Lumbar para-spinal haemangioma as a rare differential diagnosis of lumbar disc prolapse

Paraspinal muscle haemangioma in itself is an uncommon entity with very few literatures documenting it. It can present as a rare differential diagnosis of lumbar disc prolapse. Although excision is the standard treatment, chances of recurrences cannot be ruled out . INTRODUCTION Intramuscular haemangiomas are a rare entity unlike their cutaneous counterparts, with the lumbar paraspinal location barely mentioned in the literature. Muscular ischaemia due to haemangioma in this region presents as low back ache. The haemangiomas of this type have a later age of presentation with exacerbations during pregnancy. Associayed cutaneous lesions may not be present thus making a clinical diagnosis more diffcult than childhood haemangiomas. Prior angiographic localization helps in planning the surgical excision with or without embolization. CASE REPORT A 29 year old female attended us with complaints of low back ache, which was being treated elsewhere for the last six months conservatively as a case of posterior intervertebral disc prolapse of the lumbar spine. The pain was exaggerated on forwards and sideways bending and was not relieved by the treatment she was receiving in the form of rest, analgesics and lumbar traction. ON EXAMINATION Mild loss of lumbar lordosis was present Forward and sideway bending was painful An inconspicuous, diffuse, non fluctuant, non tender, soft swelling was observed over right lumbar (L3-L4) area, measuring 9 x 7 cm, not extending to midline with no impulse on coughing and the overlying skin was normal. Swelling was more discernable on forward bending and the patient complained of pain. No bony tenderness, signs of nerve root irritation or sciatic scoliosis was present. DIFFERENTIAL DIAGNOSIS Hamartoma