Case analysis and clinical implications of a hemangioma located between the pronator quadratus and interosseous membrane

Abstract

Background

Hemangiomas are seldom considered as a differential diagnosis for conditions with common etiologies. Reports detailing hemangiomas in unique locations with comprehensive analyses are scarce. This study aims to investigate a hemangioma uniquely located between the pronator quadratus (PQ) and the interosseous membrane (IOM) with gross, histological, and biomechanical analyses.

Methods

A unilateral (right) hemangioma was discovered during routine dissection of an adult human cadaver, measured, weighed, transected, and photographed. Two tissue samples were collected, processed for histology (H&E), and scanned for examination via digital light microscopy. Maximal isometric force (F_max) of the overlying PQ was calculated to determine the central force vector that would compress the hemangioma upon contraction.

Results

The 4.85 g multilobulated hemangioma was supplied by the anterior interosseous artery and bound by the PQ, IOM, and distal radius and ulna. The hemangioma was roughly circular (r = ∼2.65 cm) in the coronal plane and disproportionally thicker on its ulnar side (1.88 cm vs. 0.45 cm). Histological analysis revealed atrophic skeletal muscle and clusters of leukocytes. The PQ muscle exhibited a F_max of 45.47 N and the ability to compress the hemangioma with 12.56 N.

Conclusions

Despite its likelihood for provoking sequelae, a hemangioma presenting between the PQ and IOM may not be considered when evaluating musculoskeletal pain, distal forearm fractures, compartment syndrome, or carpal tunnel syndrome. This study may provide new and important insights to orthopedists, vascular surgeons, medical educators, clinical anatomists, and allied health professionals when analyzing, diagnosing, or treating related cases.