Vertebral hemangiomas (VH) are common unifocal or multifocal benign lesions in spine imaging with incidence of 10%-12%. Patients are usually asymptomatic and often vertebral hemangioma is incidental finding on imaging. An aggressive or atypical vertebral hemangiomas have associated imaging features like extra-osseous extension, compression fractures, vertebral ballooning & soft tissue components exist with incidence of 1% to 3%. Treatment protocols for aggressive VHs include combination of radiotherapy, vertebroplasty, alcohol injection, embolization, and surgery. We present a case of 24 year female patient having aggressive D12 vertebral hemangioma showing extra-osseous extension, ballooning and small intra-spinal soft tissue component not causing cord compression and follow up imaging after completion of radiotherapy.