Aggressive Dorsal Vertebral Hemangioma Causing Compressive Mielopathy

Vertebral hemangiomas are common benign lesions of the spine, characterized by abnormal vascular proliferation, being commonly asymptomatic incidental findings, presenting symptoms in only a small portion of affected individuals. In a smaller number of cases, however, hemangiomas can present an expansive effect and extra-osseous extension, determining a mass effect and neurological symptoms, being therefore called aggressive hemangiomas. On MRI, aggressive hemangiomas are characterized by having a larger vascular component and a smaller fat component, thus producing a low signal on T1-weighted images. We illustrate the case of a young male patient who presented with pain in the upper thoracic spine, who developed paraparesis and ascending sensory deficit and progressive lower limbs, progressing to paraplegia and loss of sphincter control.