BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive ...BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive VH may be difficult.Aggressive VHs are likely to recur even with en bloc resection.CASE SUMMARY A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity.Physical examination showed sacral tenderness and limited mobility,and the muscle strength was grade 4 in the right digital flexor.Computed tomography revealed osteolytic bone destruction from S1 to S2.Magnetic resonance imaging(MRI)showed that the mass was compressing the dural sac;it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI,and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1.The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively,and MRI examination showed recurrence of the mass.The mass was larger in size than before the operation,and it was extending into the spinal canal.CONCLUSION The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction,extension of the mass into the spinal canal,and heterogeneous signal intensity on T1-,T2-,and enhanced T1-weighted MRI.These characteristics make preoperative diagnosis difficult,and biopsy is necessary to verify the lesion.Surgical decompression and gross total resection are recommended for treatment of aggressive VH.However,recurrence is inevitable in some cases.展开更多
Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected ...Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.展开更多
文摘BACKGROUND Aggressive vertebral hemangioma(VH)is an uncommon lesion in the adult population.The vast majority of aggressive VHs have typical radiographic features.However,preoperative diagnosis of atypical aggressive VH may be difficult.Aggressive VHs are likely to recur even with en bloc resection.CASE SUMMARY A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity.Physical examination showed sacral tenderness and limited mobility,and the muscle strength was grade 4 in the right digital flexor.Computed tomography revealed osteolytic bone destruction from S1 to S2.Magnetic resonance imaging(MRI)showed that the mass was compressing the dural sac;it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI,and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1.The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively,and MRI examination showed recurrence of the mass.The mass was larger in size than before the operation,and it was extending into the spinal canal.CONCLUSION The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction,extension of the mass into the spinal canal,and heterogeneous signal intensity on T1-,T2-,and enhanced T1-weighted MRI.These characteristics make preoperative diagnosis difficult,and biopsy is necessary to verify the lesion.Surgical decompression and gross total resection are recommended for treatment of aggressive VH.However,recurrence is inevitable in some cases.
文摘Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.
