Lung Pathology |

A Case of Hemangioma Presenting as a Large Left Upper Lobe Mass FREE TO VIEW

Matthew McLaughlin, DO; Joshua Sill, MD
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Eastern Virginia Medical School, Norfolk, VA

Chest. 2015;148(4_MeetingAbstracts):606A. doi:10.1378/chest.2266610
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SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Hemangiomas are rare lung lesions, particularly in adults. They can present as asymptomatic findings on imaging, with respiratory distress or with hemoptysis.

CASE PRESENTATION: A 65 year old African American woman with a 50 pack year smoking history presented with 1 month of dyspnea, cough, fatigue and mild weight loss. A chest x-ray showed a large left upper lobe cystic lesion. A CT scan of the chest showed a left upper lobe mass with cystic components, which occupied most of the left upper lung field. Sputum cultures were negative for bacteria, fungus and acid fast bacilli. She underwent bronchoscopy with bronchoalveolar lavage and transbronchial biopsies. Cultures from the bronchoalveolar lavage were again negative. Biopsies showed only chronic inflammation. A CT guided biopsy of the lesion showed vascularized fibrous tissue with mild inflammation, insufficient to make a definitive diagnosis. She was referred to cardiothoracic surgery due to concerns for malignancy and underwent left upper lobectomy with mediastinal lymph node dissection. Tissue pathology showed benign lung tissue with numerous dilated vascular spaces, consistent with hemangioma. All lymph nodes were normal.

DISCUSSION: Hemangiomas are benign tumors that contain widely dilated vascular structures. The vessel walls are coated with squamous endothelial cells and contain a heterogeneous distribution of connective tissue. Pulmonary hemangiomas are rare and have been reported in patients between the ages of 10 weeks and 61 years. When hemangiomas do occur in the lung, they may present as a solitary mass or as multiple masses. Symptoms related to hemangiomas depend on the location and size of the lesion(s). They can include respiratory distress, cyanosis and hemoptysis. Solitary hemangiomas can be treated with surgical excision.

CONCLUSIONS: Hemangiomas are rare causes of lung lesions. They can present as asymptomatic findings on imaging or present with hemoptysis. Our patient’s symptoms and presentation were quite unusual. To our knowledge, she is one of the oldest patients to be have been diagnosed with hemangioma, and her mass is one of the largest described in the literature.

Reference #1: Sirmal M, Demirag F, Aydin E, Karasu S, Kaya S. A Pulmonary Cavernous Hemangioma Causing Massive Hemoptysis. Annals of Thoracic Surgery 2003; 76:1275-6)

Reference #2: Kim E, Kim T, Han J, Kim H, Choi Y. Recurrent Pulmonary Capillary Hemangioma: Dynamic Contrast-Enhanced CT and Histopathologic Findings. Korean Journal of Radiology 2012; 13 350-354.

DISCLOSURE: The following authors have nothing to disclose: Matthew McLaughlin, Joshua Sill

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