Biopsies of the right rib lesion were negative for malignancy, showing benign reactive fibrovascular tissue with intraosseous hemangioma being on the top of the differential. The radiologic findings are consistent with multifocal intraosseous hemangiomas, similar to other cases reported in the literature. The lesions are being followed annually and are reportedly stable.

The radiologic features of multifocal intraosseous hemangiomas encompass distinctive patterns across different body sites ¹. For vertebral hemangiomas, typical radiological signs include a "fence" appearance on X-rays, a "polka-dot" pattern on axial CT scans, and high signal intensity on T1 and T2-weighted MRI images. Aggressive vertebral hemangiomas may exhibit cortical expansion, involvement of the entire vertebral body, and associated soft tissue mass, particularly in the thoracic region. Rib hemangiomas typically present as expansile lesions with fine trabeculae, sometimes displaying a "sunburst" or "honeycomb" appearance. Long bone hemangiomas may mimic other bone tumors, showing a "soap bubble" appearance on imaging studies.

Case co-author: Alice Barrington (Loyola University)