What is the differential diagnosis based on imaging?
Differential diagnosis would include multifocal intraosseous hemangiomas, polyostotic fibrous dysplasia, metastatic disease, and chondrosarcoma.
What are the typical locations/distribution of intraosseous hemangiomas?
Intraosseous hemangiomas are usually seen in the spine, skull, and less likely in the extremities. Multifocal distribution affecting different body parts is rare.
What are the challenges associated with diagnosing rib hemangiomas?
Rib hemangiomas can mimic aggressive lesions due to a sunburst appearance but are typically asymptomatic or exhibit slow growth. Biopsy is typically not recommended due to the high risk of bleeding, which may require embolization if severe.
What are the treatment options for intraosseous hemangiomas?
Treatment depends on symptoms, lesion characteristics, and risk factors for complications such as bleeding or pathological fractures. Localized, well-circumscribed lesions may be treated with excision, radiotherapy, or direct cement injection. Large lesions may require more extensive surgical interventions like curettage with grafting or en bloc resection. Embolization may also be performed.
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.