histologically it can be categorized as one of five histologic subtypes : capillary , cavernous , venous , arteriovenous or mixed . case reports describe hemangiomas of the chest wall arising from intercostal muscles ( intramuscular , intercostal ) or from the medullary canal of the rib ( bone hemangioma ) .
we describe a patient with an intercostal venous hemangioma presenting as a chest wall tumor , for which resection of the chest wall was successfully accomplished .
a 36-year - old male was admitted to the clinic of thoracic surgery for a slowly progressing chest mass and six - month pain of the thoracic spine and left chest .
there was no medical history of trauma of the chest wall and no oncological disease . during clinical examination a slowly growing soft resistance located dorso - laterally in the range of the seventh to ninth rib on the left chest
chest magnetic resonance ( mr ) imaging showed a well - bordered tumor of the left chest wall , with a size of 9.5 x 9 x 3 cm with calcifications , overgrowing to the seventh and eighth intercostal space ( fig .
the patient underwent surgery . a complete resection of the tumor with the left seventh , eighth and ninth ribs and their intercostal muscles was successfully accomplished ( fig .
microscopically , structures of benign vascular lesions corresponding to intramuscular venous hemangioma with numerous phleboliths were found in adipose tissue and striped muscle in the resected chest wall .
the patient was discharged on the seventh postoperative day , and presently , ten months after the operation , he is doing well , without any evidence of local recurrence .
coronal t2-weighted mr images of the intercostal hemangioma of the chest wall ( a ) and enhancement by contrast media ( b ) reconstruction of the chest wall with used polypropylene mesh ( a ) .
intramuscular hemangiomas occur most often in people under 30 years of age and show no sex predilection .
generally they are considered to be congenital , but factors such as chest trauma or repetitive bruises may play a role in development of intramuscular hemangioma [ 2 , 3 ] .
patients with intercostal hemangioma clinically may present with palpable mass of the thoracic wall , soft - tissue bulging , pain or a combination of these signs and symptoms .
intercostal hemangioma should be included in the differential diagnosis of primary soft tissue chest wall tumors , such as fibromas , lipomas , giant cell tumors , neurogenic tumors , desmoids , soft tissue sarcomas , connective tissue tumors and metastatic tumors .
conventional radiography hemangiomas may be seen as an ill - defined soft - tissue mass .
regional ribs may show periostitis , trabecular coarsening and cortical changes such as thickening , thinning or erosion . computed tomography ( ct ) of the chest localizes and characterizes chest wall hemangioma , its effect on adjacent structures and it can also reveal phleboliths .
a preliminary diagnosis may be established by mr examination , when classic mr findings are present : tumor mass of low or intermediate signal intensity in t1-weighted images and a high signal intensity in t2-weighted images ( vascularity is manifested as a high signal intensity ) .
invasive diagnostic techniques , such as open or percutaneous ( ct - guided or echo - guided ) needle biopsy are also available , but needle biopsy of hemangioma may cause bleeding . in the case of big hemangiomas , a preoperative embolization of hemangiomas with the aim to minimize the risk of intraoperative complications like excessive bleeding ,
intercostal hemangiomas are managed by complete surgical chest wall resection with clean surgical margins . the next decision about skeletal reconstruction
posterior defects that lie above the fourth rib and are covered by the scapula do not need to be reconstructed .
the choice of synthetic prosthetic material depends on the location of the defect , its size and surgeon 's preference and experience . in conclusion
presumptive diagnosis was based on mr , resection was performed for definitive diagnosis and treatment .
 the authors describe a case of a 36-year - old patient who had six months pain of the thoracic spine and left chest . 
 a soft slowly growing resistance was present on the dorso - lateral side of the left chest wall , in the range of the seventh to ninth rib . according to the medical history 
 , the patient did not have any prior trauma and malignancy . 
 a well - defined tumor of the left chest wall with calcifications , which grew to the seventh and eighth intercostal space , was present on computed tomography ( ct ) and magnetic resonance ( mr ) scans . 
 the patient underwent resection of the tumor with the chest wall and reconstruction with polypropylene mesh . 
 histologically , it was a venous hemangioma , one of very rare tumors of the chest wall . 
Introduction
Case report
Discussion
Disclosure