Vertebral hemangiomas are most often benign, incidentally imaged lesions with a good prognosis; however, a rare subset of them can be aggressive with devastating neurologic sequela. It is important for the clinician to keep aggressive hemangioma as a differential diagnosis in any patient presenting with myelopathic symptoms and obtain early imaging, especially MRI, in order to guide proper treatment. As aggressive hemangiomas often mimic other aggressive spinal lesions, additional imaging modalities such as CT, angiography, and radiography are usually needed to make a definitive diagnosis.

From the manuscript

Aggressive hemangioma of the thoracic spine

Abstract
Vertebral hemangiomas are common lesions and usually considered benign. A rare subset of them, however, are characterized by extra-osseous extension, bone expansion, disturbance of blood flow, and occasionally compression fractures and thereby referred to as aggressive hemangiomas. We present a case of a 67-year-old woman with progressive paraplegia and an infiltrative mass of T4 vertebra causing mass effect on the spinal cord. Multiple conventional imaging modalities were utilized to suggest the diagnosis of aggressive hemangioma. Final pathologic diagnosis after decompressive surgery confirmed the diagnosis of an osseous hemangioma.