Intramuscular hemangioma presenting with multiple phleboliths: a case report

Area of Science:

• Radiology and Medical Imaging
• Head and Neck Surgery
• Vascular Malformations

Background:

• Intramuscular hemangiomas are rare benign vascular tumors, often presenting as asymptomatic masses.
• Phleboliths, or calcified venous thrombi, can be associated with hemangiomas, aiding in diagnosis.
• The masseter muscle, a large muscle of mastication, is an uncommon site for intramuscular hemangiomas.

Observation:

• A 21-year-old female presented with a noticeable swelling of her right masseter muscle.
• Radiography revealed numerous round, target-like radiopacities indicative of phleboliths within the soft tissue.
• Ultrasound demonstrated a lobulated, cystic lesion with increased echogenicity in the affected muscle.
• Magnetic Resonance Imaging (MRI) showed a space-occupying lesion with characteristic signal intensities on T1 and T2-weighted images.

Findings:

• Plain soft tissue radiography effectively visualized multiple phleboliths, suggesting hemangioma.
• Ultrasound provided details on the cystic nature and echogenicity of the masseteric lesion.
• MRI characterized the intramuscular lesion, noting signal characteristics and internal septations.

Implications:

• Plain radiography is a valuable initial tool for detecting phleboliths in suspected intramuscular hemangiomas.
• Multimodality imaging, including ultrasound and MRI, offers comprehensive information for diagnosis and surgical planning.
• Early and accurate diagnosis of intramuscular hemangioma is crucial for appropriate management and patient outcomes.