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Imaging in spinal posterior epidural space lesions: A pictorial essay

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ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

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Miscellaneous: Collateral venous pathway: Coronal (A), sagittal (B), and axial (C) Computed tomography scan images of the abdomen showing dilated ascending lumbar vein (arrow), anterior, and posterior epidural plexuses (elbow arrow) due to the chronic obstruction of inferior vena cava caused by metastatic retroperitoneal lymphadenopathy (star) from seminoma in a 50-year-old patient
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Figure 40: Miscellaneous: Collateral venous pathway: Coronal (A), sagittal (B), and axial (C) Computed tomography scan images of the abdomen showing dilated ascending lumbar vein (arrow), anterior, and posterior epidural plexuses (elbow arrow) due to the chronic obstruction of inferior vena cava caused by metastatic retroperitoneal lymphadenopathy (star) from seminoma in a 50-year-old patient

Mentions: There are numerous collateral pathways returning the blood from lower extremities and pelvis to right side of the heart when there is obstruction of IVC. Most important of these pathways is the deep pathway that recruits the ascending lumbar veins (which originates from common iliac veins) and anastomose with azygous vein on the right side and hemiazygyous vein on the left side.[57] The vertebral venous plexus of Batson, which includes the intervertebral veins and epidural venous plexus, also provides collateral pathway and communicates with the azygous system.[58] Enlarged and engorged epidural venous plexus can compress on the cord and nerve roots resulting in backache and radicular symptoms, as reported by Paksoy et al. in 13 patients with IVC obstruction [Figure 25].[7]


Imaging in spinal posterior epidural space lesions: A pictorial essay
Miscellaneous: Collateral venous pathway: Coronal (A), sagittal (B), and axial (C) Computed tomography scan images of the abdomen showing dilated ascending lumbar vein (arrow), anterior, and posterior epidural plexuses (elbow arrow) due to the chronic obstruction of inferior vena cava caused by metastatic retroperitoneal lymphadenopathy (star) from seminoma in a 50-year-old patient
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036327&req=5

Figure 40: Miscellaneous: Collateral venous pathway: Coronal (A), sagittal (B), and axial (C) Computed tomography scan images of the abdomen showing dilated ascending lumbar vein (arrow), anterior, and posterior epidural plexuses (elbow arrow) due to the chronic obstruction of inferior vena cava caused by metastatic retroperitoneal lymphadenopathy (star) from seminoma in a 50-year-old patient
Mentions: There are numerous collateral pathways returning the blood from lower extremities and pelvis to right side of the heart when there is obstruction of IVC. Most important of these pathways is the deep pathway that recruits the ascending lumbar veins (which originates from common iliac veins) and anastomose with azygous vein on the right side and hemiazygyous vein on the left side.[57] The vertebral venous plexus of Batson, which includes the intervertebral veins and epidural venous plexus, also provides collateral pathway and communicates with the azygous system.[58] Enlarged and engorged epidural venous plexus can compress on the cord and nerve roots resulting in backache and radicular symptoms, as reported by Paksoy et al. in 13 patients with IVC obstruction [Figure 25].[7]

View Article: PubMed Central - PubMed

ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

No MeSH data available.


Related in: MedlinePlus