左侧上颌骨海绵状血管瘤(Intraosseous cavernous hemangioma of the left maxillary bone )MRI病例图片影像诊断分析鼻窦 2010-10-22
【临床病史】:患者，49岁，男性出现鼻内肿块。49-year-old male with an intranasal mass.
【影像改变】：Noncontrast orbital CT demonstrates a mass arising from the left maxillary bone with internal bony trabeculations in a “honeycomb,” “sunburst,” or “spokewheel” pattern typical for an intraosseous cavernous hemangioma (yellow arrow).
This pattern of trabeculation on CT translates into a network of linear hypointense T1 and T2 signal with interspersed areas of enhancement on the T1 post gadolinium images characteristic of this entity
【影像诊断】：Intraosseous cavernous hemangioma of the left maxillary bone 左侧上颌骨海绵状血管瘤
【诊断要点】：Intraosseous cavernous hemangiomas of the facial bones and skull are benign lesions that typically contain bony trabeculations and enhancement features in a "honeycomb," "sunburst," or "spokewheel" pattern. 颅盖骨及颅面骨的海绵状血管瘤是一种良性病变，表现为“蜂窝状”、“日光状”或“轮辐状”，有明显强化。
These lesions may be monitored conservatively unless a patient develops symptoms such as visual disturbances from mass effect into the intraorbital compartement.本病可以适当随诊，除非病人出现症状，如由于对眶内结构的占位效应导致的视觉障碍
【讨论】：Intraosseous cavernous hemangiomas are benign neoplasms which comprise only up to 1% of all osseous tumors and 7-10% of skull tumors. These are most frequently seen in the frontal and parietal bones with the orbital and maxillofacial bones infrequently involved. These tumors are slow growing and are generally asymptomatic unless they cause mass effect on sensitive structures such as within the intraorbital compartment. In symptomatic cases, en bloc resection is generally the treatment of choice. Preoperative angiography with potential embolization may be helpful as these tumors can bleed profusely.
Clinical differential diagnosis includes fibrous dysplasia, osteoma, dermoid cyst, meningioma, eosinophilic granuloma, Lagerhan cell histiocytosis, and metastatic disease. On imaging, these tumors are well-defined and have characteristic internal trabeculations and enhancement features described as a "honeycomb," "sunburst," or "spokewheel" pattern. Malignant degeneration is rare.
临床鉴别诊断包括骨纤、骨瘤、皮样囊肿、脑膜瘤、嗜酸性肉芽肿、朗格汉斯组织细胞增生症、以及转移瘤。在影像上，肿瘤边界清晰，有特征性的小梁结构，明显的强化，表现为“蜂窝状”、“日光状”或“轮辐状”。恶性变是相当罕见的。(参考来源:,ACR Friday, November 27, 2009,作者:freemanpyw)