Small bowel hemangiomas are rare benign vascular tumors of the small intestine, accounting for less than 0.05% of all gastrointestinal tumors. They most commonly occur in the jejunum and are typically submucosal in location. The cavernous type is the most common histological subtype. Clinically, they are usually asymptomatic but may present with occult or overt gastrointestinal bleeding, chronic iron deficiency anemia, and rarely intussusception or obstruction. The mean age at diagnosis is broad, with higher prevalence in children and young adults. Diagnosis is usually established by CT angiography or conventional angiography; capsule endoscopy and double-balloon enteroscopy are also valuable diagnostic tools. Treatment is surgical resection, particularly in symptomatic patients.
Age Range
15-65
Peak Age
40
Gender
Equal
Prevalence
Rare
Small bowel hemangiomas are hamartomatous vascular malformations arising from vascular endothelial cells. They develop from anomalous development of mesoderm-derived vascular structures during embryogenesis; they are vascular malformations rather than true neoplasms. Histologically, the cavernous type is characterized by large vascular sinusoidal spaces lined by thin endothelial walls. The capillary type consists of small, uniform vascular channels. The lesion is located in the submucosa and may form polypoid protrusions into the lumen. On contrast-enhanced CT, early intense enhancement in the arterial phase and persistent enhancement in portal venous/delayed phases is seen — this pattern results from slow flow and prolonged retention of contrast agent in vascular sinusoids, similar to soft tissue hemangiomas. Marked hyperintensity on T2-weighted MRI reflects the long T2 relaxation time of slow-flowing blood in vascular spaces. Bleeding risk arises from disruption of the thin endothelial wall integrity through mechanical trauma or mucosal erosion.
Well-defined lesion showing marked hyperintensity on T2-weighted MRI — bright appearance like a light bulb. This finding reflects the long T2 relaxation time of slow-flowing blood in vascular spaces and is the small bowel counterpart of the classic finding in hepatic hemangioma. Signal intensity approaches CSF and helps differentiate from other submucosal tumors.
Well-defined submucosal mass showing intense, homogeneous or peripheral nodular enhancement in the arterial phase. The lesion enhances markedly more than the surrounding bowel wall. In small lesions, homogeneous enhancement is typical; in larger lesions, a peripheral-to-central (progressive) enhancement pattern is characteristic. Contrast agent accumulates in vascular spaces, making the lesion conspicuous.
Report Sentence
Well-defined submucosal lesion in the small bowel showing intense arterial phase enhancement is consistent with a vascular tumor (hemangioma).
Persistent enhancement in the delayed phase — the lesion remains hyperdense in portal venous and delayed phases, with slow washout of contrast from vascular spaces. Hyperdense punctate calcifications due to phleboliths may be seen within the lesion. This finding is highly characteristic of cavernous hemangioma and helpful in differential diagnosis.
Report Sentence
Submucosal lesion in the small bowel with persistent delayed enhancement and internal phleboliths is consistent with cavernous hemangioma.
Well-defined submucosal lesion showing marked hyperintensity on T2-weighted MRI — bright appearance similar to 'light bulb sign.' Signal intensity approaches that of cerebrospinal fluid. The lesion may be homogeneous or have lobulated contours. In larger lesions, internal septations and fluid-fluid levels (hemorrhage/thrombus) may be observed.
Report Sentence
Markedly hyperintense submucosal lesion on T2-weighted sequence in the small bowel is consistent with hemangioma.
Iso- to slightly hypointense submucosal lesion relative to surrounding bowel wall on T1-weighted MRI. Post-contrast dynamic series show peripheral nodular enhancement with progressive centripetal fill-in pattern similar to hepatic hemangioma. In case of internal hemorrhage, focal T1 hyperintensity (metHb) may be seen.
Report Sentence
Submucosal lesion in the small bowel iso/hypointense on T1 showing peripheral nodular enhancement with progressive fill-in is consistent with hemangioma.
Well-defined, soft tissue density submucosal mass in the small bowel wall on non-contrast CT. The mass may form polypoid protrusion into the lumen. Punctate calcifications due to phleboliths may be seen internally — this finding is pathognomonic for vascular lesion. The lesion may be slightly hyperdense or isodense to surrounding bowel wall.
Report Sentence
Well-defined submucosal mass with internal punctate calcifications (phleboliths) in the small bowel is consistent with vascular malformation/hemangioma.
CT angiography may show a dilated mesenteric arterial branch (feeding vessel) supplying the lesion. The vascular nature of the lesion becomes apparent in the arterial phase, and the feeding arterial pedicle can be traced. In cases of active bleeding, contrast extravasation from the lesion into the lumen may be seen.
Report Sentence
Intensely enhancing submucosal lesion in the small bowel accompanied by a dilated mesenteric arterial branch (feeding artery) on CT angiography is consistent with vascular lesion (hemangioma).
Criteria
Characterized by large, irregular vascular sinusoidal spaces — most common type
Distinct Features
Larger size with phleboliths, marked T2 hyperintensity, peripheral-to-central enhancement pattern, higher GI bleeding risk
Criteria
Lesion consisting of small, uniform vascular channels, generally smaller in size
Distinct Features
More homogeneous enhancement, phleboliths rare, usually asymptomatic, more common in infants
Criteria
Lesion containing both cavernous and capillary components
Distinct Features
Heterogeneous enhancement pattern, variable T2 signal intensity, coexisting cavernous and capillary areas
Criteria
Multiple hemangiomas in multiple segments of small bowel — may be syndromic (Blue Rubber Bleb Nevus Syndrome)
Distinct Features
May be accompanied by cutaneous hemangiomas, recurrent GI bleeding, chronic anemia, multiple enhancing submucosal lesions on CT
Distinguishing Feature
GIST typically shows heterogeneous enhancement, central necrosis, and larger size; does not have phleboliths and is not as bright on T2 as hemangioma. GIST may demonstrate exophytic growth.
Distinguishing Feature
Carcinoid tumor is hypervascular but generally smaller, accompanied by mesenteric retraction (desmoplasia) and calcified mesenteric mass. Not as bright on T2 as hemangioma.
Distinguishing Feature
Lipoma is a homogeneous fat-density (-50 to -100 HU) non-enhancing submucosal lesion — distinctly different from hemangioma. On T1, lipoma is hyperintense while hemangioma is hypointense.
Distinguishing Feature
Metastasis is usually multiple, irregularly marginated, and shows heterogeneous enhancement. T2 signal is variable and differs from hemangioma's homogeneously bright signal. Known primary malignancy history is important.
Urgency
routineManagement
surgicalBiopsy
Not NeededFollow-up
specialist-referralSmall bowel hemangiomas are benign vascular lesions but can cause chronic GI bleeding and iron deficiency anemia. Surgical resection is the standard treatment for symptomatic lesions. Diagnosis is usually established by CT angiography or MR enterography; biopsy is contraindicated due to high bleeding risk. In syndromic forms (Blue Rubber Bleb Nevus), a multidisciplinary approach is needed.
Small bowel hemangioma is usually asymptomatic. It may present with GI bleeding requiring surgical resection. Biopsy should be performed cautiously due to bleeding risk.