Epithelioid hemangioma of the spine: an uncommon cause of spinal cord compression

Excerpt

A 65-year-old female presents to the emergency room with worsening mid-back pain, rapidly progressive numbness starting from below the breasts (T5 sensory level), and bilateral lower extremity weakness. She reported increasing difficulty ambulating and was unsteady on her feet. She had radiating pain into her anterior thighs, occasionally extending into her calves, right greater than left and had new-onset loss of sphincter, bowel and bladder control. Her focused neurologic exam showed quadriceps strength of 4+/5 on the left and 4−/5 on the right. Ankle dorsiflexion was 4−/5 bilaterally. She had a known history of mid-thoracic back pain for the preceding 4 months. She denied any history of remote or recent spinal trauma. Spinal cord compression was suspected and the initial CT imaging revealed a large lytic lesion at the T7–8 level with involvement of the corresponding ribs. Coronal imaging revealed destruction, expansion and trabeculation of the vertebral bodies of T7–9 and loss of vertebral body height. On axial imaging, there was paravertebral soft tissue extension with central canal narrowing (Figs. 1, 2, 3).

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