case_images: PMC11338197_01
case_images: Ultrasonography showing a well-defined, hypoechoic lesion measuring 2.2 x 1.3 cm. Peripheral vascular flow is observed on Doppler imaging.
case_images: ICRP_A_2393819_F0001_C.jpg
case_images: PMC11338197_01_ICRP_A_2393819_F0001_C.jpg
case_images: F0001
case_images: Two years prior the patient had an ultrasonography of the lesion carried out, which revealed a 2.2 cm intramuscular hypoechoic lesion in the scapular area initially compatible with the diagnosis of an elastofibroma dorsi (Figure 1).
case_images: (arrow) Computed tomography showing a well-defined, round hypodense mass measuring 1.8 cm in diameter, immediately posterior to the left scapula and deep to the left infraspinatus. Less dense adipose tissue can be observed surrounding the lesion.
case_images: ICRP_A_2393819_F0002_B.jpg
case_images: PMC11338197_01_ICRP_A_2393819_F0002_B.jpg
case_images: F0002
case_images: This was followed by a computed tomography (CT) scan which further characterized the lesion as a well-defined hypodense mass with a maximum diameter of 1.8 cm located deep within the left infraspinatus muscle (Figure 2).
case_images: Magnetic resonance imaging shows a well-defined lesion measuring 1.7 x 1.8 x 2.1 cm with small areas of signal hypointensity suggesting fibrosis and large areas of hyperintensity on T2 weighted sequences, which persist upon fat suppression.
case_images: ICRP_A_2393819_F0003_C.jpg
case_images: PMC11338197_01_ICRP_A_2393819_F0003_C.jpg
case_images: F0003
case_images: In addition, MRI imaging further revealed a heterogenous mass of 1.7 x 1.8 x 2.1 cm in size within the left infraspinatus muscle in close contact with the scapular bone (Figure 3).
case_images: Magnetic resonance imaging 3 months after arterial embolization, showing a persistence/recurrence of the vascular lesion, having slightly increased in dimensions to 2.4 x 2.0 x 1.7 cm.
case_images: ICRP_A_2393819_F0004_C.jpg
case_images: PMC11338197_01_ICRP_A_2393819_F0004_C.jpg
case_images: F0004
case_images: Three months after the embolization an MRI revealed recurrence of the vascular lesion as well as a slight increase in its size, measuring 2.4 x 2.0 x 1.7 cm (Figure 4).
case_images: Skeletal muscle tissue infiltrated by numerous small blood vessels without features of malignancy. LEFT (Hematoxylin & eosin, x4) RIGHT (Hematoxylin & eosin, x10).
case_images: ICRP_A_2393819_F0005_C.jpg
case_images: PMC11338197_01_ICRP_A_2393819_F0005_C.jpg
case_images: F0005
case_images: Histological examination confirmed the diagnosis of intramuscular hemangioma and revealed a microscopic residual resection (R1) (Figure 5).