The recent case referred to our center with the history of lower back pain after trauma for seeking disc herniations and the hemangioma was an incidental finding.

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.