Spinal epidural venous plexus congestion
Updates to Article Attributes
Spinal epidural venous plexus congestion or dilatation is typically a complication of other pathologies.
Clinical presentation
Radiculopathy caused by the dilated epidural veins is not uncommon 1. More severe symptoms such as cauda equina compression syndrome have been reported 6, 7.
Pathology
Several spinal and pelvic diseases can result in secondary epidural venous engorgement:
pelvic venous congestion due to external compression (e.g. distended bladder) 1
excessive CSF diversion (see: overshunting-associated myelopathy)
inferior vena cava agenesis (rare) 3
venous stenosis/thrombosis up to occlusion6
(e, e.g. May Thurner Syndrome7)
As the vertebral venous system is valveless, extraspinal venous congestion can rapidly involve these veins 1. The cause for this can be a significant decrease of the local venous drainage due to a multitude of reasons including inferior vena cava thrombosis 6.
Radiographic features
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.
-<li><p>venous stenosis/thrombosis up to occlusion<sup>6</sup> (e.g. <a href="/articles/may-thurner-syndrome-2" title="May Thurner Syndrome">May Thurner Syndrome</a><sup>7</sup>)</p></li>-</ul><p>As the vertebral venous system is valveless, extraspinal venous congestion can rapidly involve these veins <sup>1</sup>. The cause for this can be a significant decrease of the local venous drainage due to a multitude of reasons including inferior vena cava thrombosis <sup>6</sup>.</p><h4>Radiographic features</h4><p>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 <sup>1,2</sup>. The distended venous plexus should not be mistaken for mass, disc herniation, or arteriovenous fistulisation. </p>- +<li><p>venous stenosis/thrombosis up to occlusion<sup>6</sup>, e.g. <a href="/articles/may-thurner-syndrome-2" title="May Thurner Syndrome">May Thurner Syndrome</a><sup>7</sup></p></li>
- +</ul><p>As the vertebral venous system is valveless, extraspinal venous congestion can rapidly involve these veins <sup>1</sup>. The cause for this can be a significant decrease of local venous drainage due to a multitude of reasons including inferior vena cava thrombosis <sup>6</sup>.</p><h4>Radiographic features</h4><p>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 <sup>1,2</sup>. The distended venous plexus should not be mistaken for mass, disc herniation, or arteriovenous fistulisation. </p>
References changed:
- 1. Tuan A, Nabavizadeh S, Pukenas B, Mohan S, Learned K. Reversible Dilatation of Lumbar Epidural Venous Plexus Secondary to Pelvic Venous Compression: Mimicker of Pathology. BJR|case Reports. 2017;3(1):20150287. <a href="https://doi.org/10.1259/bjrcr.20150287">doi:10.1259/bjrcr.20150287</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30363285">Pubmed</a>
- 3. Donmez F. Epidural Venous Plexus Engorgement: What Lies Beneath? Case Reports in Radiology. 2015;2015:1-3. <a href="https://doi.org/10.1155/2015/965106">doi:10.1155/2015/965106</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25722912">Pubmed</a>
- 6. Wong T, Gridley D, Feiz-Erfan I. Epidural Venous Plexus Engorgement Due to Inferior Vena Cava Thrombosis Resulting in Cauda Equina Syndrome: Case Report and Literature Review. Surg Neurol Int. 2018;9(1):129. <a href="https://doi.org/10.4103/sni.sni_115_18">doi:10.4103/sni.sni_115_18</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30105127">Pubmed</a>
- 1. Tuan A, Nabavizadeh S, Pukenas B, Mohan S, Learned K. Reversible Dilatation of Lumbar Epidural Venous Plexus Secondary to Pelvic Venous Compression: Mimicker of Pathology. BJR|case Reports. 2017;3(1):20150287. <a href="https://doi.org/10.1259/bjrcr.20150287">doi:10.1259/bjrcr.20150287</a>
- 3. Donmez F. Epidural Venous Plexus Engorgement: What Lies Beneath? Case Reports in Radiology. 2015;2015:1-3. <a href="https://doi.org/10.1155/2015/965106">doi:10.1155/2015/965106</a>
- 6. Wong TW, Gridley DG, Feiz-Erfan I. Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review. Surg Neurol Int. 2018 Jul 4;9:129. doi: 10.4103/sni.sni_115_18. PMID: 30105127; PMCID: PMC6044142.
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