Regional bone changes in deep soft tissue hemangiomas: radiographic and MR features

Abstract 

Objective. To evaluate changes in bone adjacent to deep soft tissue hemangiomas of the extremities.

Design and patients. We retrospectively reviewed the plain films of 115 patients with histologically proven deep soft tissue hemangiomas of the extremities. The length and pattern of the bone changes were analyzed and correlated with the MRI examination (n=55) and surgical findings.

Results. Plain film studies demonstrated reactive bone changes adjacent to the deep soft tissue hemangiomas in 24 (21%) patients and phleboliths in 23 (20%) patients. The results of plain film analysis revealed a wide spectrum of regional bone changes adjacent to the hemangiomas, including periosteal reactions (16%), regional osteopenia (1%), cortical erosion (3%), bony overgrowth (3%), coarsening of the trabeculae (5%), and a combination of the above changes (4%). The length of the reactive changes corresponded approximately to the size of the hemangioma in 70% and was longer than the largest dimension of the hemangioma in 30%. Of the 55 patients studied with MRI, 39 (71%) patients had normal bones and 16 (29%) had bone changes.

Conclusion. Deep soft tissue hemangiomas may cause changes in adjacent bones. Familiarity with the pattern of reactive bone changes may help to avoid misdiagnosis.