Presentation
Lower back pain.
Patient Data
The T1 and T2-weighted images show a lesion of increased signal intensity replacing the L5 vertebral body. Coarse vertically oriented trabeculae are present.
Another well-defined smaller lesion with a similar appearance within the D10 vertebral body is seen.
Central disc protrusion with thecal sac indentation is present at D12/L1 level causing canal stenosis and derangement of the nerve roots.
Asymmetrical disc bulging with left foraminal narrowing is seen at L4/L5 level.
Case Discussion
Vertebral hemangiomas are the most common benign vertebral neoplasms. They are usually asymptomatic and incidentally detected due to their characteristic features on imaging for other reasons. Rarely, they can be locally aggressive, though the diagnosis can be challenging. In such cases, the recognition of vertically oriented coarse bony trabeculae surrounded by fatty stroma, resulting in a “salt and pepper” appearance or "polka dot sign" on axial images and a striated appearance on coronal or sagittal images, is the key to help the correct diagnosis.