Presentation
Left lower limb weakness and urinary retention.
Patient Data
At the level of L1 there is an intramedullary mass located posteriorly. It has a low T1 and T2 rim anteriorly, and internally has a heterogeneous ("popcorn") T2 signal. High T1 and T2 signal surrounds the cord, which itself is mildly expanded. There is linear blooming artifact on GRE images.
The patient proceeded to theater and resection.
Histopathology
MICROSCOPIC DESCRIPTION: The sections show a nidus of thin-walled vascular channels. These have a back-to-back arrangement with thin walls composed entirely of collagen. No elastic tissue or smooth muscle components are seen. Collections of hemosiderin-filled macrophages are noted at the edge of the lesion. The features are of a cavernous hemangioma. No evidence of tumor is seen.
DIAGNOSIS: Cavernous hemangioma.
Case Discussion
Imaging features are that of a spinal cavernoma, with characteristics "popcorn" appearance on T2WI. There is evidence of previous hemorrhage with linear blooming artifact and a low T1/T2 signal hemosiderin ring. High T2 cord signal and expansion suggests edema, presumably secondary to recent bleeding and the cause of the patient's presentation.
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