Role of MRI in the diagnosis and evaluation of cavernous hemangioma of the arm

Sinusoidal hemangioma is a rare type of cavernous hemangioma with different clinico-pathological aspects. They are usually localized in the extremities with interest in the subcutaneous layer. The new imaging techniques play an important role in diagnosis, evaluation and follow-up of these types of tumors. We describe the case of a 21-year-old patient, four times operated for a recurrent soft tissue tumor, located intramuscularly in the distal third of the upper limb. Plain X-ray and computer tomography (CT) showed a nonspecific mass with calcification. The MRI (magnetic resonance imaging) exam demonstrated a lobulated heterogeneous signal tumor mass in the biceps brachial muscles, with high signal intensity on T2 weighted images and intermediate signal on T1 weighted images. MRI accurately assessed the extent of the tumor and evaluated the recurrence. MRI imagings combined with contrast-enhanced sequences were used to classify the lesions in low flow vascular disorders. CT angiography with multiplanar reconstructions (MPR), maximum intensity projections (MIP) and volume-rendered reconstructions (VR) was useful in confirming the venous origin of the tumor.