Weekly Case

Title : Case 552

Age / Sex : 75 / M


Chief complaint : Low Back Pain, Bilateral Lower Extremity Radiating Pain

PMHx : s/p Lumbar disc operation (50YA), s/p Cervical disc operation (4MA)

Question: What is the radio-opaque material in the central canal of C-T-L spine (&intracranial aspect) ?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Eugene Lee, Seoul National University Bundang Hospital



Discussion


Answer:  Intradural Oil-based contrast agent


 


Findings:



  • Multifocal intradural tiny calcifications along the whole spinal canal

  • probable previous oil-based contrast myelography related finding

  • A well-defined cystic lesion within the dural sac from L4 to S1 level

  • probable arachnoid cyst related with adhesive arachnoiditis


 


Differential Diagnosis: arachnoiditis Ossificans


 


Discussion:



  • Myodil, and oil based positive contrast media, now discontinued, was widely used for performing myelography 30–70 years ago

  • Myodil remained widely used substance until 1980s, gradually becoming replaced by water soluble contrast media

  • Side effects: arachnoid adhesion (1%), and arachnoid cysts

  • Half time: months or even years

  • Imaging

  • CT : Intradural radio-opaque dots

  • T1WI : Hyper-intense signal intradural lesions

  • T2WI: Iso-intense to hypo-intense intradural lesions


 


References:



  • J spinal Cord Med 2012; 35:187–190


 



Correct Answer
Total applicants 19 Correct answers 5
Name Institution
서지운 전문의
정소용 생생병원, 전문의
전성희 전문의
정희석 양산부산대학교병원, 전문의
김완태 중앙보훈병원, 전문의


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