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Case Reports
. 2024 Aug 13:2024:2307950.
doi: 10.1155/2024/2307950. eCollection 2024.

Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature

Krishna Timilsina  1 , Sandesh Shrestha  2 , Om Prakash Bhatta  3 , Sushil Paudel  2 , Rajesh Bahadur Lakhey  2 , Rohit Kumar Pokharel  2
Affiliations
Case Reports

Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature

Krishna Timilsina et al. Case Rep Orthop. .

Abstract

Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.

Keywords: aggressive hemangioma; embolization; spinal cord compression; spinal neoplasms; thoracic vertebrae.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
MRI findings. (A) T1 and (B) T2 sagittal images showed hypointense and hyperintense signals in the body and posterior elements, respectively. (C) T2 weighted axial image at T4 vertebrae showing increased signal intensity with cord compression (D) Contrast-enhanced sagittal image showing lesion with soft tissue extension posterior to the body causing almost circumferential compression of the cord.
Figure 2
Figure 2
Digital subtraction angiography (DSA) findings. Selected DSA at T3–T4 levels demonstrating abnormal pooling of contrast (white arrow) in T4 vertebral body consistent with a hemangioma.
Figure 3
Figure 3
Intraoperative sclerotherapy. Intraoperative picture showing fluoroscopic guided insertion of alcohol (99.9% ethanol) with sodium tetradecyl sulfate on T4 vertebral body.
Figure 4
Figure 4
Postoperative X-ray showing posterior instrumentation and stabilization done T2 to T6 levels with pedicle screw fixation at T2, T3, T5, and T6.
Figure 5
Figure 5
HPE findings suggestive of osseous hemangioma. Histopathological examination (HPE) shows thin-walled blood vessels of various sizes (white arrow) filled with blood and sinuses lined by endothelium between the thickened, vertically oriented trabeculae of bone (black arrow), consistent with osseous hemangioma.
See this image and copyright information in PMC

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