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Aggressive thoracic vertebral hemangioma: case report and literature review

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Abstract

Introduction

Vertebral hemangiomas are common and typically benign vascular lesions, with a prevalence of 10–12% in the general population and 2–3% in all spine tumors. A small subset of vertebral hemangiomas can be categorized as “aggressive” if they exhibit extraosseous expansion that compress the spinal cord, causing pain and various neurologic symptoms. This report details a case of aggressive thoracic hemangioma resulting in worsening pain and paraplegia to draw attention to this rare condition, including identification and treatment.

Case presentation

In this case, we present a 39 year-old female with a history of progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma. Clinical presentation, imaging, and biopsies, confirmed the diagnosis. A combined surgical and endovascular treatment strategy was implemented, and the patient’s symptoms improved.

Discussion

Aggressive vertebral hemangioma is a rare condition that may cause symptoms that diminishes the quality of life, including pain and various neurological symptoms. Given the low number of such cases, and significant impact on lifestyle, it is beneficial to identify cases of aggressive thoracic hemangiomas to ensure timely and accurate diagnosis and help development of treatment guidelines. This case highlights the importance of identifying and diagnosing this rare but serious disease.

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Fig. 1: 39-year-old female with progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma.
Fig. 2: 39-year-old female with progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma.
Fig. 3: 39-year-old female with progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma.
Fig. 4: 39-year-old female with progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma.
Fig. 5: 39-year-old female with progressively worsening pain and paraplegia caused by compression of the spinal cord from an aggressive thoracic vertebral hemangioma.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Andy Kuo, Peter Ahorukomeye & Zachary L. Gordon

  2. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA

    Peter Ahorukomeye & Zachary L. Gordon

Authors
  1. Andy Kuo
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  2. Peter Ahorukomeye
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Contributions

AK: Conceptualization, writing original draft, writing review and editing. PA: writing review and editing. ZLG: conceptualization, writing review and editing, supervision.

Corresponding author

Correspondence to Andy Kuo.

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Kuo, A., Ahorukomeye, P. & Gordon, Z.L. Aggressive thoracic vertebral hemangioma: case report and literature review. Spinal Cord Ser Cases 9, 20 (2023). https://doi.org/10.1038/s41394-023-00577-3

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