Vanishing bone metastasis in pediatric mediastinal lymphoma: A diagnostic pitfall on contrast-enhanced computed tomography

Vanishing bone metastasis (VBM), a reversible pseudopathologic vertebral enhancement related to vertebral venous congestion, is an imaging pitfall that can mimic true osseous metastases in patients with thoracic venous obstruction. We report a rare pediatric case involving a 15-year-old boy with mediastinal large B-cell lymphoma who presented with superior vena cava obstruction. Contrast-enhanced computed tomography revealed multiple vertebral enhancements suggestive of metastases, which were visible exclusively on post-contrast images and completely resolved following recanalization of the thrombosed veins. This case emphasizes the pathophysiologic mechanism of this reversible phenomenon, resulting from vertebral venous congestion, and underlines the importance of recognizing vanishing metastasis to avoid misdiagnosis and unnecessary oncologic treatment. Awareness of vanishing bone metastasis is essential to prevent misinterpretation as true bone metastases.