Agressive hemangioma

Case contributed by Pramit Phal


Back pain

Patient Data

Age: 41
Gender: Male

The body and left pedicle of T6 are largely replaced by hypointenseenhancing material. Changes in the trabecula and the cortex are also present and thefeatures are entirely in keeping with the clinical history of hemangioma. There isextraosseous hemangioma as well on the left lateral aspect of the vertebral body andalso in the left anterior and left lateral aspect of the epidural space at the samelevel. The combination of features results in minimal flattening of the lateraldiameters of the canal.

Similar changes are present in the left pedicle of T7. The extraosseous soft tissuematerial probably narrows the left T6-T7 exit foramen to a mild degree. It wouldrequire clinical correlation to determine whether the left T6 root is affected by thisprocess.

No other relevant abnormal finding.


Bony hemangioma of the body and left pedicle of T6 and also at the left pedicle ofT7. 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 was 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 obtained along this path.

Case Discussion

Atypical or aggressive vertebral body hemangiomas can be challenging to manage if cord compression is present. 

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