Presentation
Patient presented with several weeks of bilateral (left > right) upper extremity radiculopathy, decreased range of motion, and difficulty using his hands due to decreased grip strength and finger dexterity.
Patient Data
There is mild broad-based right convex thoracic curvature and mild exaggeration of the normal thoracic kyphosis.
There are hemangiomas occupying the majority of the T2, T4, T11, T12, and L1 vertebra. Additional smaller hemangiomas are located in T3, T9, and T10. A hemangioma is also present within the right sixth rib.
The hemangioma at T2 has soft tissue epidural extension into the anterior/lateral epidural recesses bilaterally, which results in effacement of the anterior/lateral CSF. The posterior CSF is preserved, without significant cord compression or spinal stenosis. Soft tissue also extends into the bilateral neural foramina, resulting in mild bilateral foraminal stenosis at this level.
The large hemangioma throughout the entirety of T4 has soft tissue tumor extension out of the pedicle and into the left lateral epidural space and into the left neural foramina. While there is no significant associated spinal stenosis or cord compression, there is mild left foraminal stenosis.
No significant soft tissue tumor extension associated with the remainder of the hemangiomas (T3 and T9-L1).
Mild multilevel discogenic degenerative change in the thoracic spine. There are small posterior disc herniations at several levels, without evidence of nerve impingement, spinal stenosis, or foraminal stenosis. Minimal multilevel facet and costovertebral joint degenerative change.
Case Discussion
This is a case of both typical (T3 and T9-L1) and aggressive vertebral hemangiomas (T2 and T4). In addition, there is a hemangioma in the right sixth rib.
Due to the extent of disease and relatively mild symptoms, surgery was deferred at presentation. The patient has been followed by neurosurgery and physical therapy for management to improve hand/grip strength.
CO-AUTHORS:
Kimberly Owens, DO
Michael Cooley, MD