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Case Reports
. 2021 May 16;9(14):3411-3417.
doi: 10.12998/wjcc.v9.i14.3411.

Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report

Kai-Jay Chia  1 , Li-Han Lin  2 , Ming-Tse Sung  3 , Tsung-Ming Su  1 , Jin-Fu Huang  1 , Hsiang-Lin Lee  4 , Wen-Wei Sung  5 , Tsung-Han Lee  6
Affiliations
Case Reports

Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report

Kai-Jay Chia et al. World J Clin Cases. .

Abstract

Background: Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.

Case summary: A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process. She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma. The primary lab survey showed all within normal limits. Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging. A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia. The lesion was confirmed as lymphangioma. This patient recovered well within one month.

Conclusion: This study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.

Keywords: Case report; Decompressive laminectomy; Epidural hematoma; Intraspinal; Lymphangioma; Paraplegia.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Hematoxylin and eosin staining. A: Proliferation of irregular thick wall vascular channels lined by flat endothelial cells with clear lymphatic fluid in the lumens [hematoxylin and eosin (H&E), 40 ×]; B: Some of the proliferative vessels are filled with blood, instead of lymphatic substance (H&E, 100 ×).
Figure 2
Figure 2
Preoperative spinal magnetic resonance imaging demonstrating an intraspinal epidural hematoma at the T4 to the T8 levels (arrows). A: Sagittal T1-weighted image (T1WI); B: Sagittal T2-weighted image; C: Sagittal T1WI with enhancement showing mildly thin peripheral enhancement (arrowheads) and the spinal cord is compressed and flattened (dashed thin arrows).
Figure 3
Figure 3
Dark reddish blood (arrows) in the epidural space was exposed after a laminectomy.
Figure 4
Figure 4
After a laminectomy of T5, numerous epidural vessels (arrowheads) were found.
Figure 5
Figure 5
Postoperative spinal angiography shows the artery of Adamkiewicz arising from the right radiculomedullary artery at T10 level.
Figure 6
Figure 6
Postoperative spinal magnetic resonance imaging revealing a faint T2 hyperintense intramedullary signal at the T6-T8 levels (arrow heads) with no residual epidural hematoma and no remaining spinal cord compression. A: Sagittal T1-weighted image; B: Sagittal T2-weighted image.
See this image and copyright information in PMC

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