Figure 1. Lumbar radiograph, lateral view. A close-up of the lower lumbar segments shows coarse, thickened vertical trabeculae evident at the L5 vertebral body (arrows), suggestive of a vertebral hemangioma. While the outside radiology report suggested a hemangioma at L4 as well, our secondary review was not concordant with this determination, as the sclerosis in L4 appeared more heterogeneous. Also, while not noted in the original report, the superior endplate of L3 was noted to be slightly concave (arrowhead), compatible with a possible occult vertebral fracture. Disc space narrowing was also apparent at L4–5 and L5-S1 (*). Due to the original images being taken on plain film, there was a loss of quality when copying these into the patient’s file.