- See:
Hemangioma of Soft Tissue
- Discussion:
- typically seen in asymptomatic patients;
- symptomatic patients over 40 years old may present following small
spine fractures;
- hemangiomas affect bone are rare;
- these tumors may be located on the periosteal surface, within the cortex, or within the medullary canal;
- Hemangioma of Spine:
- hemangiomas are usually located in lower thoracic spine & are found in 11 % of spines examined post mortem;
- they are generally asymptomatic; when symptoms do occur they are due to vertebral collapse or expansion of tumor into the spinal canal;
-
radiographs:
- classically has "jail house striations" on plain films &
- typical radiographic image of a hemangioma shows vertical striations, and the CT scan usually demonstrates the vertical
trabeculae with intervening soft-tissue or fat attenuation;
-
CT scan:
- key finding is "spikes of bone" w/ in vertebral body;
-
MRI:
- shows markedly increased signal intensity on
T1 images &
T2 images;
- hemorrhage and thrombosis can also cause increase in signal intensity on T1 images;
-
treatment:
- treatment is observation, and radiation therapy in cases of persistent pain on pathologic diagnosis;
- in some cases, vascular embolization is indicated, either as a definative means of treatment or as a means of
reducing blood loss during surgery;
- anterior resection and fusion are reserved for refractory cases or pathologic collapse and neural compression;
- in the report by JD Heiss MD et al NEJM, the authors report on injection of ethanol into vertabral hemangiomas;
- two patients underwent these injections with improvement in their condition being maintained for over three years;
- they noted that in a larger series that 2 out of 7 patients had compression fractures which complicated their treatment;
- references:
- Treatment of Vertebral Hemangioma by Intralesional Injection of Absolute Ethanol
John D. Heiss, M.D.
The New England Journal of Medicine -- May 16, 1996 -- Vol. 334, No. 20
- Relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol.
Heiss JD, Doppman JL, Oldfield EH.
N Engl J Med 1994;331:508-11.
- Vertebral hemangioma with compression fracture and paraparesis treated with preoperative embolization and vertebral resection.
Graham JJ, Yang WC.
Spine 1984;9:97-101.
Malignant hemangioendothelioma of bone.
Massive Osteolysis of the femur (Gorham's disease): a case report and review of the literature.
AA Mendez, D Keret, W Robertsn et al.
J. Pediatric Orthopedics. Vol 9. 1989. p 604-608.
Preoperative endovascular embolisation of a vertebral hemangioma.
VW NG et al.
JBJS. Vol 79-A. No 5. Sep 1997. p 808.
Surface hemangiomas presenting as bone lesions.
Scott WeinerMD and Pravin Muniyappa.
Orthopedics.
May 1999. Vol 2. No 5.
539.
