January 1, 2025Surgical Case ReportsOpen Access

Multiple Pulmonary Cavernous Hemangioma: A Case Report

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Why the study?

Pulmonary cavernous hemangioma is extremely rare and often misdiagnosed as other conditions, such as metastatic tumors, due to a lack of specific radiological characteristics.

Structured PICO

Population

A 57-year-old man presenting with fever, found to have multiple pulmonary cavernous hemangioma and concomitant hepatic cavernous hemangioma.

Intervention

Diagnostic imaging (CT, dynamic contrast-enhanced CT, PET-CT) and surgical biopsy

Outcome

Histopathological confirmation of diagnosis

Combining suggestive imaging findings such as microcalcifications and absence of FDG uptake on PET-CT may help differentiate rare pulmonary cavernous hemangiomas from metastatic tumors and avoid unnecessary invasive procedures.

Implication

Consider PCH in well-circumscribed pulmonary nodules with HCH to avoid misdiagnosis; leaves open need for larger series to define imaging criteria.

Abstract

INTRODUCTION: Pulmonary cavernous hemangioma (PCH) is extremely rare and, due to the lack of specific radiological characteristics, is often misdiagnosed as other pulmonary diseases, including metastatic tumors. Here, we report a case of multiple PCH lesions with concomitant hepatic cavernous hemangioma (HCH), emphasizing the diagnostic implications of imaging findings. CASE PRESENTATION: A 57-year-old man presented with fever. CT revealed numerous well-circumscribed pulmonary nodules and multiple low-density hepatic lesions. Dynamic contrast-enhanced CT demonstrated mild, nonspecific enhancement of the pulmonary nodules, whereas the hepatic lesions showed enhancement from the center to the periphery. Serum tumor markers were within normal limits, and PET-CT revealed no abnormal fluorodeoxyglucose uptake in any of the lesions. Although the hepatic lesions appeared suggestive of hemangioma on imaging, the possibility of malignancy, such as hepatic angiosarcoma and its pulmonary metastases, could not be completely ruled out. Therefore, both hepatic and pulmonary biopsies were performed, and histopathological examination confirmed cavernous hemangioma in both organs. CONCLUSIONS: PCH is a rare benign tumor lacking distinctive imaging characteristics; therefore, differentiation from metastatic pulmonary tumors is often challenging and represents a key diagnostic issue. Although definitive diagnosis currently relies on surgical biopsy, combining suggestive imaging findings-such as the presence of microcalcifications within nodules and the absence of fluorodeoxyglucose uptake on PET-CT-may help avoid unnecessary invasive procedures.