Intramuscular Cavernous Hemangioma of the Latissimus Dorsi Muscle: A Rare Presentation of Chronic Musculoskeletal Pain - Case Report.

BACKGROUND Hemangiomas comprise 7% of benign soft tissue tumors, and only 0.8% of hemangiomas are intramuscular; 26% of intramuscular hemangiomas comprise the cavernous histologic variant. Intramuscular cavernous hemangiomas are benign soft tissue tumors of unknown pathophysiology. They are most commonly described in the extremities, with few reports involving the thorax. CASE REPORT A 53-year-old Chinese woman - previously healthy with no clinically significant comorbidities - presented with a chronic, painful swelling of the right lateral chest wall. Magnetic resonance imaging revealed a lobulated, patchy enhancing lesion measuring 2.4×1.2×2.3 cm within the right latissimus dorsi muscle. Radiologic and clinical findings were inconclusive; after a period of observation and serial imaging, the lesion was surgically resected. Histopathologic examination of the specimen confirmed a cavernous hemangioma. The patient had an uneventful recovery and a favorable postoperative outcome. CONCLUSIONS This case highlights the need to consider intramuscular hemangioma in the differential diagnosis of patients presenting with chronic musculoskeletal pain. Magnetic resonance imaging is the imaging modality of choice for lesion characterization; however, histopathologic analysis is often required for definitive diagnosis. Surgical management yields favorable outcomes in patients with cavernous hemangiomas; nevertheless, clinical and radiologic follow-up is recommended due to the risk of recurrence. Medical imaging may be useful in guiding preoperative and intraoperative lesion localization.