Weekly Case

Title : Case 555

Age / Sex : 35 / M


Chief complaint :


Right sided hypesthesia for several months



What is your impression?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Joon-Yong Jung, Seoul St. Mary’s hospital



Discussion


Answer:  Cavernous malformation


 


Findings:


There is a small, poorly marginated intramedullary mass in the left hemicord of T1-2 level. The mass demonstrates bright signal intensity on T1-weighted image, and heterogeneous signal intensity with surrounding dark signal-intensity rim. No contrast enhancement is subtle or absent on post-contrast T1-weighted image.


 


Differential Diagnosis:


Spinal AVM


Spinal cord hemorrhage


Hemorrhagic intramedullary tumors


 


Discussion:


Cavernous malformations (CMs), once referred to as cavernous angiomas, are angiographically occult vascular lesions, which account up to 15% of all the vascular malformations. The lesions are frequently found in the brain, but can occur throughout the central nervous system (CNS). Pathologically, these lesions are composed of dilated, thin-walled capillaries that have a simple endothelial lining with variably thin fibrous adventitia. Typically, there is no brain parenchyma in between the centrally placed vascular channels.


Spinal CMs are increasingly being diagnosed by MRI in patients with varying spinal cord related symptoms or pain syndromes. Due to space occupying growth and recurrent micro-bleeding in the relatively thin spinal cord, spinal CMs can lead to severe neurological deteriorations unlike their intracranial counterparts. The risk of significant haemorrhage like other vascular malformations is considered to be low due to the low venous pressure.


The imaging findings are identical to the intracranial CMs. The lesion has a popcorn ball–like appearance with multiple high signal intensity foci on T1-weighted images, and a low-signal-intensity rim due to hemosiderin deposition.


 


References:



  1. S Fontaine, D Melanson, R Cosgrove, G Bertrand. Cavernous hemangiomas of the spinal cord: MR imaging. Radiology 1988:839-841

  2. T Krings, M Mull, JM Gilsbach, A Thron. Spinal vascular malformation. Eur Radiol. 2005;15:267-278

  3. Zevgaridis, R.J. Medele, C. Hamburger, H.J. Steiger, H.J. Reulen. Cavernous haemangiomas of the spinal cord. A review of 117 cases. Acta neurochirurgica (Wien), 1999;141:237-245.

  4. Maslehaty, H. Barth, A.K. Petridis, A. Doukas, H.M. Mehdorn Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome Eur Spine J, 2011;20:1765-1770


 


To submit your answer, login first (for Korean radiologists) or send e-mail to balgundol@gmail.com (for non-Korean radiologists)

Correct Answer
Total applicants 33 Correct answers 21
Name Institution
박준동 뿌리병원, 전문의
김동환 군의관, 전문의
전성희 전문의
김기욱 강남세브란스병원, 전문의
손상욱 단국대학교병원, 전공의
정소용 생생병원, 전문의
서지운 전문의
김완태 중앙보훈병원, 전문의
김지은 서울대학교병원, 전공의
박선영 한림대학교 성심병원, 전문의
김미선 전문의
김성관 인제대학교 부산백병원, 전문의
윤유성 구례병원, 전문의
송윤아 전문의
이승훈 한양대학교병원, 전문의
김태형 전문의
김현수 전문의
김보람 전공의
전인환 전문의
이혜란 전문의
최희석 전병원, 전문의


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