Unusual Cause of Back Pain in an Adolescent Patient: A Case Report and Natural History of Aggressive Vertebral Hemangioma in Children

Back pain is an unusual complaint in children as compared to the adult population but is more likely to be pathological. We present a longitudinal study ofan 11-year-old patient who presented with a vertebral hemangioma which remained stable for a period of about 20 months followed by aggressive growthresulting in spinal cord compression. This is only the fourth reported case of aggressive vertebral hemangioma in children; however, we document for the firsttime the evolution of this lesion demonstrating a period of stability followed byaggressive growth of the lesion.We discuss the imaging differential diagnosis which includes asymptomatic vertebral hemangioma and malignant lesions. We also discuss different treatmentoptions available and their complications. In our patient, among the risk factors for an aggressive hemangioma, female gender and involvement of posterior elements were positive. However, the natural history of this lesion is not wellknown in children. We need to study vertebral hemangioma further especially inchildren to understand the natural course and help identify lesions which haveaggressive potential and prevent spinal cord compression. This will also help tomanage the lesion earlier with less aggressive therapies such as embolizationand ethanol injection rather than surgery.Key words: back pain, pediatrics, vertebral hemangioma