J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://jmc.elmerpub.com

Case Report

Volume 16, Number 6, June 2025, pages 232-237

Paraspinal Intramuscular Hemangioma at L5-S1 With Concurrent Disc Herniation

Figure 1. (a) Axial and (b) sagittal T2-weighted MRI show a well-defined mass at L4/L5 extending to L5/S1 (arrows). MRI: magnetic resonance imaging.

Figure 2. Pathology microscopic and immunohistochemical analysis. (a) Thick wall vascular channels (1) are associated with mature adipose tissue (2) and skeletal muscle (3). (b) Variable sized vascular channels (1) associated with mature adipose tissue (2). (c) Vascular channels (1) associated with lipomatous tissue (2) and skeletal muscle (3). (d) The lining cells express CD31 and represent vascular endothelial cells. (e) D2-40 (podoplanin) is negative ruling out a lymphangioma.

**Table 1.** Summary of All Lumbar Paraspinal Intramuscular Hemangiomas in Adults Found in the Literature Search
Source	Age	Sex	Location	Muscle(s) involved	Size	Imaging	Clinical presentation	Outcome
18F-FDG-PET: 18F-fluorodeoxyglucose positron emission tomography; MRI: magnetic resonance imaging; US: ultrasound.
[11]	29 years	Female	Trunk	Postero-lateral most muscles of right posterior para-spinal muscles	5.9 × 4.9 × 8.5 cm	US/MRI	A 9 × 7 cm non-tender, soft paraspinal swelling at L3-L4 on the right side became more prominent with painful forward and side bending movements, occurring in the setting of lower back pain and reduced lumbar lordosis but without bony tenderness or neurological findings.	Mass was excised. Symptomless local recurrence was found during a routine follow-up. MRI was done after 2 years.
[12]	39 years	Male	Trunk	Not reported	Not reported	Not reported	Asymptomatic subcutaneous mass which had been present for 3 years	No recurrence was seen for 1 year following excision.
[13]	37 years	Male	Trunk	Paraspinal/iliopsoas	4.2 × 2 × 3.1 cm	US	Painless, started 9 months prior and was stable in size	Not reported
[13]	19 years	Female	Trunk	Erector spinae	8 × 5 × 3 cm	MRI/US	Painless, started 2 months prior and was stable in size	Not reported
[14]	36 years	Female	Left buttock	Gluteus medius	15 × 10 × 5 cm	X-ray/MRI	A 5-year history of incidental and infrequent pain of the left buttock accompanied by radiating pain in the back of the thigh	Eleven months after the operation, the manual muscle testing score of her gluteus medius muscle was 5, and she resumed her normal work and exercise levels with no recurrence of pain.
[15]	20 years	Male	Trunk	Longissimus and multifidus muscle	Approximately 4 cm	MRI and 18F-FDG-PET	Back pain and tenderness on upper lumbar level. Additionally, he had compression fractures of the L1, L2, and L3 vertebral bodies, as well as the spinous process fracture at L2.	Not reported

Table 1. Summary of All Lumbar Paraspinal Intramuscular Hemangiomas in Adults Found in the Literature Search

Source

Age

Sex

Location

Muscle(s) involved

Size

Imaging

Clinical presentation

Outcome

18F-FDG-PET: 18F-fluorodeoxyglucose positron emission tomography; MRI: magnetic resonance imaging; US: ultrasound.

[11]

29 years

Female

Trunk

Postero-lateral most muscles of right posterior para-spinal muscles

5.9 × 4.9 × 8.5 cm

US/MRI

A 9 × 7 cm non-tender, soft paraspinal swelling at L3-L4 on the right side became more prominent with painful forward and side bending movements, occurring in the setting of lower back pain and reduced lumbar lordosis but without bony tenderness or neurological findings.

Mass was excised. Symptomless local recurrence was found during a routine follow-up. MRI was done after 2 years.

[12]

39 years

Male

Trunk

Not reported

Asymptomatic subcutaneous mass which had been present for 3 years

No recurrence was seen for 1 year following excision.

[13]

37 years

Male

Trunk

Paraspinal/iliopsoas

4.2 × 2 × 3.1 cm

Painless, started 9 months prior and was stable in size

Not reported

[13]

19 years

Female

Trunk

Erector spinae

8 × 5 × 3 cm

MRI/US

Painless, started 2 months prior and was stable in size

Not reported

[14]

36 years

Female

Left buttock

Gluteus medius

15 × 10 × 5 cm

X-ray/MRI

A 5-year history of incidental and infrequent pain of the left buttock accompanied by radiating pain in the back of the thigh

Eleven months after the operation, the manual muscle testing score of her gluteus medius muscle was 5, and she resumed her normal work and exercise levels with no recurrence of pain.

[15]

20 years

Male

Trunk

Longissimus and multifidus muscle

Approximately 4 cm

MRI and 18F-FDG-PET

Back pain and tenderness on upper lumbar level. Additionally, he had compression fractures of the L1, L2, and L3 vertebral bodies, as well as the spinous process fracture at L2.

Not reported