CASE REPORT Central haemangioma: variance in radiographic appearance A Nagpal*, S Suhas, A Ahsan, KM Pai and NN Rao Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal, Karnataka-576104, India Central haemangioma, a “great mimicker” which, fortunately, is a relatively rare condition, may pose a lethal risk for the patient. The diagnosis may become apparent only during biopsy or tooth extraction, which poses a risk of lethal exsanguination; therefore a correct diagnosis is desirable before any biopsy is undertaken. The clinician may not anticipate the severe haemorrhage because of vague clinical history, physical findings and ambiguous radiographic characteristics of the lesion. We report a case of central haemangioma of the mandible whose clinical and radiographic features were equivocal. In addition, an attempt is made to discuss all possible radiographic presentations of central haemangioma and consider differential diagnosis. This case is significant for the reason that it had diverse radiographic appearances in various areas of the lesion in different projections. Dentomaxillofacial Radiology (2005) 34, 120–125. doi: 10.1259/dmfr/14940087 Keywords: haemangioma, capillary, mandible, aspiration, radiography Case report A 13-year-old female patient presented to the Department of Oral Medicine, complaining of a swelling in the left mandibular body for a duration of 1 year. She reported a similar swelling 10 years ago following trauma. That lesion was surgically treated. Clinical examination The swelling on the left side of the face resulted in facial asymmetry (Figure 1). It was approximately 4 cm £ 5 cm in size over the left body of the mandible with diffuse margins. The skin over the lesion appeared normal. The swelling had bony hard consistency and it was tender on palpation. Intraoral examination showed obliteration of the buccal sulcus extending from the distal aspect of the mandibular left lateral incisor to the mesial aspect of the mandibular left second molar. There was expansion of the lateral aspect of the mandible with an irregular raised erythema- tous submucosal mass involving the attached gingiva, vestibule and buccal mucosa adjacent to mandibular left canine and first premolar (Figure 2). This area blanched on pressure but was without any pulsations. There was no evidence of bleeding from the gingival sulcus. The crowns of the mandibular left second premolar, first and second molar were displaced lingually with loss of occlusion on the left side. The crowns of the mandibular left canine and first premolar were rotated and a diastema of 4 – 5 mm was evident between the mandibular left first and second premolar. The mandibular left canine was shifted labially and a diastema of 2 mm existed between the mandibular left lateral incisor and canine. None of the teeth were tender or mobile. The teeth related to the lesion were vital. The overall appearance of the lesion gave a clinical impression of vascular malformation in the body of the mandible. Radiographic examination A panoramic radiograph (Figure 3) disclosed coarse trabeculations causing areas of increased radiodensity with ground glass appearance of the bone surrounding the mandibular left canine, first and second premolar. Bone surrounding the mandibular left first molar and mesial root of second molar showed small circular radiolucencies separated by bony septa giving a honeycomb appearance. There were multiple rounded loculations with fine bony septa located 4–5 mm below the roots of mandibular left second molar. Multiple tube-like radiopaque striae placed parallel to each other were evident distal to this region. Multiple scattered circular radiolucent areas without sclerotic border were seen in between the roots of mandibular left first and second molar. A sketch of the *Correspondence to: Dr Archna Nagpal, Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal, Karnataka-576104, India; E-mail: drarchnanagpal@hotmail.com Received 19 February 2004; revised 21 December 2004; accepted 28 December 2004 Dentomaxillofacial Radiology (2005) 34, Dentomaxillofacial Radiology (2005) 34, 120–125 q 2005 The British Institute of Radiology http://dmfr.birjournals.org