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Image of the Month—Quiz Case FREE

Emad Kandil, MD; Kurtis Campbell, MD; Anthony Tufaro, MD, DDS
[+] Author Affiliations

Author Affiliation:Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr Kandil is now with the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2009;144(2):191-192. doi:10.1001/archsurg.2008.582-a.
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A 24-year-old man was referred for evaluation and management of a large left abdominal wall mass. He had no other medical problems, no history of previous surgical procedures, and no previous abdominal wall trauma. The patient had a small spot on his abdominal wall at birth that had gradually increased; in the last year, the spot exhibited a significant increase, and the patient became alarmed when he started to experience chronic abdominal pain, constant constipation, and dysuria. A fine needle aspiration biopsy of the mass revealed evidence of small blood vessel proliferation in both the dermis and the subdermal adipose tissue. On examination there was a visible, palpable, nontender, 10 × 15-cm abdominal wall mass, with bluish skin discoloration.

Abdominal computed tomography revealed evidence of a 10.3 × 15-cm vascular heterogeneous mass centered at the level of the left rectus sheath (Figure 1). Most of the mass was intraperitoneal, with mass effect on the bladder and the transverse colon. Feeding vessels were arising from the left iliac artery, with no evidence of significant adenopathy. Because of the recent significant increase in the mass, radical en block resection of this tumor was planned (Figure 2).

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Figure 1.

Computed tomographic scan of the abdomen showing intraperitoneal extension of the hemangioma, with mass effect on the colon and feeding vessels arising from the left iliac artery. 

Graphic Jump Location

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Figure 2.

Radical resection of a rectus abdominis intramuscular hemangioma with the feeding vessels ligated. 

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WHAT IS THE DIAGNOSIS?

A. Abdominal wall angiosarcoma

B. Rectus abdominis intramuscular hemangioma

C. Desmoid tumor

D. Rhabdomyosarcoma of the anterior abdominal wall

Figures

Place holder to copy figure label and caption
Figure 1.

Computed tomographic scan of the abdomen showing intraperitoneal extension of the hemangioma, with mass effect on the colon and feeding vessels arising from the left iliac artery. 

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Radical resection of a rectus abdominis intramuscular hemangioma with the feeding vessels ligated. 

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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