Updated: 6/21/2021

Hemangioma

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https://upload.orthobullets.com/topic/8033/images/Case D - spine - xray - parsons_moved.jpg
https://upload.orthobullets.com/topic/8033/images/Case D - spine - CT - parsons_moved.jpg
https://upload.orthobullets.com/topic/8033/images/Case C - spine - xray - parsons_moved.jpg
https://upload.orthobullets.com/topic/8033/images/Case A - pelvis - xray - parsons_moved.jpg
https://upload.orthobullets.com/topic/8033/images/Histology B - moderate - parsons_moved.jpg
https://upload.orthobullets.com/topic/8033/images/Histology C - hig - parsons_moved.jpg
  • summary
    • Hemangiomas are benign vascular tumors of bone that most often occur in the vertebral bodies and craniofacial bones. Patients typically present with an asymptomatic lesion found incidentally on radiographs.
    • Diagnosis is made with radiographs showing lytic lesions with characteristic vertical striations and with biopsy showing cavernous lesions with numerous thin-walled blood vessels. 
    • Treatment is observation for asymptomatic lesions. Surgical curettage and bone grafting is indicated in progressively painful lesions. 
  • Presentation
    • Symptoms
      • may be asymptomatic
      • may present with pain or pathologic fx
  • Imaging
    • Radiographs
      • lytic lesion characteristic vertical striations giving a "honey-comb" or "jail-bar" appearance
      • may be multi-focal
    • Bone scan is warm to hot
  • Histology
    • Characteristic histology
      • cavernous lesions with numerous thin walled blood vessels
  • Treatment
    • Nonoperative
      • observation
        • indicated if the patient is asymptomatic
    • Operative
      • curettage and bone grafting
        • indicated if the lesion is symptomatic and accessible
      • low dose radiation (25 to 40 Gy)
        • indicated if the lesion is symptomatic and inaccessible

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