title: Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report.
abstract: BACKGROUND
  Vertebral hemangiomas are benign vascular tumours of the bony spine which are usually asymptomatic. Pregnancy-related anatomical and hormonal changes may lead to expansion of hemangiomas and development of neurological symptoms. We present an unusual case of vertebral fracture due to an undiagnosed hemangioma presenting as postpartum back pain following epidural analgesia.
  
  
  METHODS
  A multiparous female with an unremarkable history developed intense lumbar pain after vaginal delivery under epidural analgesia. The pain was attributed to tissue trauma associated with the epidural technique. The patient had no clinical improvement with analgesics, and her symptoms deteriorated over the following days. A magnetic resonance imaging scan revealed an acute fracture of the second lumbar vertebra (L2) with epidural extension and mild compression of the dural sac, suggesting hemangioma as the underlying cause. The patient underwent successful spinal surgery with pedicle screw fixation to stabilize the fracture.
  
  
  CONCLUSIONS
  Vertebral fractures secondary to acute expansion of a vertebral hemangioma rarely occur during vaginal delivery. In such cases, the labour epidural technique and analgesia may challenge the physician in making the diagnosis. Postpartum severe back pain should be thoroughly investigated even in the absence of neurological deficits, and osseous spinal pathology should be considered in the differential diagnosis.
authors: Department of Anesthesiology, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis Sophias Ave., 11528, Athens, Greece, c_staikou@yahoo.gr.
authors: Chryssoula
authors: C
authors: Staikou
authors: Matthaios
authors: M
authors: Stamelos
authors: Ioannis
authors: I
authors: Boutas
authors: Vassileios
authors: V
authors: Koutoulidis
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D001416:Back Pain / Q000209:etiology; D001863:Bone Screws; D005260:Female; D050815:Fractures, Compression / Q000209:etiology* / Q000601:surgery; D006391:Hemangioma / Q000150:complications* / Q000175:diagnosis; D046748:Hematoma, Epidural, Spinal / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008279:Magnetic Resonance Imaging; D049590:Postpartum Period; D011247:Pregnancy; D016103:Spinal Fractures / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000175:diagnosis