Weekly Case

Title : Case 612

Age / Sex : 73 / M

Chief complaint :

Both leg pain

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 : 
In Sook Lee, Pusan National University Hospital



Pantopaque induced arachnoiditis



On plain radiography, multiple increased opacity was seen in S1 level.

On sagittal and axial CT images, multifocal high density dot like lesions were seen in the thecal sac and along the dural wall.

On axial and sagittal T2-weighted images, multifocal high SI intradural lesions are noted, and they show high SI on T1-weighted image. Also adhesion of cauda equine and septation of thecal sac were noted.


Differential Diagnosis:

Calcified dural plaques

Calcified hematoma from remote trauma

Arachnoiditis ossificans

Intradural lipomas




  • Myodil (From 1946 to 1988, Glaxo)

  • Iophendylate, a fatty acid, formerly manufactured by Glaxo Laboratories

 (London, UK)

  • also known as Pantopaque in the USA

  • oil-based contrast media

  • widely used in myelography, ventriculography, and cisternography

     ð used substance until the 1980s, gradually becoming replaced by

         water-soluble media.

  • rare side effects of intrathecal Myodil

     ð arachnoid adhesions, cysts causing spinal cord syrinxes, compression,  

         or nerve root irritation

  • absorbed very slowly

  ⇒ months or even years, and can remain in the thecal sac for years after

      a procedure

  ⇒ usually appears as intradural dorsal droplets


  • MRI characteristics similar to those of fat or blood

  ⇒ hyperintense on T1WI and hypointense to hyperintense lesions on




  1. Magnetic resonance imaging findings of remnants of an intradural oil-based contrast agent

 - The Journal of Spinal Cord Medicine, Volume 35, Issue 3, 2012

  1. Asymptomatic thoracic Pantopaque cyst mimicking an intradural extramedullary lipoma on MR images

        - Europian spine journal, Volume 22, Issue 3, 2012


Correct Answer
Total applicants 30 Correct answers 13
Name Institution
이규정 고대안암병원, 전문의
김동수 전공의
김창현 전문의
남태훈 국군서울지구병원, 전문의
김동찬 단국대학교 병원, 전공의
이혜란 전문의
장성원 중앙보훈병원, 전공의
박선영 한림대학교 성심병원, 전문의
조은경 새움병원, 전문의
김보람 전문의
안준형 공중보건의, 전공의
윤유성 순천향대 부천병원, 전문의
김형민 전문의

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