Intraosseous hemangioma of the appendicular skeleton: imaging features of 15 cases, and a review of the literature.

OBJECTIVE: We performed a retrospective study of the imaging findings of 15 patients (nine female, six male, mean age 43 years) with the histopathological diagnosis of hemangioma.
MATERIALS AND METHODS: Radiographs, magnetic resonance imaging (MRI), computed tomography, and bone scan were performed.
RESULTS: Lower extremity was involved in nine cases, upper extremity in three cases, the acetabulum in two cases and the ilium in one case. Fourteen of the lesions were intramedullary and one was subperiosteal. Radiographs identified the lobular osteolytic intramedullary lesions with sclerotic margins (eight cases) and coarse linear trabeculation (four cases) or matrix ossification (one case) within it or a heavily calcified lesion (one case). Lesion expanded and breached the cortical cortex in four cases. The subperiosteal hemangioma presented as a soft tissue mass with proximal periosteal reaction. MRI also identified the soft tissue mass in the case of the subperiosteal hemangioma. The CT scan demonstrated the lobular osteolytic lesions, the prominent trabeculation and matrix mineralization and evaluated the cortex. In all six cases, the lesion showed increased uptake in the bone scan.
CONCLUSIONS: This is the largest reported series of imaging features of intraosseous hemangiomas of appendicular skeleton. The lesion should be differentiated from other chondral or expansile lytic tumors. The final diagnosis can only be confirmed by histopathology.