A 41-year-old patient with a history of low back pain underwent conventional radiography, CT, digital subtraction angiography (DSA), and MR imaging. An inhomogeneous sclerotic-lytic lumbar vertebra with slightly thickened spongiotic structure and intense contrast enhancement were compatible with an L4 vertebral hemangioma. Embolization and posterior surgical osseous decompression was performed. Histologic analysis of osseous parts revealed a vertebral lymphangioma instead of a hemangioma.