Epidural Venous Plexus Enlargements Presenting With Radiculopathy and Back Pain in Patients With Inferior Vena Cava Obstruction or Occlusion

Paksoy, Yahya; Görmüş, Niyazi

doi:10.1097/01.brs.0000144354.36449.2f

Cited by 123 publications

(104 citation statements)

References 8 publications

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“…9 In these patients, collateral vein engorgement due to IVC occlusion may extend to the epidural or interforaminal space; this may eventually lead to symptoms that are suggestive of disc herniation or foraminal stenosis. 10 Bozkurt et al 1 reported a case of radicular and low-back pain secondary to IVC stenosis in a patient with Budd-Chiari syndrome that was successfully treated with an endovascular procedure. To our knowledge, ours is the second reported case involving epidural venous engorgement due to Budd-Chiari syndrome Type I, which has occlusion of hepatic veins by thrombosis, not compression of an outside structure.…”

Section: Discussionmentioning

confidence: 99%

“…2 Patients with these problems commonly complain of symptoms suggestive of lumbar disc herniation or spinal stenosis. 10 Most of these patients present with low-back pain, radicular pain, or neurogenic claudication, but they rarely exhibit serious symptoms such as neurological deficit or cauda equina syndrome. 8 Lower-extremity weakness and voiding difficulty are generally considered to indicate serious complications due to thoracolumbar spinal diseases.…”

mentioning

confidence: 99%

“…pidural venous engorgement can result from various lesions, such as arteriovenous malformation, 4 thrombosis or occlusion of the inferior vena cava (IVC), 10 or an abdominal masslike lesion. 2 Patients with these problems commonly complain of symptoms suggestive of lumbar disc herniation or spinal stenosis.…”

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confidence: 99%

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Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome

Lee¹,

Song²,

Kang³

2015

SPI

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Epidural venous engorgement can result from various lesions, such as arteriovenous malformation, thrombosis or occlusion of the inferior vena cava (IVC), or an abdominal masslike lesion. Most patients with these problems complain of low-back pain, radicular pain, or neurogenic claudication, which are symptoms suggestive of disc herniation or spinal stenosis. However, these patients rarely exhibit neurological deficits or cauda equina syndrome. The authors encountered a case of a 60-year-old man presenting with lower-extremity weakness and voiding difficulty for a period of 1 year. To investigate the patient’s myelopathy-mimicking symptoms, a lumbar spine MRI scan was performed. The MR images exhibited tortuous and dilated spinal vessels compressing the spinal cord and thecal sac at the T11-L3 level, which were concurrent with syringomyelia evidenced by a 22 × 2.5-mm cyst at the T11–12 level. 3D CT scanning of the whole aorta revealed total occlusion and regression of the IVC in the intrahepatic region 3 cm inferior to the right atrium and dilation of multiple collateral veins. The patient was diagnosed with chronic Budd-Chiari syndrome Type I. The authors performed venography, followed by intrahepatic IVC recanalization via stent placement under fluoroscopic and ultra sonographic guidance and without surgical exploration. After this treatment, there was a marked decrease in epidural venous engorgement and the patient’s symptoms resolved almost completely. This case indicates that epidural venous engorgement at thoracolumbar levels may cause symptoms suggestive of myelopathy and can be successfully treated by minimally invasive procedures to eliminate the underlying causes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome

Lee¹,

Song²,

Kang³

2015

SPI

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“…Epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain (5). In some cases, as we have observed in a pregnant woman, thrombosis of inferior vena cava can extend to the renal vein giving rise to a more complex set of symptoms (6).…”

Section: Case Reportmentioning

confidence: 99%

Deep vein thrombosis of the lower limb secondary to lumbar discal hernia compression: a rarity? Review of the literature

Cello¹

2016

GCHIR

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“…In the 1960s, 4.4% of lesions preoperatively diagnosed as lumbar disk hernia were believed to be vascular abnormalities. 9) However, computed tomography (CT) and magnetic resonance (MR) imaging have reduced the incidence of confirmed epidural varices to 0.067-1.2%, 15,17,19) although a rate of approximately 5% has been reported. 10) Only 1 of 823 patients (0.12%) subjected to lumbar surgery at our institute between 1994 and 2006 was confirmed to have lumbar epidural varix.…”

Section: Introductionmentioning

confidence: 99%

Radiculopathy Caused by Lumbar Epidural Venous Varix -Case Report-

Aoyama

Hida

Akino

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 33-year-old man presented with a rare case of lumbar epidural venous varix causing radiculopathy manifesting as sciatica exacerbated during bowel movements. The left straight-leg raising test was positive and patellar tendon reflex was lost. Lumbar magnetic resonance imaging showed a mass lesion in the epidural space at the L4 level just anterior to the dural sac on the left, appearing as hypointense on T 1 -and hyperintense on T 2 -weighted images, with ring-like enhancement with gadopentetate dimeglumine. He underwent surgery under a preoperative diagnosis of cystic nerve sheath tumor. After left hemilaminectomy, intraoperative ultrasonography showed a low echoic mass lesion ventral to the L4 nerve root. The mass was dark blue with a smooth wall. Tearing of the wall resulted in continuous bleeding. After removal of the lesion, we confirmed that the dura of the nerve root was intact. Histological examination of the surgical specimen confirmed venous tissue. The postoperative course was excellent. Lumbar epidural varix is difficult to diagnose preoperatively. Lumbar epidural varix should be considered if the lesion is smaller on preoperative than intraoperative imaging, or disappears with bleeding cessation, as this may avoid unnecessary widening of the operative field. The correct preoperative diagnosis remains difficult, so we recommend surgical removal and histological confirmation.

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Epidural Venous Plexus Enlargements Presenting With Radiculopathy and Back Pain in Patients With Inferior Vena Cava Obstruction or Occlusion

Abstract: The authors believe that epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain.

Cited by 123 publications

References 8 publications

Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome

Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome

Deep vein thrombosis of the lower limb secondary to lumbar discal hernia compression: a rarity? Review of the literature

Radiculopathy Caused by Lumbar Epidural Venous Varix -Case Report-

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