Giant esophageal hemangioma diagnosed by (99m)Tc-HSA-D scintigraphy following equivocal CT, MRI, and endoscopy

Mediastinal cavernous hemangioma is a rare lesion requiring diagnosis without invasive procedure due to the risk of hemorrhage, which can be massive and even fatal. Here we describe the successful diagnosis of such a lesion using technetium-99m diethylenetriamine penta-acetic acid human serum albumin ((99m)Tc-HSA-D) scintigraphy. A 36-year-old female with a 3-week back pain underwent endoscopic ultrasonography, contrast-enhanced CT, and MRI dynamic study which together revealed a submucosal tumor of the esophagus; likely to be either hemangioma or lymphangioma. Because of poor or no enhancement, it was impossible to distinguish the nature of the lesion. However, using delayed blood-pool imaging of (99m)Tc-HSA-D (at 40 minutes postinjection), and the characteristic accumulation, the tumor was clearly identifiable as an esophageal hemangioma. This case shows (99m)Tc-HSA-D scintigraphy to be an effective noninvasive imaging method to capture the characteristic hemodynamics of hemangioma.