EURORAD ESR

Case 13830

Aggressive vertebral haemangioma

Author(s)
JA Prat-Matifoll, A Rivas Garcia, L Casas Gomila, C Torrents

Vall Hebrón Hospital,
Institut Català de la Salut,
Radiology;
Passeig Vall Hebrón 116-119
08035 Barcelona, Spain;
Email:joanalbertpratrx@gmail.com
 
Patient
female, 22 year(s)
 
 
  • Figure 1
    Diagnostic CT
     

    Vertically-oriented striations which represent reinforced trabeculae. This typical feature is called the polka-dot pattern (yellow arrow, vertebral body). Note the extension to posterior elements (green arrow).

     
    Area of Interest: Bones; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Athletic injuries;

    The lesion shows cortical destruction with soft-tissue expansion (yellow arrows).

     
    Area of Interest: Bones; Imaging Technique: CT-High Resolution; Procedure: Arthrography; Special Focus: Acute;

    Prominent soft-tissue expansion of the lesion (yellow arrows). Note the destruction of the posterior wall and invasion of the vertebral canal (blue arrows), causing spinal cord compression (aggressive behaviour).

     
    Area of Interest: Bones; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 2
    Diagnostic CT
     

    The lesion spreads to posterior elements as the transverse process (green arrow).

     
    Area of Interest: Bones; Imaging Technique: CT; Procedure: eLearning; Special Focus: Haemangioma;

    It also spreads to other posterior elements as the transverse process and the right lamina (white arrow).

     
    Area of Interest: Bones; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Acute;

    Here we can observe a loss of vertebral body height.

     
    Area of Interest: Bones; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 3
    MRI
     

    Hypointense vertebral lesion on T1-weighted image. Predominantly hyperintense on T2 image. Note the upper and lower discs' altered signal on T2 (hypointense and no distinction between nucleus and annulus disc)....

     
    Area of Interest: Bones; Imaging Technique: MR; Procedure: Complications; Special Focus: Arteriovenous malformations;

    The lesion enhances strongly after contrast administration. Low-signal-intensity vertical striations can be seen within it. Note how this lesion spreads to posterior elements of the vertebral body.

     
    Area of Interest: Bones; Imaging Technique: MR; Procedure: Complications; Special Focus: Haemangioma;

    Note its remarkable ability to invade the vertebral canal and compress the spinal cord (aggressive behaviour).

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: eLearning; Special Focus: Haemangioma;
     
     
  • Figure 4
    CT-guided biopsy
     

    Due to a clinical worsening, core-needle biopsy was required to confirm the suspected diagnosis. Red arrow: Paravertebral soft-tissue component.

     
    Area of Interest: Bones; Imaging Technique: CT-High Resolution; Procedure: Biopsy; Special Focus: Neoplasia;

    CT-guided core-needle biopsy of left paravertebral soft-tissue, confirming the presence of a vascular lesion.

     
    Area of Interest: Abdomen; Imaging Technique: CT-High Resolution; Procedure: Biopsy; Special Focus: Trauma;
     
     
  • Figure 5
    Embolisation before decompressive surgery

    Predominant left vascularization, depending on the 5th left lumbar artery. Embolisation of this left predominant artery was achieved using PVA particles. The result was a reduction of the vascularization, a key step...

     
    Area of Interest: Bones; Imaging Technique: Catheter arteriography; Procedure: Ablation procedures; Special Focus: Acute;
     
     
Vertically-oriented striations which represent reinforced trabeculae. This typical feature is called the polka-dot pattern (yellow arrow, vertebral body). Note the extension to posterior elements (green arrow).
 
The lesion shows cortical destruction with soft-tissue expansion (yellow arrows).
 
Prominent soft-tissue expansion of the lesion (yellow arrows). Note the destruction of the posterior wall and invasion of the vertebral canal (blue arrows), causing spinal cord compression (aggressive behaviour).
 
The lesion spreads to posterior elements as the transverse process (green arrow).
 
It also spreads to other posterior elements as the transverse process and the right lamina (white arrow).
 
Here we can observe a loss of vertebral body height.
 
Hypointense vertebral lesion on T1-weighted image. Predominantly hyperintense on T2 image. Note the upper and lower discs' altered signal on T2 (hypointense and no distinction between nucleus and annulus disc). Their height is decreased.
 
The lesion enhances strongly after contrast administration. Low-signal-intensity vertical striations can be seen within it. Note how this lesion spreads to posterior elements of the vertebral body.
 
Note its remarkable ability to invade the vertebral canal and compress the spinal cord (aggressive behaviour).
 
Due to a clinical worsening, core-needle biopsy was required to confirm the suspected diagnosis. Red arrow: Paravertebral soft-tissue component.
 
CT-guided core-needle biopsy of left paravertebral soft-tissue, confirming the presence of a vascular lesion.
 
Predominant left vascularization, depending on the 5th left lumbar artery. Embolisation of this left predominant artery was achieved using PVA particles. The result was a reduction of the vascularization, a key step before performing surgery.
 
 
 
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