle. Both patients presented with nonspecific symptoms like chronic pain, swelling, and functional limitation. Ultrasound evaluation and MRI confirmed their diagnose. To this end, we strongly encourage sonographic examination as the extension of physical examination in the daily clinical practice of musculoskeletal medicine for the (differential) diagnosis of several similar scenarios.
Karolína Sobotová– resident doctor, Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University in Prague
Kamal Mezian– Assistant professor, Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
Ahmad Abdulsalam– RESIDENT, PHYSICAL MEDICINE AND REHABILIATION HOSPITAL
Levent Özçakar– Professor, Department of Physical and Rehabilitation, Hacettepe University Medical School