March 28, 2016
A 25-year-old pregnant woman in her second trimester with a sudden increase in low back pain and lower limb weakness
Spinal Intradural Capillary Hemangioma
- Background:
- Hemangiomas are soft-tissue tumors rarely encountered in the neuraxis, with only a few intraspinal cases reported.
- They may originate from penetrating the pial plexus of the posterior spinal artery in the surface of the spinal cord, and grow exophytically into the intradural virtual space.
- Clinical Presentation:
- They can be clinically silent or may present with sudden neurologic deterioration with sensory and motor symptoms, as there is a significant enlargement when there is intratumoral bleeding and lesion enlargement.
- Key Diagnostic Features:
- The MRI is the modality of choice. These lesions show isointense signal compared to the the spinal cord on T1WI, with hyperintense areas representing blood components or fatty degeneration. Lesions are hyperintense on T2WI, and show avid enhancement on contrast-enhanced T1WI.
- Differential Diagnosis:
- Meningioma: Meningiomas usually display low or isointense signal intensity on T2-weighted images.
- Neurogenic tumors, such as schwannomas: Differentiating between the two can be difficult. However, the presence of fat in hemangiomas might be helpful.
- Hypervascular tumors, like hemangioblastomas and paragangliomas: Enlarged perimedullary veins are more commonly seen in these tumors than in hemangiomas. Angiography may be helpful. Hemangiomas mostly show tumor blush with progressive centripetal enhancement, persisting in venous phase.
- Treatment:
- Laminectomy with tumor resection
