Spontaneous acute extradural haematoma of the thoracic spine

Case contributed by Dr Chris O'Donnell

Presentation

Sudden onset of upper thoracic pain and paraparesis. No trauma.

Patient Data

Age: 20
Gender: Female

CT performed to exclude bony cause of acute paraparesis

Modality: CT

Subtle crescentic hyperdensity posterior to the spinal cord in the upper thoracic region without underlying fracture or other bone pathology.

Extra-axial mass of high signal on T1 (best seen on the pre-contrast T1 fat sat axial)  at the cervco-thoracic junction showing low T2 signal and peripheral enhancement.  Note how the "mass" lifts up and displaces the dura on the sagittal sequences.  No serpentine flow voids to indicate an underlying dural arterio-venous fistula.

Case Discussion

Spontaneous (ie non-traumatic) extradural haematoma in the spine is rare but can be devastating.  They typically occur at the cervico-thoracic junction posteriorly as this is a particularly prominent site for epidural veins and often in younger persons.  An underlying vascular pathology such a arterio-venous fistula may be present.  The keys to diagnosis are the sudden onset of painful paraparesis/quadraparesis with an extra axial mass on MRI sitting outside the dura, of high T1 signal and low T2 signal indicative of methaemaglobin and peripheral enhacement only.

PlayAdd to Share

Case Information

rID: 50507
Case created: 9th Jan 2017
Last edited: 19th Apr 2017
System: Spine
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.