Iconographies of rare causes of medullary compression due to primary vertebro-medullary and epidural hydatidosis: Contribution of imaging

Abstract

Vertebro-medullary and epidural hydatidosis are a very rare entity, representing 2% of all locations, and is even rarer when it involves a solitary location. It is often asymptomatic. The diagnosis is usually made during complications, particularly medullary compression or extension to the costal cage, which represents a therapeutic emergency. Surgical treatment must be radical to prevent recurrences. We report 2 cases: the first case was a 61-year-old female involved costo-vertebral hydatidosis, and the second was an 18-year-old man with primary sacral epidural location. The objective of our report is to add these 2 atypical locations of hydatid cysts to the existing literature and to present their radiological images to aid radiologists in diagnosis.

Keywords: Costo-vertebral; Echinococcosis; Epidural; Hydatid cyst; Intramedullary; Medullary compression; Sacral hydatid cyst.

Fig. 1

CT scans in parenchymal window (A) and bone windows (B and C) showing the mass in the right costovertebral gutter extending from T8 to T11, causing vertebral and rib bone lysis with severe compression of D9.

Fig. 2

MRI images demonstrating the mass in the right costovertebral gutter, with hyposignal on sagittal T1 sequence (A), intermediate hypersignal on axial T2 sequences (B,C), and STIR (D), containing rounded cystic formations related to daughter vesicles. This mass shows no enhancement on T1 sequences with gadolinium injection (E).

Fig. 3

CT scans in parenchymal and bone windows showing a left sacral soft tissue mass ( orange arrow) containing cystic compartments, exerting scalloping on the adjacent bone ( blue and yellow arrows).

Fig. 4

MRI acquisition with T2 sagittal (A) and axial (B), T1 sagittal (C) and axial with gadolinium injection (D), showing a left lateral epidural mass at the L5-S1 level. The mass presents heterogeneous hypersignal on T2 and hyposignal on T1, containing cystic compartments related to daughter vesicles, slightly enhanced peripherally after injection. This mass displaces the spinal canal to the right.