Primary intraosseous haemangiomas represent benign endothelial neoplasms that are often discovered incidentally in approximately 10 to 12 percent of the general population. Although bony haemangiomas can be found in many regions of the appendicular and axial skeleton, most of which remain asymptomatic, those that arise in the vertebral column have the potential to elicit pain and cause neurological deficits in certain patients. In fact, a subset of primary vertebral intraosseous haemangiomas

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... e been shown, albeit extremely rarely, to demonstrate aggressive, destructive and even malignant behavior. From a clinical and therapeutic standpoint, it is essential to recognize that such lesions possess certain radiological and nuclear imaging characteristics that, when observed in conjunction with patient decline, correlate strongly with the atypical and aggressive neoplasms. Ultimately, such lesions have the potential to give rise to an extremely uncommon, widespread, highly debilitating form of haemangiomatous pathology, hereafter termed "pseudomalignant haemangiomatosis". Fortunately, treatment in the form of directed radiotherapy has shown remarkable results in regards to symptomatic relief and complete neurologic restoration.