原文題目(出處)： Intramuscular hemangioma presenting with multiple phleboliths: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e32-e36.
原文作者姓名： A Zeynep Zengin, Peruze Celenk, A Pinar Sumer
通訊作者學校： Department of Maxillofacial Radiology, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey 報告者姓名(組別)： 呂珮誼 Intern I 組
報告日期： 2013/5/6
內文：
I. About the patient of the case
• A 21-year-old woman presented with a complaint of swelling of the right masseter muscle.
• The swelling had been present since 6 months of age and had gradually grown as the patient aged.
• A temporary increase in the size of the mass was observed when the patient cried, laughed, or performed handstands.
• No dental disease was observed, except dental caries over occlusal side of tooth #16.
• Unremarkable medical and family history
• Examination of the mass over R’t face:
♦ immobile
♦ with hard nodules of various sizes ♦ no bruits or pulsation
• Intra-oral exam:
♦ normal-colored mucosa
♦ normal discharge from the R’t parotid gland.
II. Radiographic examination
Based on radiographic and clinical findings, the lesion was suspected to be 1. sialolith
2. phlebolith II. Ultrasound examination
round target-like radiopacities
III. MRI examination 1. T1-weighted images
isointense mass 5-6 cm in size with distinct borders in the R’t masseter muscle (blackarrow).
Millimetric slightly hyperintense nodular areas are seen within the homogeneous mass (white arrows).
2. T2-weighted images
millimetric hypointense structures(black arrows) in the hyperintense mass 3. Contrast-enhanced T1-weighted
many nonenhancement nodular structures (phleboliths) (black arrows) in thestrongly enhancing mass with smooth borders (white arrow).
IV. About Intramuscular Hemangiomas (IMHS)
• Congenital vascular malformations
• No gender predispositions.
• Main complaint is the presence of a slowly enlarging mass
• Generally develop during the first 3 decades of life
• 50% of IMHs occur in the head and neck region, with the masseter muscle is the most common site
• The diagnosis of IMHs can be difficult, because ♦ the deep intramuscular location
♦ rare incidence
♦ lack of specific symptom
• Definitive preoperative diagnosis has been reported in 8% of cases.
• Usually no overlying skin changes.
• There may be occasional reddish-blue discoloration.
• Situations that increase the venous pressure in the head increase IMH size.
V. Differential Diagnosis of a mass in the masseter muscle
• benign muscular hypertrophy
• Lymphadenopathies
• sialocele of the parotid gland duct
• various parotid and muscle neoplasms
VI. Differential Diagnosis of calcifications in the head and neck area
• sialolithiasis
• tonsilloliths
• radiotheraphy
• sclerosing agents
• steroids
• complete excision of the tumor and involved muscle
題號 題目
1 MRI 影像中，在 T1-weighted image 與 T2-weighted image 中， 訊號 最強(Hyperintense)、看起來最亮的物質分別是?
(A) 脂肪， 水 (B) 水， 脂肪
(C) 皮質骨，空氣
(D) 肌肉，脂肪 答案(A)
題號 題目
2 治療 Intramuscular Hemangiomas (IMHS)的方法中，復發率最低的是?
(A) complete excision of the tumor and involved muscle (B) steroids
(C) sclerosing agents (D) cryotherapy
答案(A)
