scholarly journals Posttraumatic thoracic epidural capillary hemangioma – A rare case report

2020 ◽  
Vol 11 ◽  
pp. 179 ◽  
Author(s):  
G. Sudhir ◽  
Vignesh Jayabalan ◽  
T. H. Manohar ◽  
Saikrishna Gadde ◽  
Venkatesh Kumar ◽  
...  
Keyword(s):  
Epidural Space ◽  
Lower Limb ◽  
Histopathological Examination ◽  
Cord Compression ◽  
Capillary Hemangioma ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
En Bloc ◽  
Limb Weakness ◽  
Thoracic Epidural

Background: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. Case Description: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. Conclusion: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.

scholarly journals Traumatic rupture of thoracic epidural capillary hemangioma resulting in acute neurologic deficit: illustrative case

2021 ◽  
Vol 2 (21) ◽  
Author(s):  
Reilly L. Kidwell ◽  
Lauren E. Stone ◽  
Vanessa Goodwill ◽  
Joseph D. Ciacci
Keyword(s):  
Cord Compression ◽  
Spinal Fracture ◽  
Capillary Hemangioma ◽  
Traumatic Rupture ◽  
Illustrative Case ◽  
Unique Case ◽  
Lower Extremity Weakness ◽  
Thoracic Epidural ◽  
Spine Imaging ◽  
Middle Aged Adults

BACKGROUND Thoracic epidural capillary hemangioma is exceedingly rare, with only a few reported cases. The typical presentation usually includes chronic, progressive symptoms of spinal cord compression in middle-aged adults. To the authors’ knowledge, this case is the first report in the literature of acute traumatic capillary hemangioma rupture. OBSERVATIONS A 22-year-old male presented with worsening lower extremity weakness and paresthesias after a fall onto his spine. Imaging showed no evidence of spinal fracture but revealed an expanding hematoma over 24 hours. Removal of the lesion demonstrated a ruptured capillary hemangioma. LESSONS This unique case highlights a rare occurrence of traumatic rupture of a previously unknown asymptomatic thoracic capillary hemangioma in a young adult.

scholarly journals Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chi-An Luo ◽  
Meng-Ling Lu ◽  
Arun-Kumar Kaliya-Perumal ◽  
Lih-Huei Chen ◽  
Wen-Jer Chen ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Functional Recovery ◽  
Lower Limb ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Tandem Spinal Stenosis ◽  
Degenerative Cervical Myelopathy

AbstractWhen patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.

Cervical Expanding Hematomas in Dogs: Five Cases

2002 ◽  
Vol 38 (6) ◽  
pp. 533-540 ◽  
Author(s):  
A. J. Deneuche ◽  
V. T. Viateau ◽  
L. Boulouha
Keyword(s):  
Histopathological Examination ◽  
Needle Aspiration ◽  
Surgical Removal ◽  
Coagulation Disorder ◽  
En Bloc ◽  
Chronic Expanding Hematoma ◽  
Coagulation Tests ◽  
Previous Trauma ◽  
Postoperative Drainage ◽  
Veterinary School

Five puppies were presented to the Alfort National Veterinary School for a rapidly expanding, well-demarcated, subcutaneous cervical mass of a few days’ duration. In all cases, previous trauma was reported. Fine-needle aspiration of the mass in each case revealed a serosanguineous fluid containing mainly erythrocytes, with a total protein concentration ranging from 3.5 to 5.2 g/dL. Coagulation tests failed to reveal any coagulation disorder. En-bloc surgical removal of the fluid-filled mass associated with short-term postoperative drainage was curative in all cases. Histopathological examination of the mass revealed encapsulated hematoma. The disease resembles chronic expanding hematoma in humans.

scholarly journals Spinal Capillary Hemangioma: Report of Five Surgical Cases and Literature Review

2017 ◽  
Vol 3 (4) ◽  
pp. 196-203
Author(s):  
Liang Zhang ◽  
Zhifeng Zhang ◽  
Jifeng Shang ◽  
Wenqing Jia ◽  
Jun Yang ◽  
...  
Keyword(s):  
Management Strategy ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Capillary Hemangioma ◽  
Neurological Deficits ◽  
En Bloc ◽  
Limb Weakness ◽  
Intradural Extramedullary ◽  
Early Surgical Intervention

