Hemangioma cavernoso / Cavernous Hemangioma

El hemangioma cavernoso es una neoplasia benigna de los vasos sanguíneos. Este trabajo tuvo como objetivo presentar el caso de un hemangioma cavernoso gigante que fue tratado con propranolol. El diagnóstico se realizó mediante examen físico, dúplex y otros complementarios de interés. Para la decisión de la conducta terapéutica, especialistas de diferentes especialidades evaluaron al paciente: Oncología, Dermatología, Ortopedia, Pediatría y Angiología. Una vez establecido el tratamiento, se realizó un seguimiento durante cuatro semanas y luego mensual. El resultado, después de 22 meses, fue la desaparición del hemangioma. El propranolol en el hemangioma cavernoso gigante debe ser el tratamiento de elección precoz para una evolución satisfactoria y evitar complicaciones(AU)

Cavernous hemangioma is a benign neoplasm of blood vessels. This work aimed at presenting the case of a giant cavernous hemangioma treated with propranolol. The diagnosis was made by physical examination, duplex Doppler sonography, and complementary tests of interest. For deciding the therapeutic approach, the patient was assessed by several specialists from different medical fields, such as oncology, dermatology, orthopedics, pediatrics, and angiology. Once the treatment was established, a follow-up was carried out for four weeks and then monthly. The outcome, after twenty-two months, was the hemangioma disappearance. Propranolol in giant cavernous hemangioma should be the treatment of early choice for a satisfactory evolution and to avoid complications(AU)

Presentación inusual de hemangioma arteriovenoso trombosado de rodilla: reporte de caso / Unusual thrombosed arteriovenous hemangioma of the knee. Case report

Se presenta un caso de presentación inusual de hemangioma arteriovenoso trombosado de rodilla, en un paciente de sexo masculino de 54 años de edad quien consulta por dolor en cara anterior e interlínea interna de rodilla izquierda, y episodios de pseudobloqueos. Sin antecedente traumático previo. Debido a la lesión meniscal interna y la sospecha diagnóstica de tumor de partes blandas de rodilla, se indicó el tratamiento quirúrgico combinado, artroscopía para la resolución de la lesión meniscal interna y, por otro abordaje, biopsia escicional con remoción del tumor de partes blandas.El estudio anatomopatológico confirmó el diagnóstico de hemangioma arteriovenoso trombosado. Tipo de estudio: Reporte de caso. Nivel de evidencia: V

We present an unusual case of thrombosed arteriovenous hemangioma of the knee. A 54-year-old male patient, with pain about de left knee, with previous blocking episodes, without prior traumatic history.Due to the internal meniscus lesion and diagnostic suspicion of soft tissue tumor of the knee. Surgical treatment was considered, both, arthroscopy and mini open surgery.Surgical treatment was performed, arthroscopy and biopsy with removal of the soft tissue tumor. Histopathological findings confirmed the diagnosis of thrombosed arteriovenous hemangioma. Type of study: Case report. Level of evidence: V

Extradural lumbar nerve root cavernous hemangioma: case report and successful surgical resection / Hemangioma cavernoso extradural de raiz nervosa lombar: relato de caso e ressecção cirúrgica bem-sucedida

Extradural lumbar spinal canal cavernous hemangiomas (or cavernomas) are rare lesions that can induce intense back pain and neurological deficit. We present a case report of a patient with a pure radicular lombar extradural cavernoma resembling a benign neurological tumor in imaging exams and a successful surgical resection.

Os hemangiomas cavernosos do canal vertebral lombar extradural (ou cavernomas) são lesões raras que podem induzir dor intensa no dorso e déficit neurológico. Apresentamos um relato de caso de um paciente com um cavernoma extradural lombar radicular puro assemelhando-se a um tumor neurológico benigno em exames de imagem e uma ressecção cirúrgica bem-sucedida.

