Features:

• Haemangiomas are benign lesions characterised by vascular spaces lined with endothelial cells.
• Common, with approximately 10% of autopsy cases having vertebral haemangiomas.
• M:F 1:2
• Age 30–50 years

Site

• Vertebral bodies (thoracic especially) 50%.
• Calvarium 20%
• Remainder found in the tibia, femur and humerus.

Presentation

• Usually asymptomatic and solitary discovered on X-ray or at post mortem.
• Vertebral haemangiomas may present with chronic back ache and can cause neurological symptoms if they extend into the epidural space.
• May present as a pathological fracture.
• Long bones may over grow due to increased blood supply.

Radiology

Plain X-ray

• Vertebral lesions have coarse, thickened vertebral trabeculae secondary to erosion of the horizontal trabeculae giving a “corduroy” appearance.
• Vertical striations without bone expansion (differential diagnosis Paget’s(jail bar appearance).

Computed tomography

• Vertebral body lesions have a “polka dot” pattern as the vessels are seen in cross-section.
• Calvarial lesions are lytic and resemble radiating wheel spokes.
• Haemangiomas in the metaphysis or epiphysis of long bones are lytic lesions that give a spiculated pattern known as “Irish lace”.

Magnetic resonance imaging

• T1 sequences vary from low to high intensity depending on the amount of adipose tissue present.
• T2 sequences demonstrate lesions with high signal due to the vascularity.

Pathology

• Vascular hamartoma with cystic, dark red cavities.
• Four types: capillary, cavernous, arteriovenous and venous.
• Capillary and cavernous lesions are the most common in bone.
• Arteriovenous haemangiomas are remnants of foetal capillary beds.
• (Similar appearances = ABC, telangiectatic OS).

Microscopy

• Non-vascular components of haemangiomas include fat, smooth muscle, fibrous tissue, bone, haemosiderin and thrombus.

Add Fig. 3

Treatment

• Unnecessary unless the lesion is symptomatic.
• Lesions in the calvarium should be resected with a thin margin of normal bone.
• Vertebral lesions respond to radiation or can be treated with surgical excision preceded by embolisation.
• Lesions in long bones should be excised and packed with bone graft if appropriate.

• Seems to have two distinct clinical presentations.
• First, the lesion can present as multiple lesions in a single bone, two or more adjacent bones, or perhaps all the bones of a limb.
• These lesions seem to have an indolent course and the prognosis remains good.
• The second presentation is that of single or multiple rapidly progressive lesions that metastasise to other bones or to the lung this form of the disease has a very poor prognosis.