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Dumbbell-shaped spinal cavernous hemangioma: a case report.

An otherwise healthy 46-year-old man had had midthoracic pain and lower-extremity hypoesthesia for 10 months. Chest radiographs showed a smoothly marginated, 3-cm, left-sided paraspinal mass. Lumbar and subsequent cervical myelograms showed cord compression with high-grade epidural block and mostly left-sided epidural disease extending from T2 to T4. CT scans obtained after myelography showed a dumbbell-shaped mass with a large intrathoracic component extending through the T3-T 4 neural foramen (Fig. 1 A). The well-circumscribed left-sided epidural component of the mass extended from T2 to the T4-T5 interspace. No intradural component was seen. The mass was isodense with muscle and relatively homogeneous. The T3 vertebral body was mildly eroded but intrinsically normal. The well-circumscribed mass was isointense with spinal cord and skeletal muscle on T1-weighted MR images (600/20) (Figs. 1 B and 1 C) and markedly hyperintense to these structures on T2weighted images (2150/60) (Fig . 1 D), where scattered serpiginous foci of hypointensity were noted within the lesion. The coronal T1weighted images showed the dumbbell shape and long intracanalicular segment. A small hyperintense focus was present in the posterolateral aspect of the vertebral body adjacent to the mass. The preoperative differential diagnosis included lymphoma, neurofibroma, schwannoma, and meningioma. Thoracotomy and laminectomies revealed a more infiltrative mass than suspected preoperatively, and only partial resection was possible. No intradural or osseous involvement was present despite the suggestion of vertebral involvement on the axial T2-weighted MR images. Pathologic examination showed