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 of an 11-year-old patient who presented with a vertebral hemangioma which remained stable for a period of about 20 months followed by aggressive growth resulting in spinal cord compression. This is only the fourth reported case of aggressive vertebral hemangioma in children; however, we document for the first time the evolution of this lesion demonstrating a period of stability followed by aggressive growth of the lesion. We discuss the imaging differential diagnosis which includes asymptomatic vertebral hemangioma and malignant lesions. We also discuss different treatment options 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 well known in children. We need to study vertebral hemangioma further especially in children to understand the natural course and help identify lesions which have aggressive potential and prevent spinal cord compression. This will also help to manage the lesion earlier with less aggressive therapies such as embolization and ethanol injection rather than surgery.