Presentation
Back pain
Patient Data
The body and left pedicle of T6 are largely replaced by hypointense-enhancing material. Changes in the trabecula and the cortex are also present and the features are entirely in keeping with the clinical history of hemangioma. There is extraosseous hemangioma as well on the left lateral aspect of the vertebral body and also in the left anterior and left lateral aspect of the epidural space at the same level. The combination of features results in minimal flattening of the lateral diameters of the canal.
Similar changes are present in the left pedicle of T7. The extraosseous soft tissue material probably narrows the left T6-T7 exit foramen to a mild degree. It would require clinical correlation to determine whether the left T6 root is affected by this process.
No other relevant abnormal finding.
COMMENT:
Bony hemangioma of the body and left pedicle of T6 and also at the left pedicle of T7. There is a significant amount of intra and extradural extraosseous soft tissuematerial. At this stage this probably impacts upon the left T6 root at foramen leveland it displaces but does not compress the cord in the midthoracic region.
The procedure and rationale were discussed with the patient.
Left T7 pedicle was decided on for biopsy.
With patient prone, aseptic technique and intravenous sedation, periosteal local anesthetic infiltration was used.
A 12G/13G bonopty bone biopsy needle was used to access the left pedicle, and solid core about 2.5 cm in length was obtained along this path.
Case Discussion
Atypical or aggressive vertebral body hemangiomas can be challenging to manage if cord compression is present.