Aggressive epithelioid vertebral haemangioma with atypical imaging features presenting as compressive myelopathy: a case series

We report two cases of atypical vertebral haemangiomas. The first case involves a 44-year-old male presenting thoracolumbar pain, abdominal paresthesias, a T7 sensory level, and paraparesis. Imaging revealed an osteolytic lesion of the T3 vertebral body, epidural extension and spinal cord compression. An initial corpectomy with stabilization was performed, and histopathology was consistent with haemangioma. After partial neurological recovery, the patient experienced deterioration due to tumour regrowth. Preoperative embolization followed by combined posterior and thoracotomy-assisted resection allowed extended tumour removal and spinal stabilization, with sustained improvement at 12 months follow-up. The second case concerns a 65-year-old female with lumbar pain radiating to the left L5 dermatome and mild paresis. Magnetic resonance imaging demonstrated an L5 vertebral body lesion hypointense and hyperintense on T1/T2-weighted sequences. Biopsy confirmed diagnosis. These are benign lesions; however, atypical or aggressive forms—1%—may mimic malignancy leading to neurological compromise. This highlights the importance of early diagnosis and multidisciplinary management.