Epithelioid Hemangioendothelioma of the Foot


  • Christopher Sardon Naval Medical Center Portsmouth
  • Christin Foster Dartmouth-Hitchcock Medical Center
  • Javier De Luca-Johnson Naval Medical Center Portsmouth
  • Adam Fehringer Naval Medical Center Portsmouth




Epithelioid hemangioendothelioma, vascular tumor, osseous tumor, lower extremity, polyostotic bone tumor


We describe the case of an 18-year-old male Army reservist presenting with left lower extremity pain for which he was initially diagnosed with a stress injury. After failing conservative treatment, a radiograph was obtained showing a "lacelike" appearance of the medullary bone in the foot and ankle. Magnetic resonance imaging subsequently demonstrated widespread polyostotic marrow replacement with coarsened trabeculations. A biopsy was obtained which diagnosed the patient with polyostotic epithelioid hemangioendothelioma which is the most common malignant vascular tumor of bone. The patient ultimately underwent a below the knee amputation once computed tomography of the chest, abdomen, and pelvis excluded distant metastatic disease. It is important for radiologists to be aware of this diagnosis because osseous epithelioid hemangioendothelioma can present like a stress injury and be mistaken for a less serious diagnosis while potentially having visceral involvement.

Author Biographies

Christopher Sardon, Naval Medical Center Portsmouth

Department of Radiology

Christin Foster, Dartmouth-Hitchcock Medical Center

Department of Radiology

Javier De Luca-Johnson, Naval Medical Center Portsmouth

Department of Pathology

Adam Fehringer, Naval Medical Center Portsmouth

Department of Radiology





Musculoskeletal Radiology