Aggressive Hemangioma

56-year-old female presenting for chronic back pain. Centered at the T5 vertebral level involving both the anterior, lateral, and posterior elements of T5, there is a T1 hypointense, T2/STIR hyperintense, enhancing lesion with prominent vertical trabeculations and associated osseous expansion. The lesion extends into the dorsal epidural space with elevation and displacement of the posterior dural margin resulting in anterior displacement and partial effacement of the thoracic spinal cord anteriorly. The deformity of the underlying thoracic spinal cord at that level is best demonstrated on the axial pre- and postcontrast images where there are lobular margins of the osseous lesion resulting in marked spinal canal stenosis at that level. Findings are compatible with an aggressive hemangioma. Aggressive hemangiomas represent an aggresive form of the more common vertebral hemangiomas which are characterized by extra osseous extension, bone expansion, disturbance of blood flow and occasional compression fractures. Aggressive vertebral hemangiomas most often occur between T3 and T9. The lesions typically occupy the entire vertebral body extending into the neural arch with associated osseous expansion and an extraosseous soft tissue component.