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Case#15 History:
Young female with history of a skin lesion on the
back, treated with laser with no significant
improvement. The skin lesion is relatively large,
slightly raised and not compressible, but quite
painful.
Imaging Studies:
- MRI
performed at outside institution (see images
below)
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1st
sagittal MR image is a T2 weighted image
showing bright signal in two vertebral bodies.
Same vertebral bodies demonstrate low signal
on T1 weighted MR image (2nd image). These
imaging findings are consistent with vertebral
venous malformations (or commonly called as
"hemangiomas").
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These
MR images are axial cuts through the above
mentioned diseased appearing vertebrae. In
addition to bone signal abnormalities, there
is a soft tissue mass-like lesion seen in the
neural foramina on the left extending into the
spinal canal and displacing the spinal cord to
the right.
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These
two images are T1 weighted MR images obtained
following intravenous contrast material
injection. The soft tissue abnormality
(mass-like lesion) demonstrates noticeable
enhancement.
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Management:
Due to unusual skin lesion (? pseudo-port-wine
stain), Cobb
disease is suspected. CTA
was performed (not shown here) which did not show
any high-flow anomaly and demonstrated above
detailed soft tissue abnormality. This abnormality
showed inhomogenous subtle contrast
enhancement.
Based
on these findings, low-dose radiotherapy is
recommended for her pain. CT imaging after therapy
to decide the degree of involvement of the vertebral
bodies. If the vertebral bodies appear weak at that
point (prone to compression fracture),
vertebroplasty will be considered to lower the risk
of vertebral collapse (which would cause acute cord
compression in this patient).
Diagnosis:
Spinal
Venous Malformation ("hemangioma") with
extra-osseous soft tissue component.
Reading
Materials (PDF file): Percutaneous
Treatment of Spinal Hemangiomas (1)
Percutaneous
Treatment of Spinal Hemangiomas
(2)
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