Painless but problematic. Imaging modalities were useful in the diagnosis and treatment of an unusual tumor.

An asymptomatic 61 year old woman was referred for evaluation of a suspected inguinal hernia. She had a voluminous indolent pubic mass that had developed over several years (Figure, A). Investigation with 64-slice multidetector-row computed tomography (CT) demonstrated a peripherally hypervascularized mass, 16 cm in maximum diameter, supplied by the left pudendal artery and the left anterior obturator artery, which arose, in this patient, from the left inferior epigastric artery; these arteries shunted into multiple veins that drained into the pudendal vein (Figure, B and C; Video Clip). Preoperative digital subtraction angiography confirmed the feeding arteries and enabled presurgical embolization with Spongostan, a hemostatic agent, and coils (Figure, D). Surgery ensued 48 hours later.