Hemangioma of the Ilium Simulating an Aggressive Bone Lesion on Imaging

We present the case of a 35-year-old man with a hemangioma in the iliac wing that simulated an aggressive bone lesion on CT, MRI, and bone scintigraphy. On CT, the lesion, 12 cm in in maximum dimension, was expansile and septated. On MRI, the lesion was isointense with respect to muscle on T1 weighted images, and hyperintense on T2 images, with focal regions of cortical breach. Radionuclide bone scan showed increased tracer accumulation. The diagnosis was made following surgical biopsy, and the lesion was treated conservatively.