A case of multiple aggressive osseous hemangiomas on bone scan

A 49-year-old male with worsening back and right leg pain was referred for bone scan imaging. Bone scan demonstrated multifocal expansile osteoblastic bony lesions, atypical for benign osseous hemangiomas, which are commonly cold on bone scan. Multisite bone biopsies were compatible with the diagnosis of multifocal osseous hemangiomas. This case illustrates that aggressive osseous hemangiomas, a rare subtype of hemangiomas, may have variable osteoblastic activity on bone scan, ranging from mild to severe uptake.