Hemangioma of bone

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Tumor biology and incidence

  • Benign lesion; may be associated with disappearing bone disease
  • Often incidental findings in spine: Autopsy findings suggest up to 10% of population may have spine hemangiomas
  • Approximately 1% of all investigated benign bone lesions


Most commonly affects persons 40-60 years of age


M:F = 1:2

Associated syndromes

  • Disappearing bone disease of Gorham, also known as massive osteolysis, can affect any bone
  • Related to hemangioma or lymphangioma-like proliferations in the bone
  • Etiology unknown
  • Rare condition; more often affects children or young adults
  • May be self-limited condition, but progression unpredictable


Incidental finding in majority of cases

Physical Findings

  • Spine lesions may present with neurologic symptoms if there is hematoma secondary to fracture
  • Expansion or collapse may cause direct cord compression (rare)

Plain films

  • Thoracic spine > craniofacial > femur or humerus > hands and feet
  • Usually involves vertebral body with secondary extension into lamina, pedicles, spinous processes, or transverse processes


Tumor effect on bone
  • Coarse vertical striations caused by linear, reactive ossification around areas of rarefied hemangiomatous lesions
    • Striations known as "jailhouse" or "corduroy " vertebra
  • "Honeycombing" pattern may be present due to the dilated vascular channels between residual enlarged bony trabeculae
Bone response to tumor

Rarefaction and may have reactive ossification around hemangiomatous elements



  • Rarely breached by lesion
  • Ballooning of cortex may occur
Soft tissue mass

Rarely present

CT scan

  • Classically shows "polka dot" sign
    • Polka dots represent cross-sectional arrangement of vertical striations seen on plain films


Bright T1- and T2-weighted signal intensity classically seen (representative of intralesional fat and cellularity)

Differential diagnosis

For spinal lesions

  • Paget's
    • Differentiated by a picture frame appearance and expansion of vertebral body
  • Myeloma
  • Metastases
    • Myeloma and metastases distinguished from hemangioma by the lack of striations and fact that they are usually radiolucent


  • Gross: Hemorrhagic tissue with cystic spaces may be present
  • Microscopic: Proliferation of vessels; can be of varying sizes
  • Most commonly dilated capillaries intersect between bone trabeculae

Diagnosis and treatment

  • For spinal lesions, plain radiographs usually diagnostic
    • CT or MRI used to confirm the diagnosis
    • Once the vertebrae collapses, conventional radiographs may no longer be diagnostic
  • If lesion is asymptomatic, no treatment required.
  • Tumor is usually resected anteriorly if there is:
    • Neurologic deficit
    • Collapse with neurologic change or chronic painful kyphus
  • Consider pre-operative embolization
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