Aggressive vertebral hemangioma with pathological fracture
Sudden onset of lower back pain.
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Abnormal bone marrow heterogeneous signal with mottled appearance of the L1 vertebra is present suggestive for vertebral hemangioma.
Evidence of L1 pathologic fracture (low-signal intensity lesion on T1 and high on STIR sequences) with the epidural component is seen causing the thecal sac compression and canal stenosis.
On the post-contrast scan, heterogeneous contrast enhancement is seen within the vertebral body, posterior elements, and epidural soft tissues.
Disc bulging also is noted at the L1-L2 level.
Imaging features are consistent with aggressive vertebral hemangioma with extension into the epidural space compromising spinal canal and complicated by pathologic fracture. Cortical interruption with an epidural component in a vertebral hemangioma are characters of the aggressive type.