Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4307-4313
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4307
Three-dimensional image simulation of primary diaphragmatic hemangioma: A case report
Pei-Yi Chu, Kuan-Hsun Lin, Hao-Lun Kao, Yi-Jen Peng, Tsai-Wang Huang
Pei-Yi Chu, Kuan-Hsun Lin, Tsai-Wang Huang, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Hao-Lun Kao, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Yi-Jen Peng, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Chu PY is the first author of this case report, and she wrote the case report and completed literature review; Lin KH was the assistant surgeon, and he made the 3D image constructor; Kao HL was the attending radiologist; Peng YJ was the attending pathologist; Huang TW was the attending surgeon; Huang TW made final editing and reconstruction of the paper for approval; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tsai-Wang Huang, MD, PhD, Chief Doctor, Surgeon, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Neihu District, Taipei 114, Taiwan. chi-wang@yahoo.com.tw
Telephone: +886-2-87927167 Fax: +886-2-87927403
Received: September 13, 2019
Peer-review started: September 13, 2019
First decision: October 24, 2019
Revised: November 8, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 26, 2019
Abstract
BACKGROUND

Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional (3D) simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.

CASE SUMMARY

A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.

CONCLUSION

In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.

Keywords: Diaphragmatic tumor, Hemangioma, Case report, Three-dimensional image simulation, Video-assisted thoracic surgery, Thoracoscopy

Core tip: Diaphragmatic hemangioma is rare, and its diagnosis is challenging. We present the case of a 40-year-old man with incidental abnormal findings in chest imaging studies. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm. Three-dimensional (3D) image simulation revealed a supra-diaphragmatic tumor. Successful tumor resection followed by primary repair of diaphragm was performed via minimally invasive thoracoscopic surgery. The pathological findings confirmed a primary cavernous hemangioma of the diaphragm. In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.