Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 24, 2016
Cavernous Hemangioma of the Skull
- Background:
- Intraosseous skull hemangiomas are uncommon lesions, representing 0.2% of all bone tumors.
- It occurs predominantly in women and more frequently in the fourth decade of life.
- Benign vascular neoplasms with a slow grow rate
- Clinical Presentation:
- Most often an incidental finding
- When symptomatic, may present with headache, dizziness, eye pain, and proptosis.
- Key Diagnostic Features:
- Skull radiography: A lytic lesion with esclerotic borders, "honeycomb" apparence
- CT: The most common pattern is an expansie lesion with thin borders and intact inner and external tables
- MRI: Signal intensity depends on the amount of blood products due to venous stasis and the rate of transformation of red marrow into fatty marrrow. High T2 signal is common.
- Differential Diagnosis:
- Aneurysmal bone cyst
- Fibrous dysplasia
- Paget disease
- Metastasis
- Langerhans cell histiocytosis (eosinophilic granuloma)
- Angiomatous meningioma
- Hemangioperycitoma
- Treatment:
- Surgery may be considered when there is significant mass effect, intralesional hemorrhage, or due to aesthetic reasons.
- Tumor embolization and radioterapy are other, less frequently used therapeutic options.
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