Hemangioma cavernomatoso hepático gigante, presentación infrecuente de una lesión común / Giant hepatic hemangioma, an uncommon presentation of a frequent disease

Los hemangiomas hepáticos, también denominados hemangiomas cavernomatosos, son los tumores hepáticos más comunes. Se caracterizan por ser lesiones solitarias, pequeñas y benignas que se diagnostican frecuentemente de forma incidental. Suelen ser lesiones asintomáticas, si bien los síntomas se presentan más frecuentemente en aquellas lesiones mayores de 5 cm, también conocidas como hemangiomas gigantes. Presentamos el caso de una mujer de 43 años, pauci-asintomática que presenta un hemangioma gigante de 16x16x27 cm, así como se realiza una revisión sistemática de la literatura.

Hepatic hemangiomas, also referred to as cavernous hemangiomas, are the most common benign mesenchymal hepatic tumors. They are often solitary, small lesions that have an excellent safety-prognosis and were commonly incidentally detected. Hepatic hemangiomas are frequently asymptomatic, although symptoms are more likely in those lesions larger than 5 cm also referred to as giant hemangiomas. We present a case of a pauci-asymptomatic 43 year-old woman with an uncommon 16x16x27 cm giant hemangioma and perform a review of the literature.

Hemangioma cavernoso laríngeo en adultos: reporte de un caso y revisión de la literatura / Cavernous hemangioma of the larynx in adults: case report and literature review

RESUMEN Los hemangiomas son uno de los tumores más frecuentes en cabeza y cuello. Los hemangiomas de laringe se pueden dividir clínicamente en formas infantiles y adultas. En niños es una patología frecuente, mientras que en adultos es muy infrecuente. En adultos, tiene mayor incidencia en hombres y su ubicación más frecuente es supraglótica. Su histología más frecuente es el hemangioma cavernoso (HC), que corresponde a una malformación de origen venoso, con paredes delgadas y vasos dilatados. La presentación más habitual es con disfonía o ronquera de meses o años de evolución y se sospecha mediante la nasofaringolaringoscopía o el estudio de imágenes (TC y/o RM). Existen distintas formas de tratamiento, incluidas la observación, la corticoterapia, la radioterapia, la cirugía láser, la cirugía abierta, etc., sin existir un consenso sobre la mejor opción. Se presenta el caso de un paciente de 43 años con antecedentes de tabaquismo que consultó por una historia de disfonía de un año de evolución. Se diagnosticó mediante nasofaringolaringoscopía y TC de cuello una gran masa supraglótica que se extirpó mediante un abordaje de laringofisura. La biopsia diferida informó un HC.

ABSTRACT Hemangiomas are one of the most frequent head and neck tumors. Clinically, they can be divided into childish and adult forms. In children it is a frequent pathology, whereas in adults it is very rare. In adults, it has a higher incidence in men and its more frequent location is supraglottic. Its most frequent histology is the cavernous hemangioma, which corresponds to a malformation of venous origin, with thin walls and dilated vessels. The most common presentation is with the disphony or hoarseness lasting from months to years of evolution and suspicion is made through nasofibroscopy or the imaging study (CT and / or MRI). There are different forms of treatment, including observation, corticotherapy, radiotherapy, laser surgery, open surgery, etc., without a consensus on the best option. We present the case of a 43 year old male with a history of smoking who consulted for dysphonia of a year of evolution. A large supraglottic mass was diagnosed through nasofibroscopy and CT of the neck, which is removed by a laryngopharyngeal approach. Deferred biopsy reported a cavernous hemangioma.

Hemangioma gástrico como causa de hemorragia digestiva alta / Gastric hemangioma as a cause of upper gastrointestinal bleeding

El hemangioma gástrico como causa de hemorragia digestiva alta (HDA) es un evento clínico raro. Presentamos el caso de un varón de 83 años con historia de dolor abdominal, intolerancia oral y melena con pérdida de peso de 8 Kg. En la endoscopía digestiva alta muestra una lesión elevada en antro gástrico con úlcera y vaso visible en su parte superior el cual recibe terapia endoscópica, en la tomografía abdominal se observa una tumoración dependiente de pared gástrica de contornos definidos captadora de contraste. Por persistencia HDA con descompensación hemodinámica ingresa a laparotomía exploratoria encontrándose una tumoración vascularizada que en el estudio histopatológico se concluye como hemangioma cavernoso gástrico.

