Mahdi Hamza, Allevato Pat Anthony, Naeem Abdul Haseeb
Schulich School of Medicine and Dentistry, Windsor, Canada.
Department of Pathology and Laboratory Medicine, Windsor Regional Hospital, Windsor, Canada.
J Med Cases. 2025 Jun 30;16(6):232-237. doi: 10.14740/jmc5132. eCollection 2025 Jun.
Intramuscular hemangiomas are rare, benign vascular tumors, with very few reported cases arising in lumbar paraspinal muscles. We describe the seventh documented adult case involving a 39-year-old male presenting with acute severe right-sided S1 radiculopathy. Magnetic resonance imaging (MRI) identified an 8.0 × 3.0 × 3.3 cm lesion within the erector spinae muscles at the L5-S1 level, accompanied by concurrent right-sided L5-S1 disc herniation compressing the S1 nerve root. Conservative treatment initially alleviated radicular pain, but persistent back pain and diagnostic uncertainty necessitated further evaluation. Negative metastatic screening and an inconclusive computed tomography (CT)-guided biopsy led to surgical excision, revealing an intramuscular hemangioma with significant adipocytic stromal components. This case highlights diagnostic challenges and underscores the importance of including vascular lesions in the differential diagnosis of persistent back pain, particularly when coexisting spinal pathologies complicate clinical presentation.
肌内血管瘤是一种罕见的良性血管肿瘤，很少有报道称其发生于腰椎旁肌肉。我们描述了第七例有记录的成年病例，患者为一名39岁男性，表现为急性严重右侧S1神经根病。磁共振成像（MRI）显示在L5-S1水平的竖脊肌内有一个8.0×3.0×3.3 cm的病变，同时伴有右侧L5-S1椎间盘突出压迫S1神经根。保守治疗最初缓解了神经根性疼痛，但持续的背痛和诊断不确定性需要进一步评估。转移性筛查阴性以及计算机断层扫描（CT）引导下的活检结果不明确，导致进行手术切除，结果显示为一个具有大量脂肪细胞基质成分的肌内血管瘤。该病例突出了诊断挑战，并强调了在持续性背痛的鉴别诊断中纳入血管病变的重要性，尤其是当并存的脊柱病变使临床表现复杂化时。
