- See: Hemangioma of Soft Tissue
- 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;
- 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;
- shows markedly increased signal intensity on T1 images & T2 images;
- hemorrhage and thrombosis can also cause increase in signal intensity on T1 images;
- 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
- anterior resection and fusion are reserved for refractory cases or pathologic collapse and neural compression;
- in the report by Heiss JD, et al, 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;
- Treatment of Vertebral Hemangioma by Intralesional Injection of Absolute Ethanol
- Brief report: relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol.
- Vertebral hemangioma with compression fracture and paraparesis treated with preoperative embolization and vertebral resection.
Malignant hemangioendothelioma of bone.
Massive osteolysis of the femur (Gorham's disease): a case report and review of the literature.
Preoperative endovascular embolisation of a vertebral hemangioma.
Surface hemangiomas presenting as bone lesions.