Diagnostic imaging challenge of an extensive anorectal cavernous hemangioma: a case report

Anorectal vascular lesions, such as hemangiomas and vascular malformations, are uncommon clinical entities.Cavernous hemangioma is particularly rare, with only a limited number of histopathologically confirmed cases reported in the literature.This case report presents a 20-year-old woman with lifelong hematochezia and transfusion-dependent anemia.She was previously misdiagnosed with grade III hemorrhoidal disease.Non-contrast-enhanced computed tomography (CT) images showed multiple mural phleboliths in the rectal region.Contrast-enhanced CT showed concentric mural thickening of the rectum, multiple perirectal serpentine vascular structures, and phleboliths in the rectal wall.Contrast-enhanced pelvic magnetic resonance imaging (MRI) demonstrated diffuse circumferential rectal wall thickening and numerous perirectal serpiginous vessels.There was marked enhancement of the rectal wall and perirectal vessels after gadolinium administration with signal voids corresponding to phleboliths.The combination of phleboliths and serpentine vessels is a pathognomonic feature that suggests the diagnosis of cavernous hemangioma.Laparoscopic abdominoperineal resection was successful, and the patient was discharged with a functional colostomy.Postoperative imaging confirmed complete lesion resection.Histopathologic examination of the surgical specimen confirmed the diagnosis of cavernous hemangioma.This case report is for educational purposes.It exemplifies the essential imaging-pathologic correlation and highlights the critical role of multimodality imaging.