Weekly Case

Title : Case 613

Age / Sex : 67 / F


Chief complaint : Back pain and radiating pain in both lower leg(L>R)


 P/Hx: laminectomy at T12-L3, 35 years ago/posterior fixation at L5-S1, 5 years ago

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 : 
Jeongmi Park, Yeouido St. Mary’s Hospital


 



Discussion


Answer:  Arachnoiditis ossificans


 


Findings:


Saccular distention & septation of thecal sac at multiple laminectomy level at T12-L3, especially at L1-L3 body .
 - partly calcified peripheral wall of distended thecal sac.
 - distortion of the cauda equina


 - posterior bony erosions of L 1 & 2  body
 


Differential Diagnosis:


 Adhesive arachonoidits, arachnoid hemorrhage


 


 


Discussion:



  • Unusual chronic meningeal inflammatory process: Sequale of end-state adhesive arachnoiditis

  • Cause: trauma, surgery, arachnoid hemorrhage, myelography (particularly oil based contrast agents), and spinal anesthesia

  • Etiology: uncertain, osseous metaplasia associated with chronic inflammation

  • CT: ossified intraspinal lesion & nerve roots, specific & diagnostic

  • MR: central clumping of nerve roots, peripheral adhesion of the nerve roots and intradural cysts due to loculation of subarachnoid space


 


 


References:


A rare cause of progressive myelopathy Open Neuroimag J 2015; 9:13-20.


Arachnoiditis Ossificans: MR imaging features in five patients AJR 2001;177:461-464



Correct Answer
Total applicants 26 Correct answers 6
Name Institution
김기욱 국군대전병원, 전문의
조은경 새움병원, 전문의
장성원 중앙보훈병원, 전공의
정보미 전문의
김보람 전문의
김창현 전문의


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