Hemolymphangioma involving bones and bladder detected on (68)Ga-NEB PET/CT: A rare case report

RATIONALE: Hemolymphangioma is a rare developmental defect of combined vasal and lymphatic vasculature. It is very rare that hemolymphangioma affects the bones and bladder simultaneously, and this condition has never been reported in PubMed. PATIENT CONCERNS: A 12-year-old male has a history of hospitalization for recurrent episodes of chyluria of 8 years duration and progressively worsening gross hematuria with right hip pain for 6 months. DIAGNOSIS: Chylous test of urine fluid was positive. There was no organic disease in the kidneys. (68)Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography (PET/CT) images demonstrated clearly several round and strip-shaped low-density shadows with mildly increased radioactive uptake in both bladder wall and pelvis, including sacral, pubic, and ischial bones. Histopathological analysis of biopsy on pubic and ischial bones confirmed the diagnosis of hemolymphangioma. INTERVENTIONS: The patient received treatment with traditional Chinese medicine. OUTCOMES: At the 6-month follow-up visit, the patient's symptoms of chyluria, hematuria, and pain were all mitigated. LESSONS: Hemolymphangioma is a rare benign disease. (68)Ga-NEB PET/CT is a specific method for the lymphatic system, and it might provide more accurate and comprehensive information about the disorder of the lymphatic system compared with CT and magnetic resonance imaging. When patients suffer from suspected lesions of the lymphatic system, (68)Ga-NEB PET/CT might be recommended.