Aggressive vertebral hemangioma with pathological fracture

Case contributed by Dr Bahman Rasuli

Presentation

Sudden onset of lower back pain.

Patient Data

Age: 35 years
Gender: Female

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.

Case Discussion

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. 

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