Sunday 1 December 2013

Spinal epidural lesion causing cord compression MRI

A 15 yo female with bilateral lower limb weakness.
Compressive myelopathy clinically.
MRI Dorsal spine performed with contrast.
Non contrast T1
Post contrast T1
Axial T2
Axial Post contrast T1
D7 vertebral body and adjacent posterior elements show an abnormal altered marrow signals, heterogeneously hyper intense on T2 and STIR with low signal intensity vertical striations on sagittal sections, multiple punctate low signal intensity dots on Axial T2w sections so called as 'Polka dot' appearance corresponds to coarse, thickened vertical trabeculae characteristic of Spinal Osseous Hemangioma.
An associated posterior epidural lentiform shaped soft tissue with intense homogeneous enhancement on post contrast T1 causing canal stenosis, anterior displacement of cord with significant cord compression.

Imaging wise possible diagnosis : Aggressive vertebral Hemangioma with significant cord compression. 

Patient operated, cord decompressed by complete excision of posterior epidural soft tissue by Laminectomy. Tissue subjected for histopathology.


Specimen: D7 vertebral lamina and spinous process with epidural soft tissue.

Gross Appearance : The specimen consists of grey brown soft and largely bony fragments together measuring ~ 25x14mm. Representative sections are submitted for processing after de calcifying bone.

Microscopy : A benign neoplasm composed of vascular tubes or spaces lined by endothelium and many containing blood. The interstitial tissue contains a couple of spicules or trabeculae of bone.

Histopathological Diagnosis : Spinal Intraosseous Hemangioma. 

Vertebral body hemangioma are usually benign looking and asymptomatic.
Rarely aggressive and pt may present with cord compression due to an associated epidural soft tissue as in this case. 

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