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)
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").

 

 

 

 

 

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.

 

These two images are T1 weighted MR images obtained following intravenous contrast material injection. The soft tissue abnormality (mass-like lesion) demonstrates noticeable enhancement. 

 

 

  

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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