Hemangioma of the Spine

 

General Considerations

  • Benign
  • Most often located in lower thoracic, upper lumbar spine
    • Skull is second most common location (spoke-wheel appearance)
  • Mostly asymptomatic
  • More frequent in females
  • Peak incidence in 40’s
  • Multiple in up to 1/3 of cases
  • Most often occur in the medullary cavity of bone
  • Microscopically, there is hamartomatous proliferation of vascular tissue
    • Classified as to cavernous, capillary, arteriovenous and venous
    • Spine hemangiomas are usually capillary type; skull are cavernous

Clinical Findings

  • Usually asymptomatic
  • Very slow growing
  • No known malignant potential
  • Over 40, patients may present with pain from compression fracture

Imaging Findings

  • Conventional radiography is usually the first means of imaging hemangiomas
    • Prominent trabecular pattern from resorption of trabeculae by enlarged vascular channels produces
      • Vertical striations
    • Overall density of vertebral body is increased
    • Cortex is not thickened and vertebral body is not increased in size
    • Small hemangiomas will not be visible on conventional radiographs
  • CT
    • Corduroy (aka accordion, honeycomb, polka-dot) spine from coarse trabeculae seen in cross section
      • Thickened vertebral trabeculae produce a polka-dot appearance
    • Bone destruction and soft tissue extension may be present but are rare
  • MRI
    • Allows for diagnosis of soft-tissue extension
    • Increased signal intensity on both T1 (high fate content) and T2 (increased vascularity)
  • Nuclear medicine
    • Usually normal uptake on bone scan

Differential Diagnosis

  • Paget disease
  • Metastases
  • Lymphoma
  • Multiple myeloma

Treatment

  • Observation
  • Treatment is instituted only if they are symptomatic and may include
    • Vascular embolization prior to surgery
    • Surgical excision
    • Vertebroplasty
    • Ethanol injection

Complications

  • Pathologic fracture
  • Hemorrhage, when it occurs, is usually iatrogenic
  • Thrombosis
  • Displacement of adjacent nerves producing pain

 

Hemangioma of the spine. An axial CT scan image of the lower abdomen demonstrates a vertebra; body with a very prominent trabecular pattern characteristic of the corduroy or polka-dot appearance of a hemangioma of the spine (red circle). The cortex is not thickened and the surrounding soft tissues are normal.
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Hemangioma of Bone  eMedicine  Chasi, I and Hide, G