https://orcid.org/0000-0003-1219-3690
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Zhongyi Zeng, Haonan Lin, Xiaoqin Lai, Feng Lin, ‘Rubies’ on the lung surface: pulmonary cavernous hemangioma, QJM: An International Journal of Medicine, Volume 117, Issue 11, November 2024, Pages 793–794, https://doi.org/10.1093/qjmed/hcae122
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A 35-year-old woman was admitted with a pulmonary nodule that was asymptomatic for over 3 years. Physical examination was not abnormal. A chest CT showed a solid nodule in the right lower lobe (Figure 1a). Considering the risk of malignancy, the patient underwent thoracoscopic wedge resection of the involved lobe. During the operation, a red vascular mass, which resembled a ‘ruby’, appeared on the lung surface (Figure 1b). Pulmonary cavernous hemangioma (PCH) was diagnosed with postoperative histopathological examination. The patient had no symptoms or recurrence at 2 months postoperative follow-up.
PCH is a rare disease, and its pathogenesis is not completely clear. Consequently, most of the auxiliary examinations of PCH are not specific, so misdiagnosis is common. Its diagnosis is often confused with other lung diseases, such as pulmonary tuberculosis, metastatic tumors, lung cancer, hamartomas, and so on.1 The definite diagnosis of PCH requires a histopathological examination. Most patients have no clinical symptoms, but a few patients have clinical symptoms such as hemoptysis, dyspnea, and chest pain, depending on the tumor’s location, size, and number.2,3 PCH can occur on all lobes, involving the surface and parenchyma of the lung, with surface PCH present as abnormal vascular masses resembling ‘rubies’. Currently, there is no consensus on the treatment of PCH, but surgical intervention is usually preferred for solitary, symptomatic, or suspected malignant cases.4,5 For asymptomatic and stable PCH, regular imaging follow-up may be appropriate.2,5 This case demonstrates that abnormal vascular masses on the lung surface should raise a high suspicion for PCH to avoid overtreatment.
