Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 264-265

Management of thigh hemangioma by laser ablation


Orchid Centre for Laser Surgery, Mumbai, Maharashtra, India

Date of Submission04-Aug-2020
Date of Decision07-Aug-2020
Date of Acceptance28-Sep-2020
Date of Web Publication6-Jul-2021

Correspondence Address:
Rusy S Bhalla
Orchid Centre for Laser Surgery, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_113_20

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  Abstract 


Intramuscular hemangiomas are 0.8% of soft-tissue swellings. They can be present in adipose tissue or intramuscular compartment. Conventional management includes Compression, sclerotherapy, embolization, corticosteroids, and surgical excision. The laser is now advocated for hemangiomas due to no cosmetic deformity and high effectiveness. Presenting a case of Thigh hemangioma involving Vastus lateralis muscle.

Keywords: Congenital hemangioma, laser ablation, thigh hemangioma


How to cite this article:
Bhalla RS, Kapadia R A. Management of thigh hemangioma by laser ablation. Indian J Vasc Endovasc Surg 2021;8:264-5

How to cite this URL:
Bhalla RS, Kapadia R A. Management of thigh hemangioma by laser ablation. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2021 Jul 25];8:264-5. Available from: https://www.indjvascsurg.org/text.asp?2021/8/3/264/320610




  Introduction Top


Thigh hemangioma is an uncommon condition occurring in adults. Most treatment options available are currently not satisfactory for the patient [Figure 1]. Laser ablation offers a viable alternative to close the venous spaces under direct ultrasonography control.[1],[2],[3],[4],[5],[6],[7],[8]
Figure 1: Image showing swelling of thigh due to underlying hemangioma

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There is no cosmetic mutilation of the patient and a better acceptance factor.[9]

Aims

The aim of the management of this case was to ablate the venous spaces by laser and follow the results thereafter.


  Settings and Design Top


The case was a 28-year-old male patient presenting with a gradually increasing thigh circumference and soft swelling in the anterior part of the thigh. Other symptoms included progressive pain at rest and increasing while walking.

Magnetic resonance imaging (MRI) showed and extensive lesion in vastus lateralis muscle of the thigh [Figure 2].
Figure 2: MRI scan of thigh hemangioma of Vastus Lateralis pre laser

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The patient had been advised surgical excision but was unwilling for such a mutilating procedure.


  Materials and Methods Top


The patient was counseled for possible side effects of procedure, including infection and further sessions of laser.[6]

The procedure was performed Under spinal anesthesia. The hemangioma was localized under ultrasonography control.

The vascular spaces were identified, and so was the main femoral artery and vessels.

The vascular spaces were laserized under sonography control on real-time basis. The laserization and consequent defunctionalization of vascular spaces were confirmed under sonography Doppler control.

The patient tolerated the procedure well; the multiple needle marks disappeared in 2 weeks, and no skin burns were seen.

The patient was discharged on 2nd day.


  Results Top


Postoperative recovery

The pain of the thigh was decreased to a negligible level within 24 h.

Repeat MRI at 2 months showed a total resolution of the lesion [Figure 3].
Figure 3: Resolution of thigh hemangioma with no muscle loss after 2 months

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The patient presented again after 4 months with swelling of thigh locally. He was again scanned, and an avascular mass was noted at the site. The patient was counseled, and the excision of the mass was undertaken, which was found to be the necrosed leftover of the hemangioma in the subcutaneous tissue.

The patient recovered uneventfully. He has been symptom-free with no recurrence at the end of 5 years.


  Discussion Top


Interstitial laser ablation for vascular malformations using neodymium: yttrium aluminum garnet laser was reported as early as 1986.[8]

Laser ablation works by imparting heat energy to the endothelium and denaturation of blood proteins.

This leads to clotting of the vascular spaces and consequent retrograde thrombosis. Eventually, it leads to fibrosis of the compartment.


  Conclusions Top


Laser ablation of thigh hemangioma is a very good alternative and adjunct to surgery and sclerotherapy. It affords real-time demonstration of the closure of vascular spaces. Any recurrences can also be managed by relaserizing the affected area.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brown RA, Crichton K, Malouf GM. Intramuscular haemangioma of the thigh in a basketball player. Br J Sports Med 2004;38:346-8.  Back to cited text no. 1
    
2.
Wierzbicki JM, Henderson JH, Scarborough MT, Bush CH, et al. Intramuscular Hemangiomas Sports Health 2013;5:448-54. doi: 10.1177/1941738112470910PMCID: PMC3752185PMID: 24427416.  Back to cited text no. 2
    
3.
Buetow PC, Kransdorf MJ, Moser RP, Jelinek JS, Berrey BH. Radiologic appearance of intramuscular hemangioma with emphasis on MR imaging. AJR 1990;154:563-7.  Back to cited text no. 3
    
4.
Allen PW, Enzinger FM. Hemangioma of skeletal muscle: An analysis of 89 cases. Cancer 1972;29:8-22.  Back to cited text no. 4
    
5.
Beham A, Fletcher CD. Intramuscular angioma: A clinicopathological analysis of 74 cases. Histopathology 1991;18:53-9.  Back to cited text no. 5
    
6.
Bella G, Manivel J, Thompson R, Clohisy D, Cheng E. Intramuscular hemangioma: Recurrence risk related to surgical margins. Clin Orthop Relat Res 2007;459:186-91.  Back to cited text no. 6
    
7.
Patel PA, Barnacle AM, Stuart S, Amaral JG, John PR. Endovenous laser ablation therapy in children: Applications and outcomes. Pediatric Radiology 2017;47:1353-63.  Back to cited text no. 7
    
8.
Lahrach K, Abdulrazak S, Marzouki A, Boutayeb F. Surgical management of intramuscular hemangioma of the foot: A case report. Patient Safety in Surgery 2009;13:Article number: 17.  Back to cited text no. 8
    
9.
Rosenfeld H, Sherman R. Treatment of cutaneous and deep vascular lesions with the Nd: YAG laser. Lasers Surg Med 1986;6:50-1.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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