PMC4386590_01
Chest X-ray shows a well-defined radio-opaque density in the right upper hemi thorax arising from the posterior part of the 3rd rib.
poljradiol-80-172-g001.jpg
PMC4386590_01_poljradiol-80-172-g001.jpg
f1-poljradiol-80-172
CRP were a little raised. Chest x-ray was done which revealed a well-defined radio-opaque density arising from the 3rd rib (Figure 1).
Axial NECT show lobulated heterogeneous mass causing expansion of the rib with sun burst calcification.
poljradiol-80-172-g002.jpg
PMC4386590_01_poljradiol-80-172-g002.jpg
f2-poljradiol-80-172
Further an unenhanced chest CT was advised which revealed a well-defined mass with sun burst calcifications causing expansion of the 3rd rib (Figure 2).
T2 W axial image show lobulated hyper intense lesion with multiple linear hypo intensity scattered throughout the lesion suggestive of expanded trabecular pattern. Few flow voids are seen in the periphery of the lesion. T1 precontrast sagittal image show a well-defined isointense lesion arising from the 3rd rib with hyper intensities within suggestive of fat within the lesion. T1 post contrast sagittal and axial images show intense enhancement of the corresponding lesion.
poljradiol-80-172-g003.jpg
PMC4386590_01_poljradiol-80-172-g003.jpg
f3-poljradiol-80-172
T1 hypointense with scattered hyperintensity suggestive of fat, T2 hyperintense with expansion of the trabecular pattern with flow voids and showing intense enhancement and vascular channels within the lesion (Figure 3). The lesion was diagnosed as a benign vascular tumor of the 3rd rib representing hemangioma.
DSA with super selective catheterization of the costal branch of the costocervical trunk by micro catheter shows puddling of the contrast suggestive of hemangioma. Post embolization DSA show adequate stasis of the contrast which is suggestive of satisfactory embolization.
poljradiol-80-172-g004.jpg
PMC4386590_01_poljradiol-80-172-g004.jpg
f4-poljradiol-80-172
The main feeding artery of hemangioma was identified to be originating from the costo-cervical trunk of the second part of the subclavian artery which showed puddling and hold up of the contrast till delayed angiograms confirming hemangioma and further super-selective embolization was done through the costal branch of costo-cervical trunk using gel foam until stagnation was noted (Figure 4).
Post-operative chest X-ray showing complete excision of the 3rd rib and the lesion.
poljradiol-80-172-g005.jpg
PMC4386590_01_poljradiol-80-172-g005.jpg
f5-poljradiol-80-172
Postoperative course of the patient was uneventful with complete symptomatic, biochemical improvement and radiological improvement (Figure 5).