Multimodal Percutaneous Treatment of an Aggressive Intraosseous Hemangioma of the Pelvis

A 51-year-old man with a history of ankylosing spondylitis presented with gradually increasing right hip pain. Computed tomography and magnetic resonance imaging demonstrated a large lytic lesion of the right iliac bone. Percutaneous bone biopsy was performed, followed by a diagnosis of an aggressive bone hemangioma. After a multidisciplinary meeting, sequential interventional treatment combining arterial embolization, percutaneous cryoablation, and cementoplasty was proposed and performed under imaging guidance, resulting in a complete resolution of symptoms. The patient presented a local recurrence at 4 years posttreatment, managed successfully with percutaneous cementoplasty under computed tomography guidance. · - Multidisciplinary management approach is warranted to yield optimal outcomes in patients with aggressive bone hemangiomas.. · - Percutaneous cryoablation can be considered as an alternative treatment option for symptomatic bone hemangioma, especially when tumor size reduction is desired.. · - When treating vascular bone tumors with percutaneous cryoablation, preoperative arterial embolization may not only reduce hemorrhagic risks but also improve local tumor control by preventing the so-called cold sink effect..