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

Lee, Jung Hee; Song, Wook-Jae; Kang, Kyung-Chung

doi:10.3171/2015.1.spine14515

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…The final studies included were case reports or series. Eighteen reports referred to abdominal conditions that mimic spinal diseases ( Table 1 ), 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. 15 Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Mirbagheri

Etminan

Schölch

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Objective: Lower back pain is a frequent cause of Emergency Department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. Patient and Methods: A 79-year-old male presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment four weeks prior to admission. The MRI highlighted multi-segmental hyperintensities in the intervertebral disc spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic and dental examinations turned out negative for a focus of infection. A CT-guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the key words “spondylodiscitis”, “spine”, “abdominal” and “cholecystitis”, to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. Results: No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. Conclusion: Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day seven. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions, respectively. Some had undergone unnecessary invasive surgical procedures before the right diagnosis was concluded. Because of the high incidence of symptoms such as lumbar back pain as well as abdominal pain, considering optimal patient care as well as economic aspects it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Mirbagheri

Etminan

Schölch

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…There are only 20 previously reported cases of myelopathy associated with EVPE secondary to IVC thrombosis, only five of which exhibited symptoms of CES [ Table 1 ]. [ 1 2 4 5 7 8 9 10 12 13 ] Anticoagulation, pharmacomechanical thrombectomy, and IVC stenting were the treatment of choice in many of these cases. Here, following a decompressive laminectomy to rule out an epidural abscess and resect the anteriorly massive dilated L5-S1 venous plexus, the patient's symptoms resolved.…”

Section: Discussionmentioning

confidence: 99%

Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review

Wong¹,

Gridley²,

Feiz-Erfan³

2018

Surg Neurol Int

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Background:Epidural venous plexus congestion at L5-S1 due to inferior vena cava (IVC) thrombosis led to an acute cauda equina syndrome (CES). Laminectomy to rule out an epidural abscess, allowing for resection of the dilated veins, led to immediate symptom resolution.Case Description:A 47-year-old male presented with acute urinary retention and left greater than right lower extremity paresis of 2 weeks duration. Magnetic resonance imaging (MRI) revealed a contrast-enhancing space-occupying anterior epidural L5-S1 level lesion resulting in cauda equina compression. As the patient was septic, he underwent an emergency laminectomy for a presumed epidural abscess. Intraoperative findings, however, documented a markedly dilated epidural venous plexus secondary to a newly diagnosed IVC thrombus. One day postoperatively, the patient was symptom-free and neurologically intact.Conclusions:Here we report a patient who uniquely presented with a CES characterized by acute paraparesis. This was attributed to a massively engorged anterior lumbar epidural venous plexus attributed to newly diagnosed IVC thrombus.

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“…This rarity of IVC occlusion as an etiology for radiculopathic pain is demonstrated by Paksoy et al, who found in a cohort of 9,640 patients with lumbar back pain or radiculopathic symptoms that only 10 patients had an underlying IVC thrombosis [ 19 ]. Engorgement of Batson’s plexus culminating in radiculopathic pain has been reported for a few rare disease processes: IVC obstruction secondary to Budd-Chiari syndrome, arteriovenous malformation, thrombosis, or a compressing abdominal mass [ 20 - 22 ]. Although diagnostically challenging because it closely mimics much more common pathologies such as disc herniation or spinal stenosis, cord compression secondary to engorgement of the epidural venous plexus must be considered on the differential for all patients with an IVC filter who present with lower extremity pain or weakness [ 19 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Engorgement of Batson’s plexus culminating in radiculopathic pain has been reported for a few rare disease processes: IVC obstruction secondary to Budd-Chiari syndrome, arteriovenous malformation, thrombosis, or a compressing abdominal mass [ 20 - 22 ]. Although diagnostically challenging because it closely mimics much more common pathologies such as disc herniation or spinal stenosis, cord compression secondary to engorgement of the epidural venous plexus must be considered on the differential for all patients with an IVC filter who present with lower extremity pain or weakness [ 19 - 20 ]. With prompt diagnosis and intervention, complete resolution of these symptoms can be achieved.…”

Section: Discussionmentioning

confidence: 99%

Inferior Vena Cava Filter Thrombosis in the Postoperative Neurosurgical Setting: Case Report and Review of the Literature

Loriaux

Cobb

Zomorodi

et al. 2016

Cureus

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There are no definitive treatment guidelines for caval-filter thrombosis in the postoperative setting. Clinical management for partial or complete postoperative inferior vena cava (IVC) occlusion relies solely on expert opinion, anecdotal evidence, and small clinical trials. As such, the primary objective of the present report is to offer a complex case of extensive IVC filter occlusion in a neurosurgical patient with past medical history significant for protein C deficiency. The presentation, unique radiological findings, management, and outcome will be discussed. No similar cases of massive IVC-occlusive disease in a thrombophilic patient early in the postoperative course following neurosurgical intervention are documented in the medical literature.

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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

Cited by 13 publications

References 12 publications

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review

Inferior Vena Cava Filter Thrombosis in the Postoperative Neurosurgical Setting: Case Report and Review of the Literature

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