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Intramuscular hemangioma
Intramuscular hemangiomas are unique vascular tumors which are benign in nature, most commonly occurring in the trunk and extremities. When present in head and neck, they most frequently involve the masseter and trapezius muscles, accounting for less than 1% of all hemangiomas.
Case reports
In a case report Hamza Mahdi et al. from the Windsor Regional Hospital, Windsor published in the Journal of medical cases to describe a rare case of intramuscular hemangioma in the lumbar paraspinal region with coexisting L5-S1 disc herniation, and to discuss diagnostic complexities and management strategies. This case underscores the diagnostic challenge of distinguishing benign vascular tumors from other soft tissue lesions in the context of coexisting spinal pathologies. The lesion was misidentified preoperatively despite advanced imaging and biopsy, requiring definitive surgical excision for diagnosis. The authors advocate for the inclusion of vascular tumors in the differential diagnosis of persistent lumbar pain, especially when imaging reveals atypical soft tissue masses 1).
Critical Review
This is the seventh documented adult case of lumbar paraspinal intramuscular hemangioma, lending marginal novelty to the case. The radiologic and histologic evaluation is competently detailed, yet the lack of advanced imaging modalities such as contrast-enhanced MRI or MR angiography limits preoperative characterization. Furthermore, the diagnostic sequence—proceeding to surgery after an inconclusive CT-guided biopsy—reflects a pragmatic yet debatable strategy in light of possible biopsy sampling errors.
The report lacks a robust literature synthesis, despite claiming to provide a review. Its utility to neurosurgeons is modest; while the coexisting disc herniation adds some complexity, the discussion does not significantly enhance diagnostic or therapeutic paradigms. A more rigorous comparison with previously reported cases and insights into surgical planning, recurrence risk, or vascular control would have added value.
Final Verdict: A competently presented but academically thin case with limited contribution to surgical decision-making.
Takeaway for the Practicing Neurosurgeon: In cases of persistent back pain with atypical imaging findings, consider intramuscular hemangioma even in the presence of more common compressive pathologies.
Bottom Line: A rare pathology in a common location, misdiagnosed until excised; merits consideration but not paradigm shift.
Rating: 3.5 / 10
Published: June 30, 2025
Blog Categories: Case Reports, Spinal Tumors, Rare Pathologies Tags: intramuscular hemangioma, lumbar spine, vascular tumor, spinal surgery, case report, erector spinae, disc herniation, L5-S1, histopathology