Right ventricular haemangioma as a rare cause of chest pain: a case report

Background Cardiac haemangioma is a rare primary cardiac tumour. Most patients with cardiac haemangioma have no typical symptoms, and some may present with non-specific manifestations, such as shortness of breath, heart palpitations, or cardiac insufficiency, making it difficult to distinguish cardiac haemangioma from other diseases. We report a case of cardiac haemangioma that present with chest pain. This haemangioma was finally completely excised to relieve the patient’s symptoms and a avoid poor prognosis. Case summary A 14-year-old boy presented with an intermittent and progressive non-exertional chest pain for 2 weeks. Echocardiography showed a space-occupying mass at the right ventricular apex, which was later confirmed by computed tomography angiography and magnetic resonance imaging (MRI). The mass was successfully resected, and postoperative pathology confirmed a cardiac cavernous haemangioma. The patient had an uneventful postoperative recovery at the 8-month follow-up. Discussion Cardiac haemangioma is a benign tumour with no typical clinical manifestations, and very few patients may present with chest pain. Preoperative echocardiography, computed tomography, and MRI are helpful for diagnosis, and surgery can relieve symptoms and may improve the prognosis of patients with cardiac haemangioma.

Pure epidural spinal cavernous haemangioma

Background: Pure epidural spinal cavernous hemangiomas (SCH) account for only 4% of all spinal epidural lesions. Our literature review identified 61 publications reporting on, a total of 175 cases in the magnetic resonance imaging era. Here, we reviewed those cases, and have added our case of what appeared to be a multifocal SCH. Case Description: A 72-year-old male presented with a progressive paraparesis attributed to a T5/T6 dorsolateral extradural mass extending into the right T5/6 foramen. Surgical excision documented the lesion, histologically, was a SCH. A second similar lesion was noted involving the left C7/T1 foramen; as the patient was asymptomatic from this lesion, and no additional biopsy was performed. The patient returned to normal neurological function within 2 months postoperatively. Conclusions: Here, a 72-year-old male presented with a pathologically confirmed T5/T6 epidural SCH and a secondary C7/T1 foraminal lesion suspected to represent a secondary focus of an epidural SCH.

EP.WE.484Conservative management of post-operative chyle leak after surgery for a large adrenal cavernous haemangioma

Post-operative chyle leak is a rare but recognised complication after abdominal surgeries particularly those involving dissection adjacent to the retroperitoneal lymph nodes and/or lymphatic systems. There are limited cases of post-operative chyle leak associated with adrenal surgery reported in the literature with no consensus on its management. Lymphatics of the adrenal gland drain into the thoracic duct via regional lymph nodes or directly into the cisterna chyli, posterior to the aorta. If not adequately managed, chyle leak can be associated with hypovolemia, electrolyte imbalances, malnutrition and immunosuppression. These consequences can be attributed to the loss of fluid, electrolytes, lipids, proteins, and immunoglobulins. We hereby report a case of post-operative chyle leak in a 79-year-old male who underwent an open left adrenalectomy, left nephrectomy, splenectomy and distal pancreatectomy for a large, 20.8cm left adrenal cavernous haemangioma. Chyle leak was confirmed on post-operative day 7 based on high levels of triglycerides in the abdominal drain output. Intra-operatively there was no evidence of lymphatic damage. However, the major abdominal surgery involving retroperitoneal viscera close to the lymphatic trunk predisposed the patient to this complication. The patient was managed conservatively with the aim of decreasing chyle production by dietary manipulation and use of somatostatin. Enteral nutrition was continued with a strict low-fat diet and regular dietician input. These strategies contributed to the gradual resolution of chyle leak and the patient’s recovery.

1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain

Background Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare Case Summary we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma. Discussion Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin. Conclusions Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.

Cavernous haemangioma of the duodenum with acute massive bleeding in the ascending portion: a case report

Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120–175 g/l). Albumin level was also low at 28 g/l (normal range, 40–55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.

560 Case Report: A Very Rare Case of Incidentaloma of a Large Adrenal Cavernous Haemangioma

Introduction Incidentaloma are asymptomatic and unanticipated adrenal tumours found on radiological imaging for unrelated diagnostic inquiries. Adrenal cavernous haemangioma is a rare, differentiated and benign tumour arising from the endothelial layer of blood vessels. This is a rare phenomenon with only 66 cases reported in the literature between 1955 and 2018. Case Details This is a case of a 79-year-old Caucasian gentleman who presented in March 2020 with vague abdominal discomfort and anaemia on a background of multiple co-morbidities including in particular, an asymptomatic left 5.6cm adrenal incidentaloma found in 2014. A computed tomography scan of abdomen-pelvis in June 2020 revealed progression in size of the incidentaloma to 20.8cm. Biochemical tests confirmed non-functioning adrenal tumour. The patient underwent open left adrenalectomy, left nephrectomy, splenectomy and distal pancreatectomy. The diagnosis of adrenal cavernous haemangioma was subsequently made on histopathological examination. Post-operatively, our patient made a good physiological recovery. Discussion There are no established diagnostic and treatment guidelines for adrenal cavernous haemangioma. Larger tumours are often treated surgically to exclude malignancies and to prevent potential complications as well as symptom relief. Literature reviews showed that most cases were surgically managed, and diagnoses were made through histology post-operatively. Conclusions Adrenal cavernous haemangioma typically present as incidentalomas which require further investigations. They are very rare non-functioning benign tumours that can be difficult to be differentiated from other adrenal malignancies.

Management of parapharyngeal space cavernous sinus haemangioma using transoral robotic surgery

Cavernous haemangiomas are a very rare occurrence in the parapharyngeal space (PPS). Here, we present a case of a 58-year-old woman with an incidentally identified left PPS mass thought to be a pleomorphic adenoma that underwent excision by transoral robotic surgery (TORS). Intraoperative findings demonstrated no solid mass present and histological assessment of resected tissue confirmed a cavernous haemangioma. We discuss our experience in the management of a radiological and surgical mismatch of a PPS mass in what we believe to be the first cavernous haemangioma to be excised by TORS in this region.

Compound haemangioma of lower lip: an interesting and rare case report

Haemangiomas are common benign vascular tumours of infancy and childhood. Haemangiomas occur in 10-12% of children of 1 year of age and most of them are self-resolving within 9 years of age. Most common sites are head and neck (around 90%) and lip is one of the preferred sites. Sometimes persistence of haemangiomas may require surgical intervention. Capillary haemangiomas generally located superficially and cavernous haemangiomas located deep. Mixed capillary-cavernous haemangiomas or compound haemangiomas are one of the rarer types and location at lip rarest. Here we report a 14-years-old boy presented to paediatric surgery outdoor with swelling in lower lip for last 3 years. The excisional biopsy done with a clinical diagnosis of granuloma and sent for histopathological study. On microscopy of tissue sections given from lesion showed stratified squamous epithelium with sub epithelium revealing two distinct areas of capillary haemangioma component and cavernous haemangioma component within the lesion. So, final diagnosis of capillary-cavernous haemangioma (compound haemangioma) was made without any granuloma or malignant component. Patient followed up for six months and he was completely asymptomatic without any residual disease and recurrence.

466 Resection or Enucleation for Extremely Giant Hepatic Haemangiomata? A Case Report and Review of The Literature

Background Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available. Case presentation We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter. Conclusions This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.