Intraosseous hemangioma

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[edit] Discussion

  • Slow growing vascular neoplasm, usually located in the medullary cavity
  • Classified as benign, but rarely may be locally aggressive
  • Very common, with vertebral lesions seen in 10-15% of the adult population.
  • 4 histologic types: capillary, cavernous, ateriovenous, and venous
  • Histologically demonstrates hamartomatous vascular tissue within endothelium, but may also contain fat, smooth muscle, fibrous tissue, and thrombus.


Typical locations:

  • Vertebra (capillary hamangiomas)
  • Skull (cavernous hemangiomas)
  • Involvement of long and short tubular bones is rare


Symptoms:

  • Lesions are typically asymptomatic, and discovered incidentally
  • Pain
  • Swelling or a palpable mass, especially in the skull


Complications are rare:

  • Pathologic fracture
  • Neural impingement, producing radiculopathy, motor deficits, autonomic dysfunction
  • Bleeding if biopsied


Treatment only if symptomatic:

  • Radiation therapy
  • Embolization to reduce intraoperative blood loss
  • Surgical resection, especially if complicated by spinal cord compression
  • Vertebroplasty
  • Intralesional ethanol injection

[edit] Imaging Findings

[edit] Radiographs

  • Radiographs are usually first line and may be sufficient in vertbera or calvarial lesions:
  • Prominent trabecular pattern
  • Sclerotic vertebra with vertical trabeculae
  • Lytic calvarial lesions with spoke-wheel appearance
  • Irregualr and lytic in long bones, with a honeycomb appearance
  • Pathologic fractures

[edit] CT

  • Usually as an incidental finding
  • Better visualization of thickened vertical trabeculation (polka-dot appearance)

[edit] MR

  • Demonstrates complications, such as neural impringement
  • Shows intralesional fat and vascularity
  • May show extraosseous extension

[edit] Nuclear medicine bone scan

  • Usually normal but may show increased or decreased uptake

[edit] Images

Patient #1: Spinal intraosseous hemangioma


Patient #2: Intraosseous hemangioma in digit

Patient #3: MR images demonstrate intraosseous hemangiomas

[edit] See Also

[edit] External Links

[edit] References

  • Murphey MD, et al. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics. 1995 Jul;15(4):893-917.