Kim Young-Wouk, Taihi Lokmane, Viry Flore, Bossard Philippe, Polivka Marc, Bousson Valérie
Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France.
Service d'Anatomopathologie, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France.
BJR Case Rep. 2020 Sep 29;6(2):20190091. doi: 10.1259/bjrcr.20190091. eCollection 2020 Sep.
Vertebral hemangiomas are relatively frequent among tumors of the spine. Most of them are asymptomatic and the diagnosis is usually made based solely on imaging. However, although rare, some hemangiomas with atypical imaging features (aggressive hemangiomas) can pose a diagnostic challenge. Clinically, these patients present with neurological symptoms. In imaging, aggressive hemangiomas appear as lesions with significant osseous expansion or extraosseous extension, mimicking the appearance of other tumors, such as metastasis or plasmacytoma. In such cases, a biopsy is often required to obtain a histopathological diagnosis in order to rule out the differential diagnoses mentioned above. We report on two cases of aggressive hemangiomas whose diagnosis remained uncertain until the pathology analysis. On CT-scan control immediately after biopsy, we have been surprised to observe the formation of gas bubbles inside the biopsied lesion, spreading over almost the whole vertebra. This gas web sign may support its liquid-filled spaces composition and its benign nature. Our goal was to highlight this finding and its usefulness.
椎体血管瘤在脊柱肿瘤中相对常见。它们大多无症状，诊断通常仅基于影像学检查。然而，尽管罕见，但一些具有非典型影像学特征的血管瘤（侵袭性血管瘤）可能带来诊断挑战。临床上，这些患者会出现神经症状。在影像学上，侵袭性血管瘤表现为具有明显骨质膨胀或骨外扩展的病变，类似其他肿瘤的表现，如转移瘤或浆细胞瘤。在这种情况下，通常需要进行活检以获得组织病理学诊断，从而排除上述鉴别诊断。我们报告两例侵袭性血管瘤病例，其诊断在病理分析之前一直不确定。活检后立即进行的CT扫描显示，我们惊讶地观察到活检病变内形成了气泡，几乎蔓延至整个椎体。这种气体网征可能支持其充满液体的腔隙组成及其良性性质。我们的目的是强调这一发现及其有用性。
