Solitary vertebral plasmacytoma causing compression fracture in a patient with multiple vertebral hemangiomas: a diagnosis easily missed!

The imaging mimics, acute osteoporotic compression fractures, metastasis and malignant melanoma or plasmacytoma pathological fractures are the important clinical problems in geriatric age group that need to be differentiated due to their grossly differing prognostic and therapeutic implications. There are few suggestive features on magnetic resonance imaging (MRI) that help differentiate between these entities. Hemangiomas are very common benign spinal tumors that have characteristic features on MRI. In the setting of multiple vertebral hemangiomas causing cord compression in elderly patients, the scenario is even more complex with four different entities with different prognostic profiles. We report such a diagnostic dilemma we encountered in a middle aged female patient with multiple vertebral hemangiomas and compression fracture in D10 vertebra.