Epidural venous congestion
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Epidural venous congestion represents the pathological dilatation of the spinal epidural venous plexus, and is typically a complication of other pathologies.
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Radiculopathy caused by the dilated epidural veins is not uncommon 1.
Several spinal and pelvic diseases can result in secondary epidural venous engorgement:
vertebral artery occlusion 2
inferior vena cava agenesis (rare) 3
pelvic venous congestion due to external compression (e.g. distended bladder) 1
lumbar spinal canal stenosis 4
excessive CSF diversion (see overshunting-associated myelopathy)
As the vertebral venous system is valveless, extraspinal venous congestion can rapidly involve these veins 1.
MRI is the method of choice for imaging spinal epidural venous plexus pathology. Axial and sagittal plane T2-weighted sequences usually clearly demonstrate the engorged epidural veins and effacement of CSF spaces 1,2. The distended venous plexus should not be mistaken for mass, disc herniation, or arteriovenous fistulisation.
- 1. Tuan August S, Nabavizadeh S Ali, Pukenas Bryan, Mohan Suyash, Learned Kim O. Reversible dilatation of lumbar epidural venous plexus secondary to pelvic venous compression: mimicker of pathology. (2016) BJR|case reports. doi:10.1259/bjrcr.20150287
- 2. Uhl E, Brückmann H, Goetz C. Congestion of epidural venous plexus secondary to vertebral artery occlusion mimicking a herniated cervical disc. Clin Neurol Neurosurg. 2007 May;109(4):357-60. doi: 10.1016/j.clineuro.2006.12.001. Epub 2007 Jan 11. PMID: 17222506.
- 3. Epidural Venous Plexus Engorgement: What Lies Beneath?. (2015) Case Reports in Radiology. doi:https://doi.org/10.1155/2015/965106
- 4. Ju J, Ha H, Jung C, Kim H, Lee C, Kim J. Patterns of Epidural Venous Varicosity in Lumbar Stenosis. Korean J Spine. 2012;9(3):244-9. doi:10.14245/kjs.2012.9.3.244 - Pubmed