Objective Capillary hemangioma is a benign vascular malformation that is usually encountered in soft-tissue. Rarely, it may occur in the neuraxis, and spinal capillary hemangioma (SCH) is a rare variant of it. Existing literature on SCH is limited because of its rarity. As a result, epidemiological and clinical characteristics as well as management strategy for SCH are still lacking. Here, we present a report on five patients with pathologically proven SCH, treated in Beijing Tiantan Hospital between 2013 and 2015. Methods Patients' age, gender, clinical manifestations, radiological features, operative methods, and surgical outcomes were retrospectively reviewed, and an updated review of the literature was also provided. Results Four patients were men and one was a woman, with a median age at presentation of 43 years (range: 15–66 years). Two lesions were intramedullary, two epidural, and one intradural extramedullary. The thoracic segment was most commonly affected (n = 3, 60%), followed by the cervical (n = 1, 20%) and lumbar (n = 1, 20%) segments. Common symptoms, in descending order, were numbness and paresthesia, limb weakness, and pain. The surgical procedure was successfully performed with total resection of the tumor achieved in 4 patients and subtotal in 1 patient. During an average follow-up period of 32 months (range: 27–43 months), recovery of the clinical symptoms was observed in all five patients. Conclusions SCH is a rare benign vascular disease, for which surgical resection of the lesion, by the en bloc method, is recommended. Clinically, it usually manifests with progressive myelopathy, but early surgical intervention usually produces good results and may prevent permanent neurological deficits.

scholarly journals Multiple Cartilaginous Exostoses Causing Severe Cervical Myelopathy in a Puppy Dog

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e1-e4
Author(s):  
Mareliza Possa de Menezes ◽  
Andréia Coutinho Facin ◽  
Larissa Godoi Máximo ◽  
Mayara de Cássia Luzzi ◽  
Luis Gustavo Gosuen Gonçalves Dias ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Histopathological Examination ◽  
Cord Compression ◽  
Surgical Removal ◽  
Medium Term ◽  
Progressive Development ◽  
Neurological Signs ◽  
Atlantoaxial Fusion ◽  
Dorsal Laminectomy ◽  
Multiple Cartilaginous Exostoses

AbstractThis study aimed to report a case of multiple cartilaginous exostoses (MCE) causing severe cervical myelopathy in a puppy dog. An 80-day-old Dachshund cross weighing 2.2 kg presented with progressive development of non-ambulatory tetraparesis, proprioceptive ataxia in all four limbs, and cervical hyperesthesia. Multiple calcified masses in the cervical spine at the levels of C1–C2 and C4–C7, with several points of spinal cord compression, were identified. Ventral atlantoaxial fusion was performed. Four days later, four masses were surgically removed by dorsal laminectomy of C1–C2 and C4–C7, and a right facetectomy between C4 and C5 was performed. Multiple cartilaginous exostoses were confirmed by histopathological examination. Thirty-six months after surgery, the patient showed no recurrence of neurological signs. Ventral atlantoaxial fusion, and surgical removal of MCE masses followed by decompression was effective on alleviating clinical sings in the short and medium term.

scholarly journals Report of a case of Cobb syndrome: multimodality imaging

2020 ◽  
pp. 20200145
Author(s):  
Dalia Ibrahim ◽  
Shady Mashhour
Keyword(s):  
Upper Limb ◽  
Vascular Malformations ◽  
Multimodality Imaging ◽  
Skin Lesions ◽  
Cord Compression ◽  
Low Flow ◽  
Vascular Lesions ◽  
Cervical Cord ◽  
Limb Weakness ◽  
The Right

Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2–C6 levels with removal of the epidural lesion, after which his symptoms had improved.

scholarly journals Intranasal Lobular Capillary Hemangioma with Multiple Sites of Origin during Pregnancy: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Lama S. Alalula ◽  
Abdullah S. Arafat ◽  
Riyadh A. Alhedaithy ◽  
Mohammed Elkrim
Keyword(s):  
Case Report ◽  
Nasal Cavity ◽  
Symptomatic Relief ◽  
Middle Turbinate ◽  
Posterior Part ◽  
Capillary Hemangioma ◽  
Surgical Removal ◽  
En Bloc ◽  
Lobular Capillary Hemangioma ◽  
Recurrent Epistaxis

In the present case report, we describe a 33-year-old pregnant woman in the third trimester with a history of recurrent epistaxis leading to frequent visits to the emergency department. Each episode of epistaxis was managed by anterior nasal packing. During endoscopic examination, a left nasal mass was seen. She was admitted and managed conservatively until she delivered her baby without complication. After delivery, a CT scan was taken, which showed an enhancing mass in the middle and lower meatus of the nasal cavity with no bony erosions. For symptomatic relief and tissue diagnosis, endoscopic surgical removal was advised. An intraoperative examination revealed a red, smooth, and well-circumscribed mass occupying the left nasal cavity and originating from the medial surface of the inferior turbinate and the inferior surface of the posterior part of the middle turbinate. A complete en bloc resection of the mass was performed endoscopically. The mass was sent for histologic analysis, which confirmed the diagnosis of lobular capillary hemangioma. Eventually, upon follow-up at two weeks, one month, three months, and six months postsurgery, no evidence of recurrence was detected.