Gastric hemangioma as a cause of upper gastrointestinal bleeding (UGIB) is a rare event. We present the case of an 83 years old male with a history of abdominal pain, vomiting and melena, along with an 8 Kg weight loss. The upper gastrointestinal endoscopy showed an elevated, ulcerated lesion in the gastric antrum with a visible vessel, for which he receives endoscopic therapy. In the abdominal computed tomography, a contrast enhancing, well-circumscribed mass attached to the gastric wall is observed. Due to the persistence of the UGIB, the patient suffers hemodynamic decompensation and undergoes exploratory laparotomy, where a vascularized mass is found. The pathology report informs a gastric cavernous hemangioma

Cavernomas de tronco encefálico: presentación de 8 casos operados, análisis y revisión del estado del arte / Brainstem cavernous malformations: a series of 8 surgicalcases, analysis and state of the art review

Introducción: Las lesiones del tronco cerebral son uno de los mayores desafíos neuroquirúrgicos. Los angiomas cavernosos de esta localización son lesiones de comportamiento agresivo, con alta morbi-mortalidad asociada, donde el neurocirujano tiene la posibilidad de curar al paciente pero con un nivel de riesgo que hacen que la oportunidad de la cirugía se mantenga en debate. Material y Método: Análisis retrospectivo de 8 casos de cavernomas de tronco operados entre los años 2009-2013 con sus características clínicas, quirúrgicas y de seguimiento. Se realiza además una revisión reflexiva sobre la evolución del manejo de estas lesiones y del estado del arte a nivel en el concierto internacional. Resultados: Los 8 casos presentaron evoluciones inmediatas y mediatas favorables tras la cirugía. No hubo mortalidad ni empeoramiento del status neurológico en relación al estado preoperatorio en ninguno de los 8 casos. Tres de los pacientes de la serie fueron operados tras caer en una condición clínica crítica y son los que registran los mayores déficits durante el seguimiento. El análisis de la evolución del manejo de este tipo de lesiones a nivel mundial revela una tendencia hacia el manejo quirúrgico precoz en lesiones sintomáticas. Conclusiones: Los resultados de esta serie así como la evolución del estado del arte permiten concluir que en pacientes sintomáticos una cirugía precoz ofrece en general mejores expectativas que intervenciones tardías para lesiones relativamente superficiales.

Introduction: Brainstem lesions are a major neurosurgical challenge. Cavernous angiomas of this location are lesions of aggressive behavior, with high morbidity and mortality associated, where the neurosurgeon has the possibility to cure the patient but with a level of risk that makes that the surgery timing remains under debate. Material and Methods: A retrospective analysis of 8 brainstem cavernomas cases operated in the period 2009-2013 is presented whit its clinical, surgical and follow-up characteristics. A thoughtful review of the evolution of the management of these lesions and the state of art in the international level is also carried out. Results: All 8 patients presented immediate and mediate favorable changes after surgery. There was no mortality or worsening of the neurological condition in relation to the preoperative status in any of the 8 cases. 3 patients in this series underwent surgery after falling in a critical condition and are those who have the highest deficit in the follow-up. The analysis of the evolution of the worldwide management of these injuries reveals a trend towards early surgical management in symptomatic lesions. Conclusions: The results of this series as well as the evolution of the state of the art let us conclude that in symptomatic patients an early surgery offers overall better expectations than later interventions in relatively superficial lesions.

Computed Tomography and Magnetic Resonance Imaging Findings of Nasal Cavity Hemangiomas According to Histological Type

OBJECTIVE: To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma). MATERIALS AND METHODS: CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes. RESULTS: The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases. CONCLUSION: CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.

