Aggressive Vertebral Body Hemangioma Causing Compressive Myelopathy - Two Case Reports
Denver Steven Pinto1, V Ravi Hoisala1, Pavan Gupta1
1Department of Radiodiagnosis, St. Johns Medical College, Koramangala, Bengaluru, Karnataka, India.
Journal of Orthopaedic Case Reports
|August 19, 2017
Summary
Aggressive vertebral hemangiomas can mimic metastatic disease, leading to risky biopsies. Characteristic imaging can prevent misdiagnosis and guide treatment with embolization, surgery, or radiotherapy for symptom relief.
Area of Science:
- Radiology
- Oncology
- Neurosurgery
Background:
- Hemangiomas are benign vascular tumors; aggressive forms can cause bone expansion and extraosseous spread.
- Aggressive vertebral hemangiomas may be misdiagnosed as metastasis, necessitating risky biopsies.
- These tumors can lead to spinal cord compression and neurological deficits.
Observation:
- This case report details imaging findings of two aggressive vertebral body hemangiomas.
- Patients presented with back pain and varying degrees of motor and sensory deficits.
- Imaging revealed vertebral body and posterior element involvement with paraspinal and epidural extension.
Findings:
- Characteristic imaging features aid in identifying aggressive vertebral hemangiomas.
- Early identification prevents unnecessary and potentially hazardous biopsies.
- Treatment options include surgical decompression, radiotherapy, and embolization.
Implications:
- Accurate diagnosis through imaging is crucial for appropriate patient management.
- Embolization, particularly with onyx, is emerging as a safe and effective treatment.
- Further multicentric studies are needed to establish definitive treatment guidelines comparing embolization with surgery and radiotherapy.
