705 - Dry Bed Sheets: Rare Spinal Epidural Masson’s Hemangioma Presenting with Cessation of Nocturnal Enuresis

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EL

Ellie M. Lefkovich, MD

Resident Physician
Thomas Jefferson University Hospital/Nemours Children's Hospital
Brookhaven, Pennsylvania, United States
AB

Alec J. Birnbaum, BS

Medical Student
Rowan-Virtua SOM
Voorhees, New Jersey, United States

Co-Author(s)

KJ

Karthi Jayakumar, DO

PGY-2
TJUH/Nemours
Wilmington, Delaware, United States
ES

Eileen Shieh, MD

Clinical Assistant Professor, Division of Rehabilitation Medicine
Nemours Children's Hospital
Wilmington, Delaware, United States
RH

Rochelle Haas, MD

Attending Physician
Nemours Children's Hospital
Wilmington, Delaware, United States

Submitter(s)

EL

Ellie M. Lefkovich, MD

Thomas Jefferson University Hospital/Nemours Children's Hospital
Brookhaven, Pennsylvania, United States

Case Diagnosis: Spinal Epidural Masson’s Hemangioma

Case Description: A 16-year-old male with a history of daily nocturnal enuresis presented with four days of positional chest and back pain, leg weakness, paresthesias, and cessation of nocturnal enuresis. He was initially seen at another hospital, where CT abdomen/pelvis was unremarkable. He later presented to the pediatric hospital, where his admission exam was notable for bilateral lower extremity weakness, altered sensation, and abnormal gait. Spinal MRI showed an epidural mass at the level of T6-7. He underwent mass resection via T7 hemilaminectomy and facetectomy. Postoperative course was complicated by left lower extremity weakness and bilaterally decreased proprioception and vibratory sensation. Two days post-operative, his nocturnal enuresis returned. He completed outpatient therapies with steady improvements. Pathology of the spinal mass was consistent with an intravascular papillary endothelial hyperplasia, or Masson’s hemangioma.

Discussions: Intra-vascular papillary endothelial hyperplasia (IPEH), also known as Masson’s hemangioma, is very rarely found in the spinal canal. Fewer than ten cases of spinal compression secondary to IPEH have been published. IPEH is most commonly found in the skin and soft tissue, and is a benign lesion caused by proliferation of endothelial cells within an organizing thrombus. Spinal cord compression commonly causes urinary retention or bladder overactivity due to disruption of the reflexes that coordinate bladder-urethral-sphincter coordination. The cessation of nocturnal enuresis as the presentation of neurogenic bladder dysfunction secondary to spinal cord compression is an uncommon presentation and not well described in current literature.

Conclusions: Spinal cord compression due to epidural IPEH is an exceedingly rare diagnosis, compounded by an unusual presenting symptomatology. This case illustrates the importance of thorough investigation of deviations from functional baseline, even if those changes appear desirable. The physiatrist’s essential role of assessing changes in function can be the key to identifying a rare diagnosis, such as spinal IPEH.