Rare cavernous hemangioma of adrenal gland: case report / Hemangioma cavernoso raro da glândula adrenal: relato de caso

CONTEXT: Cavernous hemangiomas of the adrenal gland are rare benign neoplastic tumors. The clinical presentation of adrenal hemangiomas is usually vague, and they are often discovered incidentally through imaging examination s performed for other reasons. CASE REPORT: We report the case of a non-functional adrenal hemangioma found incidentally in a 37-year-old man with a one-year history of headache and hypertension. A right adrenal mass was detected by means of magnetic resonance imaging. Physical examination and all laboratory values were unremarkable. The patient underwent laparoscopic right adrenal gland resection. Histopathological evaluation confirmed adrenal cavernous hemangioma. CONCLUSIONS: Most occurrences of cavernous hemangiomas of the adrenal gland are non-functional and often discovered incidentally. Although rare, these unusual benign adrenal masses should form part of the differential diagnosis of adrenal neoplasms. The proper treatment for adrenal cavernous hemangioma is surgical removal. .

CONTEXTO: Hemangiomas cavernosos da glândula adrenal são tumores neoplásicos raros, benignos. A apresentação clínica dos hemangiomas adrenais é geralmente vaga e muitas vezes eles são descobertos acidentalmente por exame imagiológico realizado por outras razões. RELATO DE CASO: Nós relatamos um caso de hemangioma adrenal não funcional encontrado por acaso em um homem de 37 anos de idade com histórico de um ano de dor de cabeça e hipertensão. Foi detectada massa adrenal direita por meio de ressonância magnética. Exame físico e todos os valores de laboratoriais estavam normais. O paciente foi submetido a cirurgia laparoscópica para ressecção da glândula adrenal direita. Avaliação histopatológica confirmou hemangioma adrenal cavernoso. CONCLUSÃO: A maioria dos hemangiomas cavernosos de glândula adrenal são não funcionais e muitas vezes descobertos por acaso. Embora raras, essas massas adrenais benignas devem ser parte de um diagnóstico diferencial de neoplasias suprarrenais. O tratamento adequado para o hemangioma adrenal cavernoso é a remoção cirúrgica. .

Preoperative embolization of a cavernous hemangioma of the rectum / Embolização pré-operatória do hemangioma cavernoso do reto

Colorectal cavernous hemangioma is a rare benign vascular neoplasia that may be found in any segment of the colon and cause recurrent and painless rectal bleeding. Standard treatment of rectal hemangioma consists of resection of the affected segment followed by coloanal anastomosis. Massive bleeding during the operation is the most feared complication, especially during extensive resection or reoperation. The authors describe a preoperative embolization of a rectal hemangioma with Onyx-18(R) and microspheres, in a 49-year-old patient with successful prevention of uncontrolled hemorrhage during surgery. (AU)

O hemangioma colorretal cavernoso é uma neoplasia vascular benigna rara, que pode comprometer qualquer segmento do colón e causar sangramento retal indolor recorrente. O tratamento habitual da doença retal inclui ressecção do segmento afetado seguido de anastomose coloanal. Sangramento retal no intra-operatório é uma complicação temível especialmente durante ressecções extensas ou reoperações. Os autores descrevem a embolização pré-operatória com microesferas e Onyx-18(R) de um hemangioma retal em um paciente de 49 anos, com controle satisfatório de hemorragia maciça durante o ato cirúrgico. (AU)

Tumor of orbit / Tumor orbitário

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Os hemangiomas cavernosos são os tumores intraorbitais mais comuns encontrados em adultos de meia-idade. Embora histológico benigno, eles podem invadir a área orbital ou intraorbital ou ainda as estruturas adjacentes (nervo óptico) e ser considerado anatomicamente ou posicional maligno. Apresentamos um relato de caso de hemangioma cavernoso orbital da órbita direita em mulheres jovens após a gravidez, a partir de Topola perto Kragujevac (Central Sérvia), com comprometimento visual e medicado por tratamento cirúrgico endoscópico transnasal. O paciente foi controlado e tratado com terapia, terapia tópica sintomático de lágrimas artificiais e tratamento cirúrgico. Nosso paciente tem acuidade visual ideal do olho direito afetada após o tratamento cirúrgico de tumor orbital. O tratamento cirúrgico do sintomático hemangioma cavernoso orbital é segura e eficaz, de modo que os resultados cosméticos são o parâmetro importante para avaliar o resultado clínico.

