summary Hemangiomas are benign vascular tumors of bone that most often occur in the vertebral bodies and craniofacial bones. Patients typically present with an asymptomatic lesion found incidentally on radiographs. Diagnosis is made with radiographs showing lytic lesions with characteristic vertical striations and with biopsy showing cavernous lesions with numerous thin-walled blood vessels. Treatment is observation for asymptomatic lesions. Surgical curettage and bone grafting is indicated in progressively painful lesions. Presentation Symptoms may be asymptomatic may present with pain or pathologic fx Imaging Radiographs lytic lesion characteristic vertical striations giving a "honey-comb" or "jail-bar" appearance may be multi-focal Bone scan is warm to hot Histology Characteristic histology cavernous lesions with numerous thin walled blood vessels Treatment Nonoperative observation indicated if the patient is asymptomatic Operative curettage and bone grafting indicated if the lesion is symptomatic and accessible low dose radiation (25 to 40 Gy) indicated if the lesion is symptomatic and inaccessible