Intramuscular cavernous hemangioma in the triceps brachii causing ulnar nerve compression: a case presentation and literature review

Background. Intramuscular cavernous hemangiomas are rare benign vascular tumors, accounting for less than 1% of all hemangiomas. These lesions most commonly occur in the lower limbs, particularly in the quadriceps femoris, but may occasionally involve the upper limbs – an uncommon presentation that complicates diagnosis and treatment. This report presents a rare case of an intramuscular cavernous hemangioma of the triceps brachii causing ulnar nerve compression. Case presentation. A 35-year-old male presented with a gradually enlarging posteromedial elbow swelling, associated with intermittent pain and paresthesia in the ring and little fingers. Examination revealed a firm, non-tender mass with a positive Tinel’s sign. Imaging (X-ray, ultrasonography, CT, and MRI) identified a soft tissue mass with phleboliths in the long head of the triceps brachii, compressing the ulnar nerve. Surgical excision was performed via a posteromedial approach with nerve preservation. Histopathology confirmed a cavernous hemangioma. The patient experienced full recovery postoperatively. Conclusion. This case highlights the importance of multimodal imaging in the accurate diagnosis of intramuscular cavernous hemangioma. Surgical excision remains the definitive treatment in symptomatic cases. Early diagnosis and prompt intervention are crucial for optimal functional outcomes, particularly in rare upper limb presentations with neurovascular involvement.