intramuscular hemangioma ( imh ) is a relatively rare benign tumor of vascular origin , accounting for less than 1% of all hemangiomas . phleboliths are calcified thrombi found within vascular channels , often in the presence of hemangioma or vascular malformation . they are most frequently found in the pelvic veins , where they are subject to stress injury during defecation . the next most common site for a phlebolith is the head and neck area . in this area , a 51 year - old man was referred for the evaluation of a swelling of the tongue . the condition had been first noticed by the patient 2 years earlier and had increased slowly in size . these vascular tumors exhibiting a deep red color about 1 cm in diameter were noticed on the right border , lower surface and root of the tongue [ figure 1a and b ] . computed tomography ( ct ) shows multiple phleboliths in the tongue [ figure 1c ] . contrast enhanced t1-weighted magnetic resonance ( mr ) imaging shows strongly enhancing mass with smooth borders [ figure 1d ] . the diagnosis of an imh with phleboliths was made based on these findings . hemangiomas on right border ( a ) , lower surface and root of the tongue ( b ) . contrast enhanced t1-weighted mr imaging shows strongly enhancing mass with smooth borders ( d ) phleboliths taken from the intramuscular hemangioma of the tongue ( a ) . microscopically , specimen demonstrates hemangioma of the tongue ( he original magnification 3200 ) demonstrates laminated structure of thrombus ( b ) and phleboliths ( c ) histopathological examination demonstrated cavernous hemangioma with thrombus [ figure 2b ] and phleboliths [ figure 2c ] containing dysplastic venous channels with flat endothelium and irregularly attenuated walls with deficient smooth muscle cells . the diagnosis of the head or neck phlebolith requires its differentiation from other calcifications that occur in the same area . sialoliths , tonsilloliths , calcified lymph nodes , atherosclerotic plaques in the carotid artery , healed acne lesions , cysticercosis , and miliary skin osteomas all serve to muddy the diagnostic waters . the pathogenesis of phlebolith is thought to involve thrombi produced by slowing of peripheral blood flow becoming organized and mineralized . long term presence of hemangioma and stagnant blood flow caused a large number of phleboliths . attention needs to be given to the tumor location , extent , growth rate , accessibility , patient 's age , and esthetics . the ideal treatment is complete excision of the tumor with a surrounding margin of normal muscular tissue , due to the infiltrative nature of the tumor . complete tumor resection could be performed with less bleeding if a wide surgical field exposing the whole tumor and surrounding area was obtained . in this case ,
intramuscular hemangioma ( imh ) is relatively rare benign tumor of vascular origin . 
 phleboliths are calcified thrombi found in the presence of hemangioma . 
 the main treatment of the hemangioma is a surgical extirpation based on location , accessibility , and cosmetic considerations . 
 we herein report a rare case of imh with phleboliths of the tongue with clinical , imaging , and histopathological findings .