Abstract
The intramuscular hemangioma is a rare clinical entity in the upper extremity. Pronator quadratus hemangioma poses a considerable morbidity in the functional quality of life of an individual. MRI remains the gold standard modality in diagnosing this rare entity. Additionally, histopathological examination of the lesion corroborates for the same. PQH follows an individualized protocol in the management of the tumour. A 35-year-old female presented with pain over her right wrist from past 1 year which was dull aching, non-radiating, localised to the palmar aspect of distal 1/3rd of the right forearm. There was no history of trauma or infection over the right wrist. Swelling was present over the palmar aspect of distal 1/3rd of right forearm, which was non-pulsatile, non-fluctuant, non-transilluminant, non-compressible, non-reducible and skin over the swelling was pinchable. The movements of the right wrist were painful and restricted. There was no distal neurovascular deficit. The MRI of her right wrist and hand suggested the presence of low flow vascular malformation within pronator quadratus muscle. The patient underwent excision biopsy of pronator quadratus in toto without any neurological complications. No recurrence was noted in the follow-up period for 12 months. The pronator quadratus hemangioma is a rare clinical entity where the natural course of disease and pathophysiology remains controversial. MRI serves as the gold standard in the diagnosis of intramuscular hemangioma. The management of such tumour has to be individualized based on the functional needs of the patient. The natural course of the disease has to be elicited to decrease the morbidity and enhance the functional quality of life of the patient.
Similar content being viewed by others
References
Tang, P., Hornicek, F. J., Gebhardt, M. C., Cates, J., & Mankin, H. J. (2002). Surgical treatment of hemangiomas of soft tissue. Clinical Orthopaedics and Related Research, 399, 205–210. https://doi.org/10.1097/00003086-200206000-00025.
Wild, A. T., Raab, P., & Krauspe, R. (2000). Hemangioma of skeletal muscle. Archives of Orthopaedic and Trauma Surgery, 120(3–4), 139–143. https://doi.org/10.1007/pl00013761.
Mulliken, J. B., & Glowacki, J. (1982). Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plastic and Reconstructive Surgery, 69(3), 412–422. https://doi.org/10.1097/00006534-198203000-00002.
Mitsionis, G., Pakos, E., Kosta, P., Batistatou, A., & Beris, A. (2010). Intramuscular hemangioma of the foot: A case report and review of the literature. Foot Ankle Surgery, 16, e27–e29. https://doi.org/10.1016/j.fas.2009.05.008.
Rastogi, A., Srivastava, N., Vijay, V., & Agarwal, S. (2015). Intramuscular cavernous hemangioma of the triceps muscle. Indian Journal of Vascular and Endovascular Surgery, 2, 122–124. https://doi.org/10.4103/0972-0820.166937.
Melman, L., & Johnson, F. E. (2008). Intramuscular cavernous hemangioma. American Journal of Surgery, 195, 816–817. https://doi.org/10.1016/j.amjsurg.2007.08.064.
Wild, A. T., Raab, P., & Krauspe, R. (2000). Hemangioma of skeletal muscle. Archives of Orthopaedic and Trauma Surgery, 120, 139–143. https://doi.org/10.1007/pl00013761.
Patten, D. K., Wani, Z., & Kamineni, S. (2011). Intramuscular cavernous haemangioma of the triceps. International Journal of Surgery Case Reports, 2, 86–89. https://doi.org/10.1016/j.ijscr.2011.02.004.
Wierzbicki, J. M., Henderson, J. H., Scarborough, M. T., Bush, C. H., Reith, J. D., & Clugston, J. R. (2013). Intramuscular hemangiomas. Sports Health, 5, 448–454. https://doi.org/10.1177/1941738112470910.
Alexander, L. (2019). Intramuscular cavernous haemangioma of the triceps brachii: A rare tumour with good prognosis. International Surgery Journal, 6, 3817–3821. https://doi.org/10.18203/2349-2902.isj20194447.
