Dynamic computed tomography in the diagnosis of two mediastinal hemangiomas

Mediastinal hemangioma is a rare benign vascular lesion representing less than 0.5% of mediastinal masses and remains a diagnostic challenge because of its non-specific clinical and radiological presentation. We report two cases of mediastinal hemangioma in which dynamic contrast-enhanced CT demonstrated characteristic imaging findings that enabled a confident preoperative diagnosis. In both cases, the lesions showed early peripheral focal enhancement with progressive and persistent delayed centripetal fill-in, associated with draining veins, closely resembling the enhancement pattern of hepatic hemangiomas. In the first case, involving an asymptomatic 70-year-old man with a small anterior mediastinal lesion, these findings allowed conservative management and avoided unnecessary surgery. In the second case, a 56-year-old woman presented with dyspnea caused by a large infiltrative mediastinal mass encasing major vascular structures. Recognition of the vascular nature of the lesion avoided percutaneous biopsy and its potential hemorrhagic complications. These cases highlight the diagnostic value of dynamic CT in mediastinal hemangioma and emphasize that recognition of its characteristic progressive centripetal enhancement pattern and draining veins may enable a confident non-invasive diagnosis, thereby helping to avoid unnecessary biopsy or surgery and their associated hemorrhagic risk.