Severe progressive scoliosis due to huge subcutaneous cavernous hemangioma: A case report

Cavernous hemangioma consists mainly of congenital vascular malformations, which is present before birth and gradually increasing in size with skeletal growth. The vertebral body is one of the most commonly recognized sites of cavernous hemangioma, and found incidentally on radiological imaging[1,2]. While many cases of hemangioma are asymptomatic, others present with pain or spinal deformity, and those located within the spinal canal may present with neurological disorders. There are several reports of scoliosis secondary to cavernous hemangioma originating in the vertebral body [3-6], and one of scoliosis secondary to a subcutaneous cavernous hemangioma[7]. However, to our knowledge, there are no reports of surgical treatment for these conditions. Here we report a case of scoliosis caused by a huge subcutaneous cavernous hemangioma that was surgically treated.A 12-year-old boy with progressive trunk deformity and a huge subcutaneous tumor was referred to our department. At the age of three, the subcutaneous tumor was found in the back, and biopsy of the tumor indicated a diagnosis of cavernous hemangioma. During that biopsy, a massive hemorrhage occurred, and the patient required a blood transfusion (3000 ml). Scoliosis was diagnosed at age 11, and the patient underwent brace treatment. However, the scoliosis worsened progressively, and the patient was finally referred to our department. Upon physical examination, we found significant protrusion of the right back ribs. On the left back was a huge subcutaneous tumor, measuring approximately 15 cm in diameter, and a scar from a previous surgical wound that was approximately 5 cm long (Figure 1). The mass was not tender or throbbing, and no neurological abnormalities were observed.Full-length, standing radiographs demonstrated a scoliosis of 85° at T6-L1 and a kyphosis of 58° at T4-T10. The Risser sign was grade zero, and the triradiate cartilages were open (Figure 2). Traction radiography showed a correction rate of