Hemangioma cavernoso: relato de caso / Cavernous hemangioma: case report

O hemangioma cavernoso é uma neoformação vascular benigna de origem congênita, caracterizando pela formação de grandes canais e espaços vasculares preenchidos com sangue. O caso relatado no estudo chama atenção não só devido à magnitude da tumoração e ao comprometimento vascular, mas também pelo tempo de permanência da lesão, desde os 10 anos de idade. O tratamento para essa lesão varia com o tamanho, risco de ruptura do hemangioma e com a sintomatologia do paciente. As condutas que podem ser utilizadas são: ressecção cirúrgica; embolização arterial; enucleação cirúrgica e radioterapia. A raridade e complexidade do caso, somados à dificuldade de tratamento encontrada pela paciente no decorrer desses 20 anos de evolução tumoral, foram fatores que corroboraram para a apresentação desse caso.

The cavernous hemangioma is a benign vascular neoformation of congenital origin, characterizing by the formation of large vascular spaces filled with blood. The case reported in this study differentiates itself from other cases of hemangiomas, not only because of the magnitude of the tumor and the vascular compromise, but also due to the time of permanence that this tumor was lodged since she was 10. The treatment for this type of injury varies with the size and risk of a rupture of the hemangioma, and with the symptoms of the patient. Surgical resection, artery embolization, surgical enucleation and radiotherapy can be chosen by the doctor as alternatives for the treatment. The rarity and complexity of this case, added to the difficulty of treatment found by the patient during those 20 years of tumor development, compose the factors that corroborated to the presentation of this case.

RE: Evaluation of Hepatic Hemangiomas with Diffusion Weighted Imaging

No abstract available.

Síndrome de malformação vascular retinocefálica congênita unilateral (síndrome de Wyburn-Mason ou síndrome de Bonnet-Dechaume-Blanc) ? Relato de caso raro e revisão de literatura / Unilateral retinocephalic vascular malformation syndrome (Wyburn-Mason or BonnetDechaume-Blanc) ? Case report and literature review

A síndrome de Wyburn-Mason ou Bonnet-Dechaume-Blanc representa uma doença neurocutânea congênita rara, não hereditária, do grupo das facomatoses, caracterizada por anormalidades vasculares ipsilaterais comprometendo a face, as vias da visão e o encéfalo, não sendo obrigatória a existência concomitante dos três locais para a confirmação diagnóstica. Acredita-se que tal distúrbio seja atribuído a um defeito de desenvolvimento do mesoderma primitivo vascular. Em 1937 e 1943, foram relatados na literatura os primeiros casos de pacientes com malformações vasculares unilaterais afetando o olho, o cérebro e a face, com tamanha riqueza de detalhes, que tal quadro sindrômico passou a receber o nome dos autores responsáveis pelas publicações. A denominação de malformações vasculares retinocefálicas unilaterais (MVR) foi utilizada primeiramente em 1974. A síndrome de Wyburn-Mason tipicamente se apresenta após a terceira década de vida e se manifesta de várias formas. As manifestações oculares são as mais comuns, enquanto as manifestações cutâneas faciais podem não ser encontradas. No presente trabalho, apresentamos um caso raro da síndrome de malformação vascular retinocefálica unilateral em paciente adulta-jovem, do sexo feminino, submetida a ressecções cirúrgicas de lesões retiniana e encefálica supratentoriais, ipsilaterais, em tempos diferentes, com outra lesão infratentorial, assintomática, submetida a tratamento conservador até o momento. O anatomopatológico das lesões confirmou tratar-se de hemangioma cavernoso.

