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Spinal epidural hematoma. Every imaging technique counts.
EP33117
Poster Title: Spinal epidural hematoma. Every imaging technique counts.
Submitted on 10 Oct 2020
Author(s): Darío Herrán de la Gala, David Castanedo Vázquez, Teresa Cobo Ruiz, Pablo Sanz Bellón, Pablo Menéndez Fernández-Miranda, Amaia Pérez del Barrio, Javier Azcona Sáenz, Carmen González-Carreró Sixto, María Sáenz Aldea, Yasmina Lamprecht, Javier García Poza, Marta Drake Pérez
Affiliations: Santander, “Marqués de Valdecilla” University Hospital, Cantabria/Spain.
Poster Views: 108
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Poster Information
Abstract: Case presentation:
A 71-year-old female patient was admitted to the emergency department because of acute onset paraparesis alongside with thoracic pain that radiates like a belt.
A thoracoabdominal CT angiography was performed (Figure 1A, 1C) demonstrating a subtle hyperdense mass inside the thoracic segment of the spinal cavity which appear to be a hematoma. The study was completed with an MRI (figure 1B, 1D) showing an extradural collection that extended from C7 to T8 with maximum width at T6, suggestive of thoracic epidural hematoma that displaced the spinal cord anteriorly but without myelopathy signs in the MRI.

Discussion:
Spinal epidural hematoma (SEH) is a rare spinal pathology which differential diagnosis includes spinal abscess, spinal subdural hematoma and other spinal masses. They usually present as a subtle hyperdense (50-70 UH) extradural mass in a patient with acute spinal cord compression syndrome. The best way to confirm the diagnosis is MRI. Blood may have different signal intensity depending on its evolution time.

Conclusion:
SEH is most commonly caused because of spontaneous venous bleeds, especially in the context of over-anticoagulation or bleeding disorders. The usually locate in the cervicothoracic region posterior to the tecal sac. Even though MRI confirms the diagnosis, the spinal canal must be assessed carefully in CT imaging when a spinal cord injury is suspected.
Summary: Spinal epidural hematoma (SEH) is a rare spinal pathology which differential diagnosis includes spinal abscess, spinal subdural hematoma and other spinal masses.
SEH is most commonly caused because of spontaneous venous bleeds, especially in the context of over-anticoagulation or bleeding disorders. They usually locate in the cervicothoracic region posterior to the tecal sac.
References: 1. Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F. MRI findings in spinal subdural and epidural hematomas. European Journal of Radiology. 2007 Oct;64(1):119–25.
2. Lavi ES, Pal A, Bleicher D, Kang K, Sidani C. MR Imaging of the Spine: Urgent and Emergent Indications. Seminars in Ultrasound, CT and MRI. 2018 Dec;39(6):551–69.
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