CTICasesAggressive Vertebral Hemangioma
Imaging findings
A patient with progressive neurologic symptoms had a scoliosis series suggesting an abnormal or absent right T11 pedicle, and CT/MRI showed an expansile, hyperenhancing lesion involving the right pedicle and vertebral body, extending laterally and nearly obliterating the spinal cord at that level. The lesion was markedly hyperintense on T2-weighted imaging with a salt-and-pepper appearance suggesting the differential of hypervascular metastasis (renal cell, melanoma, thyroid) or paraganglioma, but was uniformly hypervascular; resection confirmed an aggressive (invasive) vertebral hemangioma.
Key takeaways
Vertebral hemangiomas are typically bright on T2-weighted imaging, hyperenhancing, and roughly isointense to mildly hypointense to muscle on T1, but an aggressive variant can mimic a hypervascular metastasis or paraganglioma by expanding the vertebral body and pedicle, disrupting cortex, and compressing the spinal cord, so hemangioma should remain in the differential for an expansile hypervascular spine lesion even without a known primary malignancy.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Disseminated CoccidioidomycosisInfection
- Post-Bronchoscopy Hemorrhage with Bronchial Obstruction and Lobar CollapseIatrogenic
- Persistent Sciatic Artery with Infected PseudoaneurysmVascular
- Polymicrobial Tracheostomy Stoma InfectionInfection
- Mediastinitis from Infected Breast Tissue ExpanderInfection
- Allergic Bronchopulmonary Aspergillosis with Bronchocentric GranulomatosisInflammatory
- Blunt Traumatic Aortic Injury with Multifocal Thoracic and Abdominal InvolvementTrauma
- Aortic Root Pseudoaneurysms from Staphylococcal EndocarditisVascular
See all cases from June 21, 2018 →
Related Neoplastic cases
- Synchronous Adenocarcinoma, Carcinoid Tumor, and Pulmonary Langerhans Cell Histiocytosis in the Same Lobe
- Diffuse Miliary Pulmonary Metastases from Papillary Thyroid Carcinoma
- Costochondral Junction Chondrosarcoma (Two Cases)
- Small B-Cell Lymphoma Presenting as Confluent Posterior Mediastinal/Paravertebral Soft Tissue
- Computer-Aided Detection (CAD) Miss of a Right Upper Lobe Lung Cancer
- Massive Endovascular Metastases from Renal Cell Carcinoma