Spinal Pseudoaneurysms Mimicking an Osteogenic Tumor: A Case Report

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Interventional Radiology

Background:

• Pseudoaneurysms are rare vascular lesions that can mimic tumors, presenting diagnostic challenges.
• This case highlights a pseudoaneurysm arising from intercostal and segmental arteries, a source not previously discussed in literature.

Observation:

• A 46-year-old male presented with a 3-year history of back swelling and pain, initially suspected as a tumor.
• MRI revealed a pulsating mass with layering effects and flow artifacts, prompting further vascular studies.
• Color Doppler and CT angiography confirmed a partially thrombosed pseudoaneurysm originating from intercostal arteries at the T9-T11 level.

Findings:

• The pseudoaneurysm exhibited turbulent, bidirectional pulsatile flow on color Doppler.
• CT angiography demonstrated contrast enhancement and internal flow within the lesion, with adjacent bone remodeling.
• Intercostal arteries at multiple thoracic levels were identified as the source of the pseudoaneurysm.

Implications:

• Accurate differentiation between pseudoaneurysms and osteogenic tumors is critical for appropriate management.
• Untreated pseudoaneurysms can lead to significant morbidity, including vertebral erosion, compression fractures, and neurovascular compromise.
• This case underscores the importance of considering vascular etiologies in paraspinal masses and the utility of advanced imaging techniques.