Aggressive Thoracic Hemangioma of Spine Presenting as Painful Adolescent Scoliosis – Diagnosis and Management

INTRODUCTION: Spinal hemangioma is the most common benign lesion of the spine with an incidence of 10–12%. Aggressive hemangioma presents with back pain, deformity, or neurologic deficit. Aggressive hemangioma presenting as painful scoliosis is very rare and literature reporting them is very limited. CASE REPORT: We present the case of a boy in his second decade who presented with back pain for 1 month radiating to his right chest with a deformity in his back. MRI showed a hyperintense lesion involving the sixth dorsal vertebra in the T2-weighted image and a hypointense lesion with striations in STIR images suggestive of hemangioma. Pre-operative embolization was done using micro platinum coils. The patient underwent a decompressive laminectomy and vertebral body decompression. The patient also underwent 12 cycles of radiotherapy. The patient had complete resolution of the deformity without any recurrence at 2 years. CONCLUSION: Management of aggressive hemangiomas with neurologic deficit needs a multidisciplinary approach with surgery, pre-operative embolization, and post-operative radiotherapy.