Intramuscular hemangyomas are benign tumours (0,8% of all hemangyomas). Their aetiology is uncertain but they are possibly congenital, although some seem to be related to trauma. Symptoms (usually pain and swelling) may be present for years. Histological subtypes are cavernous, capillary and mixed. Optimal management includes precise diagnosis and wide excision to prevent local recurrence.

Authors present a case of a 79 years male with cavernous hemangyoma of the thigh with three years of evolution. The tumour eroded the femur and the patient had a mass all over the thigh with tension and pain. Diagnosis was suspected by phleboliths seen on x-ray and MRI and was confirmed by open biopsy.

Treatment was a complete excision with double approach, medial and lateral, plus prophylactic nailing of the femur.

With a four years follow – up, the patient has no sign of recurrence and has a normal function of the inferior limb and a normal gait.