Shoulder Pain, Swelling

No complaint of blackening or redness over right shoulder and no complaint of tingling, numbness, or paresthesia.

Figure 1. Plain radiographic images: A small well-defined elongated radiolucent area surrounded by focal calcification lateral to upper shaft of right humerus. Increased soft tissue shadow over lateral aspect of right shoulder suggestive of soft tissue lesion.

Figure 2. Grey scale and color Doppler sonographic images: Ill-defined hypoechoic lesion of heterogeneous echotexture with minimal internal vascularity on color Doppler study along with phlebolith in intramuscular plane at posterolateral aspect of right shoulder.

Figure 3. Plain MRI images: A well-circumscribed, lobulated, multifocal, variably sized, altered signal intensity lesion noted involving intramuscular plane and intermuscular plane of right shoulder girdle which appears hyperintense with multiple internal fluid-fluid level on T2WI and iso- to hypointense on T1WI as compared to adjacent to muscle with phlebolith and does not suppress on fat saturated T1WI. The lesion causes smooth scalloping of underlying cortex of lateral aspect of proximal shaft of adjacent humerus.

Figure 4. Contrast MRI images: The lesion shows mild to moderate heterogeneous enhancement.

On local examination, soft swelling is noted on posterolateral aspect of right shoulder.

On grey scale and color Doppler sonographic study, an ill-defined, hypoechoic lesion of heterogeneous echo texture with minimal internal vascularity on color Doppler study is noted in intramuscular plane.

It appears hyperintense on T2WI and STIR images and iso- to hypo-intense on T1WI as compared to adjacent to muscle.

The lesion causes chondral loss with irregularity and flattening of greater tuberosity of humerus. No evidence of shoulder joint effusion is noted.

Hemangiomas are benign vascular neoplasms or hamartomas, which are indigenous to the site of origin.

Most hemangiomas can be diagnosed on clinical examination and do not require any investigation or treatment, as they tend to subside spontaneously.

Hemangioma can be distinguished from other soft tissue lesions by the features of abundant vascularity and high blood flow velocity.

MRI aids in discerning and delineating deep situated and large intramuscular hemangioma and it gives the best diagnostic information.

On pathologic analysis, vascular lesions can be classified as capillary, cavernous, venous, and arteriovenous malformations, depending on the predominant anomalous vascular channels.

The treatment of choice is total excision.

Intramuscular hemangioma should be considered in the differential diagnosis.