Post-biopsy spontaneous air in vertebrae: A tell-tale sign of vertebral hemangioma

Although most vertebral hemangiomas are asymptomatic and common incidental findings on radiographs and cross-sectional imaging, few atypical vertebral hemangiomas have aggressive imaging features and are clinically symptomatic. This atypical vertebral hemangioma poses a diagnostic dilemma and needs to be differentiated from aggressive vertebral neoplasm-like metastasis or plasmacytoma. Advances in radiological imaging, particularly MRI, help in differentiating atypical hemangioma from aggressive vertebral neoplasm to a certain extent; however, computed tomography-guided biopsy is often required for histopathological confirmation and further management. The aim of the case report is to highlight the finding of post-biopsy spontaneous gas bubble formation inside the vertebra in aggressive vertebral hemangioma, which helps to differentiate it from aggressive vertebral neoplasms.