PMC6525862_01
Preoperative physical examination revealed the flexion contracture of fingers in resting position (a). Passive extension on right index, middle, and ring fingers on the PIP joint and DIP joint was grossly limited (b).
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His right index, middle, ring, and little fingers were held in flexion, and passive extension of the PIP and DIP joints was grossly limited (Figure 1).
MRI showed the hemangioma.
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It was fed by an artery from the anterior interosseous artery, but it was not dilated (Figure 2).
Surgery revealed the intramuscular mass infiltrating the FDP of the right forearm (a, b). The passive extension of the index finger was established (c). The heterogeneous, lobulated, rubbery, red-yellow mass (2 x 2 cm) consisted of hemorrhage, vascular invasion, and central necrosis (d).
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Surgery revealed a multiloculated red-yellowish mass, measuring 2 x 2 cm, which involved the FDP, but there was no neuromuscular involvement (Figure 3).
Microphotograph of intramuscular hemangioma. The lesion is an ill-defined intramuscular mass composed of proliferation of predominant cavernous-type vascular channels (40x) (a).The vascular channels are lined by variably thick walls and contain blood components. Foci of phleboliths are identified (100x) (b). Metaplastic ossification is noted (400x) (c).
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After excision, passive extension of the index, middle, ring, and little fingers was established before skin closure (Figure 4).
Active flexion and extension of MCP, PIP, and DIP joints of index, middle, ring, and little fingers, one year after surgical excision.
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The final pathologic diagnosis was intramuscular hemangioma with the presence of thrombosis and a phlebolith (Figure 5).