Patnaik, S., Kumar, P., Nayak, B., & Mohapatra, N. (2016). Intramuscular arteriovenous hemangioma of thigh: A case report and review of literature. Journal of Orthopaedic Case Reports, 6(5), 20–23. https://doi.org/10.13107/jocr.2250-0685.612.
Bucci, T., de Giulio, F., Romano, A., Insabato, L., & Califano, L. (2008). Cavernous haemangioma of the temporalis muscle: Case report and review of the literature. Acta Otorhinolaryngologica Italica, 28(2), 83–86. (PMID: 18669073; PMCID: PMC2667234).
Hui, L., Qiang, C., Yang, H., & Hui, S. (2017). Aggressive intramuscular hemangiomas in the upper extremity. Medicine, 96(3), e5939. https://doi.org/10.1097/md.0000000000005939.
Mencke, H. J., Zilkens, J., Bigalke, K. H., & Ammon, J. (1982). The problem of intramuscular haemangioma. Archives of Orthopaedic and Trauma Surgery, 100, 243–247. https://doi.org/10.1007/bf00381664.
Jeong, E., & Kim, H. S. (2016). Intramuscular hemangioma of the pronator quadratus muscle of forearm. The Journal of Hand Surgery, 21, 262–265. https://doi.org/10.1142/s2424835516720103.
Hristov, N., Atanasov, Z., Zafirovski, G., & Mitrev, Z. (2011). Intramuscular cavernous hemangioma in the left soleus muscle: Successful surgical treatment. Interactive Cardiovascular and Thoracic Surgery, 13, 521–522. https://doi.org/10.1510/icvts.2011.272443.
Kiran, K. R., Suresh Babu, T. V., Babu, S. S., & Deepti, K. (2012). Skeletal muscle haemangioma: A cause for chronic pain about the knee: A case report. Case Reports in Orthopedics. https://doi.org/10.1155/2012/452651.
Doddanna, S. J., Dawar, G., Rallan, N. S., & Agarwal, M. (2014). Intramuscular cavernous hemangioma: A rare entity in the buccinator muscle. Indian Journal of Dental Research, 25, 813–815. https://doi.org/10.4103/0970-9290.152211.
ChandrasekarLakshmi, K., Sankarapandiyan, S., & PulivadulaMohanarangam, V. S. (2014). Intramuscular haemangioma with diagnostic challenge: A cause for strange pain in the masseter muscle. Case Reports in Dentistry, 5, 6. https://doi.org/10.1155/2014/285834.
Rai, H. R., Ballal, A., Mohan, K., & Rajsankar, N. R. (2014). Cavernous haemangioma in the gastrocnemius muscle: A rare presentation in the geriatric age group. Nitte University Journal of Health Science, 4(3), 101–104. https://doi.org/10.1055/s-0040-1703812.
Kurien, N. M., Venugopal, K., Nair, P. R., & Mony, V. (2016). Intramuscular hemangioma of the masseter muscle—a case report and review of literature. International Journal of Surgery Case Reports., 26, 209–216. https://doi.org/10.1016/j.ijscr.2016.07.025.
Lahrach, K., Abdulrazak, S., Marzouki, A., & Boutayeb, F. (2019). Surgical management of intramuscular hemangioma of the foot: A case report. Patient Safety in Surgery, 13, 17. https://doi.org/10.1186/s13037-019-0197-1.
Pourbagher, A., Pourbagher, M. A., Karan, B., & Ozkoc, G. (2011). MRI manifestations of soft-tissue haemangiomas and accompanying reactive bone changes. British Journal of Radiology, 84(1008), 1100–1108. https://doi.org/10.1259/bjr/58308513.
Vilanova, J. C., Smirniotopoulos, J. G., Perez-Andres, R., Villalon, M., Barcelo, J., Martin, F., et al. (2004). Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics, 24, 367–385. https://doi.org/10.1148/rg.242035079.
Teo, E. L. H. J., Strouse, P. J., & Hernandez, R. J. (2000). MR imaging differentiation of soft-tissue hemangiomas from malignant soft-tissue masses. AJR American Journal of Roentgenology, 174(6), 1623–1628. https://doi.org/10.2214/ajr.174.6.1741623.