Wyburn-Mason syndrome or Bonnet-Blanc-Dechaume syndrome represents a rare congenital neurocutaneous disease, nonhereditary group of phakomatoses characterized by vascular abnormalities affecting the ipsilateral face, the vision?s pathways and brain, was not mandatory the coexistence of three locations to confirm the diagnosis. It is believed that the disorder is attributed to a defect in development of primitive vascular mesoderm. In 1937 and 1943, cases reported of patients with unilateral vascular disease affecting the eye, brain and face, with such wealth of detail, such as syndrome started to receive the name of those authors in the literature. The name of unilateral retinocephalic vascular malformation syndrome (MVR) was primarily used by in 1974. The Wyburn-Mason syndrome typically presents after the third decade of life and manifests itself in many ways. Ocular manifestations are the most common, while the facial skin manifestations cannot be found. In this paper, we present a rare case of unilateral retinocephalic vascular malformation syndrome in an adult woman, who underwent surgical resection of brain injuries and retinal supratentorial ipsilateral lesion at different times, with another infratentorial lesion, asymptomatic and underwent conservative treatment for a while. The pathology of the lesions confirmed cavernous hemangioma.

Hepatic Cavernous Hemangiomas: Relationship between Speed of Intratumoral Enhancement during Dynamic MRI and Apparent Diffusion Coefficient on Diffusion-Weighted Imaging

OBJECTIVE: To investigate the relationships between the apparent diffusion coefficients (ADCs) on diffusion-weighted imaging (DWI) and the speed of contrast-enhancement in hepatic hemangiomas. MATERIALS AND METHODS: Sixty-nine hepatic hemangiomas (> or = 1 cm) were evaluated with DWI, by using multiple b values (b = 50, 400, 800 s/mm2), followed by a gadolinium-enhanced dynamic MRI. The lesions were classified into three groups, according to the speed of contrast-enhancement on the portal phase. ADCs were measured on the ADC map automatically, and were calculated by using the two different b values (mADC50-400 with b values = 50 and 400; mADC400-800 with b values = 400 and 800 s/mm2). RESULTS: The mean ADCs (x 10-3 mm2/s) were significantly higher in the rapid group (1.9 +/- 0.44) than in the intermediate (1.7 +/- 0.35, p = 0.046) or the slow groups (1.4 +/- 0.34, p = 0.002). There were significant differences between the rapid and the slow groups in mADC50-400 (2.12 vs. 1.48; p = 0.008) and mADC400-800 (1.68 vs. 1.22, p = 0.010), and between the rapid and the intermediate groups in mADC50-400 (2.12 vs. 1.79, p = 0.049). Comparing mADC50-400 with mADC400-800, there was a significant difference only in the rapid group (p = 0.001). CONCLUSION: Higher ADCs of rapidly-enhancing hemangiomas may be related to richer intralesional vascular perfusion. Also, the restricted diffusion may be attributed to the difference of structural characteristics of hemangioma.

Hemiparkinsonism associated with mesencephalic cavernoma: case report and review of literature

Parkinsonism is a movement disorder characterized by resting tremor, slow and decreased movements (hypokinesia and akinesia), rigidity, postural instability, problems with gait, and coordination. Parkinson?s disease (PD) is the most common cause of parkinsonism and its prevalence is estimated to range from 0.1 per cent to 0.3 per cent in the general population and from 1 per cent to 2 per cent in persons 65 years of age or older. Although the majority of cases of PD are describe to be sporadic, many identifiable etiologies have been included as possible causes of parkinsonism, such as genetic disorders, cerebrovascular events and intoxication. However, mesencephalic cavernoma is an extremely rare condition associated to hemiparkinsonism. In the present report, we describe the case of a Brazilian woman that evolved symptoms of hemiparkinsonism and presented a ventral mesencephalic cavernoma on radiological investigation.

