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 ADOI: 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.
| Compartment | Spinal tumors | Prevalent age-group | Typical location | Pre-contrast MR signal intensity | Post-contrast enhancement | Other imaging features |
|---|---|---|---|---|---|---|
| Epidural | Metastases | Incidence ↑ with age (typically >40 years old) | Predilection for the posterior elements. | T1↓ T2↑↔ | Enhances | Predilection 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>F | Any vertebral body, typically sparing the pedicles (vs metastases/malignancy pedicles involved) []16 | Osseous (T2↑ T1↓) Extraosseous T2↓ | Avid Homogeneous | Extraosseous 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 sarcoma | Chd, Y. Ads | Thoraco-Lumbar | T2↑ T1↓ | Heterogeneous enhancement of tumor and affected vertebrae | CT 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 spine | T2↑ | Homogeneous | Restricted diffusion with markedly low ADC | |
| Spinal epidural capillary hemangioma | Ads (4–5 decades) M | Thoracic > lumbar spine (16: 6) | T2↑ T1↓ | Homogeneous | Foraminal extension in 50% of cases | |
| SFT/HPC | Ads (4–6 decades) M>F | Thoracic >cervical >lumbar | T1↔, T1↓ T2↑ | Intense homogeneous | ||
| IDEM | Meningioma | Ads, F>M (9: 1) | Thoracic > cervical | T2↔, T2↑ | Intense homogeneous | Broad-based dural attachment and CSF cleft sign. Commonly – solitary; multiple lesions in MEN type II |
| Schwannoma | Y. Ads M>F | Dorsal nerve root, neural foramen Thoracic >cervical | T2↑ | Homogeneous or inhomo-geneous | Cysts and necrosis. Commonly – solitary; multiple lesions in MEN type II | |
| Paraganglioma | Ads M>F | Conus, cauda equina | T2↔, T2↑ | Mildly inhomoge-neous “salt-and-pepper” appearance due to prominent flow voids | Hemosiderin from prior hemorrhage (T2↓ rim “cap sign”) detected on T2 and GRE sequences | |
| Myxopapillary ependymoma (13% of all spinal ependymomas) | Y. Ads, M>F | Conus medullaris, cauda equina | T2↑ 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. | ||||||