MyPACS.net: Radiology Teaching Files > Case 6947045

previously visited AGGRESSIVE VERTEBRAL BODY HEMANGIOMA
Contributed by: Radiology Residency Program Faculty & Staff, Northeastern Ohio Universities College of Medicine-Canton Affiliated Hospitals, Ohio, USA.
Patient: 63 year old female
History: 63 year old female with lumbar/thoracic sprain/strain.
Images:[small]larger

Fig. 1: Sagittal T1WI (top), T2WI (middle), and Fat Saturation T2WI (bottom)

Fig. 2: Axial T1WI (top) and T2WI (bottom)

Fig. 3: CT

Fig. 4: CT Coronal (top) and Sagittal (bottom) reformats
Findings:

Fig. 1: Sagittal T1WI (top), T2WI (middle), and Fat Saturation T2WI (bottom) - demonstrate an expansile lesion involving the body and pedicles of the T11 vertebra.  There is a coarse trabecular pattern coursing through the vertebral body.  The lesion demonstrates intermediate signal intensity on T1 and T2 weighted images, but is hyperintense on the fat saturation T2 weighted images.

Fig. 2: Axial T1WI (top) and T2WI (bottom) - A corduroy appearance of coarse trabeculae is noted.  The mass breaks through the posterior cortex and narrows the spinal canal and adjacent neural foramen slightly.

Fig. 3: CT better delineates the expansile mass occupying the entire T11 vertebral body, with prominent central trabecular struts.

Fig. 4: CT Coronal (top) and Sagittal (bottom) reformats - There are areas  of cortical disruption anteriorly and posteriorly as well as soft tissue extension into the spinal canal.  There is a slight loss of vertebral body height as well.

Diagnosis: Aggressive Vertebral Body Hemangioma
Discussion:

Aggressive Vertebral Body Hemangioma

- aggressive variation of the common benign hemangioma
- may be extensive, replacing the entire vertebral body with extension into the pedicles, arches, and spinous processes
- cortical margins usually indistinct
- can have an associated compression fracture or epidural extension and compromise of the spinal canal or neural foramen
- usually asymptomatic; but can be painful with growth (especially in pregnant women) and with associated compression fractures

- striated appearance on plain films
- vascular on spinal angiography
- CT: thick trabeculae = "corduroy" appearance,   "polka dot" appearance, "salt-and-pepper" appearance

Differential Diagnosis
metastasis
lymphoma
giant cell tumor

References:

Grossman, RI., Yousem, DM. Neuroradiology: The Requisites. 2nd Edition. Mosby, 2003.

Castillo, M., Harris, JH. Imaging of the Spine: A Teaching File.Williams & Wilkins, 1998.

Bowen, BC.Case Review: Spine Imaging. Mosby, 2001.

Submitted by:

Aakash D. Singh, M.D. PGY-V Radiology Resident

Barry McNulty, M.D. - Radiologist
Mercy Medical Center

Comments:
No comments posted.
Additional Details:

Case Number: 6947045Last Updated: 10-15-2006
Anatomy: Spine and Peripheral Nervous System   Pathology: Benign Mass, Cyst
Modality: CT, MRExam Date: 08-12-2006Access Level: Readable by all users
Keywords: aggressive vertebral body hemangioma, corduroy appearance, polka dot appearaneACR: 328.3141

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