O parkinsonismo corresponde a um transtorno do movimento caracterizado por tremores de repouso, redução e lentidão dos movimentos (hipocinesia e acinesia), rigidez, instabilidade postural e problemas relacionados a marcha e coordenação. A doença de Parkinson (DP) é a causa mais comum de parkinsonismo e sua prevalência é estimada em torno de 0,1 por cento a 0,3 por cento em relação à população geral e 1 por cento a 2 por cento em pessoas acima de 65 anos de idade. Embora a maioria dos casos de DP tenha sido descrita como casos esporádicos, muitas etiologias identificáveis foram incluídas como possíveis causas de parkinsonismo, tais como alterações genéticas, eventos cerebrovasculares e intoxicações. No entanto, o cavernoma mesencefálico é uma causa de hemiparkinsonismo extremamente rara. No presente relato, descreve-se o caso de uma mulher brasileira que apresentou sintomas de hemiparkinsonismo relacionados à presença de um cavernoma mesencefálico ventral na investigação radiológica.

Hemihepatectomia derecha en un hemangioma gigante: presentación de caso / Right hemi-hepatectomy for a giant hemangioma: presentation of a case

El hemangioma hepático es el tumor benigno más frecuente del hígado, y su diagnóstico casi siempre es incidental por ecosonograma abdominal. Generalmente son asintomáticos excepto si son gigantes, que los síntomas serían por el efecto de masa. Este fue el caso de una paciente blanca, femenina de 42 años, que comenzó 6 meses antes de su diagnóstico con dolor punzante en hipocondrio derecho de ligera intensidad a los medianos esfuerzos. Se realizó un ecosonograma abdominal donde se informó una hepatomegalia de 3 cm, a predominio del lóbulo derecho, con aumento de la ecogenicidad hepática. A los tres meses se intensificó el dolor y se realizó tomografía axial computarizada contrastada de hígado, con el diagnóstico de hemangioma hepático gigante en el lóbulo derecho. Fue remitida a la consulta de Gastroenterología y se constató la hepatomegalia dolorosa del lóbulo derecho. Se interconsultó con cirugía la posibilidad de tratamiento quirúrgico. Los complementarios del ingreso estuvieron normales. Se constató en el acto quirúrgico dicho hemangioma con un tamaño de 15 x 13 x 5 cm. Se realizó resección de los segmentos hepáticos VII y VIII con ligadura de la suprahepática derecha. Fue egresada a los 5 días sin complicaciones, con reconsulta al mes, donde los complementarios evolutivos estaban normales y hubo regeneración total del lóbulo hepático resecado según el ecosonograma. La paciente se mantiene asintomática después de 3 meses de operada.

The hepatic hemangioma is the most frequent benign tumor of the liver, almost always diagnosed incidentally by abdominal echosonogram. They are mainly asymptomatic, except if they are giant, and the symptoms are the effect of the mass. This was the case of a white, female patient, aged 42 years, who, six month before the diagnosis, began having a shooting pain in the right hypochondria, of light intensity when doing media efforts. We made an abdominal echosonogram, showing a hepatomegaly of 3 cm, with a predominance of the right lobe and an increase of the hepatic ecogenicity. After 3 months, the pain intensified and we carried out a liver contrasted computerized tomography with the diagnosis of a giant hepatic hemangioma in the right lobe. She was remitted to the Gastroenterology consultation and they stated the painful hepatomegaly of the right lobe. There it was an interconsultation with the Surgery Service to explore the possibility of the surgery treatment. The complementary examinations for entering the patient were normal. In the surgery, it was found that the hemangioma measured 15x13x5 cm. We made the resection of the VII and VIII hepatic segments tying the right suprahepatic. The patient was discharged 5 days later without complications, with re-consultation after a month, when the evolutional complementary studies were normal, and there was a total regeneration of the resected hepatic lobe according to the echosonogram. The patient keeps asymptomatic after 3 months of the surgery.