Ly, J. Q., Sanders, T. G., Mulloy, J. P., Soares, G. M., Beall, D. P., Parsons, T. W., et al. (2003). Osseous change adjacent to soft-tissue hemangiomas of the extremities: Correlation with lesion size and proximity to bone. AJR American Journal of Roentgenology, 180(6), 1695–1700. https://doi.org/10.2214/ajr.180.6.1801695.
Goto, T., Kojima, T., Iijima, T., Yokokura, S., Kawano, H., Yamamoto, A., et al. (2001). Soft-tissue haemangioma and periosteal new bone formation on the neighbouring bone. Archives of Orthopaedic and Trauma Surgery, 121(10), 549–553. https://doi.org/10.1007/s004020100302.
Yeh, Y. L., Yeh, S. I., & Cheng, C. T. (2017). Intramuscular hemangioma causing periosteal reaction and cortical hypertrophy misdiagnosed as osteoid osteoma. International Journal of Surgery Case Reports, 34, 106–109. https://doi.org/10.1016/j.ijscr.2017.03.013.
Ly, J. Q., Sanders, T. G., & SanDiego, J. W. (2003). Hemangioma of the triceps muscle. AJR American Journal of Roentgenology, 181, 544. https://doi.org/10.2214/ajr.181.2.1810544.
Priestnall, S. L., De Bellis, F., Bond, R., Alony-Gilboa, Y., & Summers, B. A. (2010). Spontaneous regression of congenital cutaneous hemangiomas in a calf. Veterinary Pathology, 47(2), 343–345. https://doi.org/10.1177/0300985809358429.
Ronchese, F. (1949). Radium in treatment of hemangioma. Archives of Dermatology Syphilology, 60(5), 717–721. https://doi.org/10.1001/archderm.1949.01530050079006.
Carabin, J., Bouhamama, A., et al. (2020). Percutaneous cryoablation of symptomatic intramuscular venous malformation. Journal of Vascular and Interventional Radiology, 31(4), 558–563. https://doi.org/10.1016/j.jvir.2019.10.024.
Podgornyĭ, V. K., & Polishchuk, E. I. (1976). Treatment of hemangiomas with carbon dioxide snow. Klinichna Khirurhiia, 5, 72–73. (PMID: 972487).
Thorns, J., & Fjeldborg, N. (1953). Radiation treatment of hemangiomas. Acta Radiologica, 40(1), 39–53. https://doi.org/10.3109/00016925309135311.
Park, S., Yoon, S. M., Lee, S., Park, J. H., Song, S. Y., Lee, S. W., et al. (2017). Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus. Radiation Oncology Journal, 35(3), 268–273. https://doi.org/10.3857/roj.2017.00199.
Park, W. C., & Phillips, R. (1970). The role of radiation therapy in the management of hemangiomas of the liver. JAMA, 212(9), 1496–1498. https://doi.org/10.1016/0360-3016(91)90693-x.
Wang, B., Meng, N., Zhuang, H., et al. (2018). The role of radiotherapy and surgery in the management of aggressive vertebral hemangioma: A retrospective study of 20 patients. Medical Science Monitor., 24, 6840–6850. https://doi.org/10.12659/msm.910439.
Silva, V. A., Lima, N. L., & Mesquita, A. T. M. (2011). Intramuscular hemangioma in lip treated with sclerotherapy and surgery. Case Reports in Dentistry. https://doi.org/10.1155/2011/302451.
Acknowledgements
We thank Dr. Rashmi Jain, Resident, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh who helped in data collection and proofreading the manuscript.
Funding
Nil.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical standard statement
All procedures performed in studies involving human participant was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its alter amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from the individual participant included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kumar, R., Ranjan, R., Jeyaraman, M. et al. Pronator Quadratus Hemangioma (PQH): A Rare Case Report and Review. JOIO 55, 1056–1063 (2021). https://doi.org/10.1007/s43465-020-00295-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-020-00295-0