CTICasesMediastinal Capillary Hemangioma
Imaging findings
CT shows a mediastinal mass just above the aortic arch in the region of the phrenic nerve that has grown slowly over about three years. It demonstrates snake-like central enhancement and enhancement along its edges with areas of low internal attenuation. There is a suggestion of extension into an adjacent brachiocephalic vein and an associated small left pleural process. No phleboliths were identified.
Key takeaways
Capillary hemangioma is a rare benign mediastinal tumor that can present as a slowly growing, enhancing mass and may be difficult to distinguish from a schwannoma given its location near the phrenic nerve, or from a slow-flow venous vascular malformation. Apparent extension into an adjacent vein raises concern despite the benign nature, and distinguishing a hemangioma (with fatty endothelial-associated cells) from a vascular malformation (with normal endothelium) may require the full resection specimen.
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