A rare case of pyomyositis with intramuscular hemangioma in the upper arm.

Abstract

Intramuscular hemangiomas are infrequently considered in musculoskeletal pain differentials, particularly in the upper extremities, and their coexistence with infectious abscesses within the biceps brachii muscle is exceptionally rare. We report a case of intramuscular hemangioma with abscess formation in the biceps muscle of a 56-year-old male who presented with left upper arm pain and swelling, a hot sensation, redness, and limitations of elbow flexion and forearm supination. The level of C-reactive protein was high (25.43 mg/dL), and the visual analogue scale score was 10 with left upper arm and elbow movement before surgery. Plain radiograph revealed 3 small phleboliths. Magnetic resonance imaging showed an ill-defined enhancing lesion (2.5×2.7×9.8 cm) within the left lateral part of biceps muscle with increased T1-weighted signal throughout and a small, round, low-signal-intensity focus within the lesion, consistent with an intramuscular hemangioma, and a geographic non-enhancing area in the medial part of the biceps muscle, consistent with infectious myositis with abscess formation. We performed surgery for excision of the intramuscular hemangioma and drainage of the abscess in the biceps muscle. By 5 weeks post-surgery, all functional limitations had resolved, and no recurrence was observed at the 5-month follow-up.