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Hemangioma of Bone

- 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 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;
                   - references:
                         - 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.