Spinal epidural lipomatosis

Case contributed by Dr Derek Smith

Presentation

Long term steroid use for inflammatory bowel disease. Few weeks progressive arm and leg weakness, with leg numbness. Pain at mid thoracic level. Distal reflexes preserved.

Patient Data

Age: 55 years
Gender: Male

High T1w and T2w signal extradural mass, consistent with lipomatosis. Mass extent from T1 to T11, with excessive extradural fat around the sacral levels. Breathing artefact, but effacement of the thecal sac throughout the thoracic spine, with mid thoracic compression; no cord signal change.

Multilevel cervical and L5/S1 degenerative changes. Vertebral endplate fractures at T5, T8 and T11.

Conservative management was agreed, with a tapered reduction in steroids and weight loss management.

The patient was reimaged (with fat sensitive sequences) after six months.

Interval reduction in extent of lipomatous mass (with signal loss confirmed on STIR sequences).

CSF effacement and cord compression at T5-T9 levels (reduced from previous).

"Y-sign" demonstrated on transverse lumbar sequences.

Case Discussion

Excessive fat signal returned from the extradural spaces, with a history of steroid use and symptoms of canal stenosis. Features, including the "Y-sign" in the lumbar canal, are of spinal lipomatosis.

With steroid reduction and general weight loss measures there was some improvement both radiologically and clinically.

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