Cavernous Hemangioma Masquerading as a Ganglion Cyst of the Flexors of the Index Finger: A Case Report

Introduction: Vascular lesions, such as cavernous hemangiomas of the finger’s flexor tendon sheath are uncommon and can easily be mistaken for more common masses, such as ganglion cysts. Early recognition is important to plan appropriate imaging and excision with correct surgical technique. Case Report: We report a 60-year-old female who presented with a painless, slowly enlarging subcutaneous swelling over the palmar aspect of her right hand. The initial clinical impression was a ganglion cyst of the flexor sheath. Ultrasound suggested a hypoechoic lesion without any internal vascular flow on Doppler. However, intraoperative findings revealed a vascular mass firmly adherent to the flexor tendon sheath. Complete excision was performed. Final histopathological examination confirmed the diagnosis of cavernous hemangioma. The patient had an uneventful recovery with full finger motion and no recurrence at annual follow-up. Conclusion: Cavernous hemangioma of the flexor tendon sheath can present like a ganglion cyst. Pre-operative suspicion (especially when imaging shows internal vascularity), careful operative planning, and complete excision are keys to a good outcome. Keywords: Cavernous hemangioma, tendon sheath, ganglion cyst, hand lump, case report.