| Title : Case 84 |
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Age / Sex : / Age / Sex : 86/F
1) What is your impression? Two weeks later, you can see the final diagnosis with a brief discussion of this case. * Send Application Answers to Ja-Young Choi, MD ([email protected]) . Courtesy : Younghwan Lee, MD. Daegu Catholic University Medical Center Diagnosis: aggressive vertebral hemangioma DiscussionFindings: T2-weighted sagittal image shows extensive high signal intensity with punctuated or linear areas of low signal intensity throughout the T2 and T3 vertebral bodies and posterior elements. These lesions show heterogeneous high signal intensity is seen on the T1-weighted image and heterogeneous enhancement. Axial images show enhancing paraspinal and anterior epidural extension causing cord compression. Differential Diagnosis: Multiple myeloma Metastasis Lymphoma Diagnosis: Aggressive vertebral hemangioma Discussion: Hemangiomas are the most common benign tumors of vertebrae with an estimated incidence of 10-12%, and are usually asymptomatic. Plain radiography shows a coarse, vertical trabecular pattern, the cordulay appearance, is identified in the vertebral body. Axial CT or MR scan reveals a polka dot pattern within the vertebral body. MR imaging reveals areas of high signal intensity on T1- and T2-weighted images; these areas have been related to the presence of fatty marrow intimate with the dilated vascular channel within the tumor. Symptomatic aggressive hemangiomas are rare. They are characterized by significant bony expansion or extraosseous extension with compression of the spinal cord. References: 1. Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In Resnick D. Diagnosis of bone and joint disorders. Philadelphia : Saunders, 2002;3979-3985 2. Lee S, Hadlow AT. Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression. Spine 1999;24:2111-2114 3. Hurley MC, Gross BA, Surdell D, Shaibani A, Muro K, Mitchell CM, et al. Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol 2008;29:1095-1097 |
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| Name | Institution |
| Total Applicants (10) | |
| Correct Answer (4) | |
| 김권형: 제주한마음병원 | |
| 박소영: 분당서울대병원 | |
| 이경규: 한강성심병원 | |
| 이유경: 서울대병원 전공의 | |
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