Presentation
Status post prostatectomy in 2007 for prostate cancer, now presenting with pelvic pain.
Patient Data
There are expansile lesions with a sunburst appearance in the bilateral ribs, largest in the right fifth rib and left third rib. Relatively smaller lesions are seen in the right seventh rib, left second rib, and left twelfth rib. There is also a large heterogenous lesion in the left iliac bone extending to the left acetabulum. Lesions with a honeycomb appearance are seen in the T2, T9, and L2 vertebrae.
A limbus vertebra is seen at L3. Chronic cystic changes are seen around the pubic symphysis, degenerative. Intraosseous pneumatocysts are seen in the right sacrum and left iliac bone along the sacroiliac joints, degenerative.
No mass is identified in the lungs or abdominal organs. There is no lymphadenopathy. Cysts are seen in the liver. The patient is status post prostatectomy.
Case Discussion
Biopsies of the right rib lesion were negative for malignancy, showing benign reactive fibrovascular tissue with intraosseous hemangioma being on the top of the differential. The radiologic findings are consistent with multifocal intraosseous hemangiomas, similar to other cases reported in the literature. The lesions are being followed annually and are reportedly stable.
The radiologic features of multifocal intraosseous hemangiomas encompass distinctive patterns across different body sites 1. For vertebral hemangiomas, typical radiological signs include a "fence" appearance on X-rays, a "polka-dot" pattern on axial CT scans, and high signal intensity on T1 and T2-weighted MRI images. Aggressive vertebral hemangiomas may exhibit cortical expansion, involvement of the entire vertebral body, and associated soft tissue mass, particularly in the thoracic region. Rib hemangiomas typically present as expansile lesions with fine trabeculae, sometimes displaying a "sunburst" or "honeycomb" appearance. Long bone hemangiomas may mimic other bone tumors, showing a "soap bubble" appearance on imaging studies.
Case co-author: Alice Barrington (Loyola University)
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