scholarly journals Communicating spinal epidural thoracic arachnoid cyst en-bloc resection

2019 ◽  
pp. 517-520
Author(s):  
M. Al-Zekri ◽  
F. Aichaoui ◽  
I. Assoumane ◽  
A. Khelifa ◽  
W. Bennabi ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Motor Deficit ◽  
Surgical Removal ◽  
Dural Defect ◽  
En Bloc ◽  
Post Contrast ◽  
Extradural Arachnoid Cyst

Background: Spinal extradural arachnoid cyst is an uncommon, expanding lesion which may communicate with the subarachnoid space, The etiology still remains unclear, but the most accepted explanation is the existence of areas of weakness in the spinal dura , Spinal arachnoid cysts are usually in the thoracic spine, and they may cause symptoms due to spinal cord compression. Case Presentation: Patient is a 54-years-old female who presented with progressive back pain and motor deficit, Magnetic resonance imaging (MRI) study revealed an extradural cyst extending from T2 to T4 isointense with the cerebrospinal fluid (CSF) on all sequences and did not enhance on T1-weighted post-contrast MRI. Patient underwent T2-T4 laminectomy, en-bloc resection of the lesion was achieved and the histopathological examination objectified an arachnoid cyst. Conclusion: Spinal extradural arachnoid cyst can cause neurologic deficit and the mainstay of treatment in patients with neurological symptoms is surgical removal of the cyst together with ligation of the communicating pedicle and closure of the dural defect.

scholarly journals Giant hepatic capillary hemangioma, a diagnostic dilemma: case report

2021 ◽  
Vol 8 (5) ◽  
pp. 704
Author(s):  
Arkadeep Dhali ◽  
Anirban Hazra ◽  
B. Rathna Roger ◽  
Gopal Krishna Dhali ◽  
Avik Sarkar
Keyword(s):  
Histopathological Examination ◽  
Capillary Hemangioma ◽  
Vascular Lesions ◽  
Benign Tumors ◽  
Diagnostic Dilemma ◽  
Contrast Enhanced ◽  
One Year ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Hepatic Hemangiomas (HH) are benign tumors of the liver consisting of a blood-filled cavity supplied by the hepatic artery. Most of the HH are asymptomatic and are discovered incidentally during radiological imaging of various unrelated pathology. Typical capillary hemangiomas range from a few millimeters to three centimeters and are unlikely to generate any future symptomatology. However, giant liver hemangiomas (more than 10 cm) are a very rare entity and might become symptomatic, hence requiring prompt intervention. We are reporting this case to make the readers aware of the pitfalls and radiological uncertainties while interpreting vascular lesions of the liver. We reported a case of a 21-year-old female with complaint of awareness of a mass over the right upper abdomen since a period of one year which has been gradually increasing in size. On pre-operative Contrast-Enhanced Computed Tomography, features suggestive of Fibrolamellar variant of Hepatocellular Carcinoma was found which was substantiated by biochemical investigations. However, post-operative histopathological examination revealed a capillary hemangioma.

scholarly journals Aneurysmal bone cyst of thoracic spine with neurological deficit and its recurrence treated with multimodal intervention – A case report

2020 ◽  
Vol 11 ◽  
pp. 274
Author(s):  
B. Yogesh Kumar ◽  
R. Thirumal ◽  
S. G. Chander
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Arterial Embolization ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Lytic Lesion ◽  
Neurological Involvement ◽  
En Bloc ◽  
Limb Weakness ◽  
Primary Bone Tumors

Background: Aneurysmal bone cysts (ABCs) are rare, representing about 1% of primary bone tumors, and 15% of all primary spine/sacral tumors. Notably, when they are located in poorly accessible regions such as the spine and pelvis, their management may be challenging. Treatment options include selective arterial embolization (SAE), curettage, en bloc excision with reconstruction, and radiotherapy. Case Description: A 16-year-old male presented with 2 months of mid back pain, left-sided thoracic radiculopathy, and left lower limb weakness (MRC – 3/5). MR imaging revealed an expansile, lytic lesion involving the T9 vertebral body, and the left-sided posterior elements resulting in cord compression. He underwent SAE followed by intralesional excision, bone grafting, and a cage – instrumented fusion. ABC was diagnosed from the biopsy sample. Postoperatively, the pain was reduced, and he was neurologically intact. Five months later, he presented with a new lesion that was treated with repeated SAE and three doses of zoledronic acid. At the end of 2 years, the subsequent, MRI and CT studies documented new bone formation in the lytic areas, with healing of lesion; additionally, he clinically demonstrated sustained pain relief. Conclusion: Here, we emphasized the importance of surgery for patients with ABC who develop focal neurological deficits. Treatment options should include SAE with bisphosphonate therapy for lesions that recur without neurological involvement.

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