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14 July 2022: Articles

Lumbar Spinal Epidural Capillary Hemangioma: A Case Report and Literature Review

Mistake in diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Shiying Wu B* , Krishan Kumar Sharma B , Chi Long Ho A

DOI: 10.12659/AJCR.936181

Am J Case Rep 2022; 23:e936181

Table 2. Differentiating spinal epidural capillary hemangioma from other epidural and intradural extramedullary tumors.

CompartmentSpinal tumorsPrevalent age-groupTypical locationPre-contrast MR signal intensityPost-contrast enhancementOther imaging features
EpiduralMetastasesIncidence ↑ with age (typically >40 years old)Predilection for the posterior elements.T1↓ T2↑↔EnhancesPredilection for the posterior elements, may have cortical destruction with associated soft tissue mass. Commonly seen in breast, lung, prostate, renal, gastrointestinal, and thyroid
Multiple myeloma (MM)E. Ads M>FAny vertebral body, typically sparing the pedicles (vs metastases/malignancy pedicles involved) []16 Osseous (T2↑ T1↓) Extraosseous T2↓Avid HomogeneousExtraosseous lesions contiguous with bone, often larger and occur in a paraspinal or epidural location. MM can be associated with collapsed vertebral body, and cord compression
Ewing sarcomaChd, Y. AdsThoraco-LumbarT2↑ T1↓Heterogeneous enhancement of tumor and affected vertebraeCT scan: Lytic permeative destruction
Primary vertebral lymphoma (commonly NHL type)Ads (5–7 decades), M>F (8: 1)Lesions arise from epidural lymphoid tissue along the thoracic and lumbar spineT2↑HomogeneousRestricted diffusion with markedly low ADC
Spinal epidural capillary hemangiomaAds (4–5 decades) MThoracic > lumbar spine (16: 6)T2↑ T1↓HomogeneousForaminal extension in 50% of cases
SFT/HPCAds (4–6 decades) M>FThoracic >cervical >lumbarT1↔, T1↓ T2↑Intense homogeneous
IDEMMeningiomaAds, F>M (9: 1)Thoracic > cervicalT2↔, T2↑Intense homogeneousBroad-based dural attachment and CSF cleft sign. Commonly – solitary; multiple lesions in MEN type II
SchwannomaY. Ads M>FDorsal nerve root, neural foramen Thoracic >cervicalT2↑Homogeneous or inhomo-geneousCysts and necrosis. Commonly – solitary; multiple lesions in MEN type II
ParagangliomaAds M>FConus, cauda equinaT2↔, T2↑Mildly inhomoge-neous “salt-and-pepper” appearance due to prominent flow voidsHemosiderin from prior hemorrhage (T2↓ rim “cap sign”) detected on T2 and GRE sequences
Myxopapillary ependymoma (13% of all spinal ependymomas)Y. Ads, M>FConus medullaris, cauda equinaT2↑ at tumor margin (hemosiderin)Typically homogeneous (except hemorrhage)Hemorrhage detected on GRE sequences
ADC – apparent diffusion coefficient; Adol – adolescent; Ads – adults; Chd – children; CT – computed tomography; E – elderly; F – females; GRE – T2*-weighted gradient-recorded echo; HPC – hemangiopericytoma; IDEM – intradural extramedullary; M – men; MEN – multiple endocrine neoplasia; MR – magnetic resonance; NHL – non-Hodgkin’s lymphoma; SFT – solitary fibrous tumor; Y – young; symbols: ↑ – hyperintense; ↓ – hypointense; ↔ – isointense.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923