| Popis: |
Background: Aggressive vertebral hemangiomas (VHs) are uncommon in adults. Although most have typical radiographic features, some present with atypical findings, which makes their diagnosis difficult. Aggressive VHs have a high likelihood of recurrence even after resection.Case presentation: A 52-year-old woman presented with a 3-month history of right lower extremity pain and numbness. On physical examination, the sacrum was tender, her mobility was limited, and right plantar flexion strength was 4/5 on manual muscle testing. Computed tomography (CT) revealed osteolytic bony destruction from S1 to S2. Magnetic resonance imaging (MRI) showed a sacral mass invading the S1 vertebral endplate and compressing the dural sac; the mass was heterogeneously hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and heterogeneously enhanced. Six months after surgical resection of the mass, the patient presented with back pain and bilateral extremity numbness. MRI showed lesion recurrence with thecal sac compression.Conclusions: Aggressive VHs may exhibit atypical radiological findings that include osteolytic vertebral bony destruction, spinal canal extension, heterogeneous signal intensity on T1- and T2-weighted imaging, and heterogeneous enhancement. These can make accurate preoperative diagnosis difficult; biopsy may be necessary. Surgical decompression and resection are recommended for aggressive VHs. Nonetheless, recurrence may still occur despite resection. |
