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Spinal epidural abscess mimicking lymphoma: a case report
Deepan Patel1, Eli M Baron, W Steven Enochs
1Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Orthopedics
|March 19, 2009
Summary
This case highlights how thoracic epidural abscess can mimic epidural lymphoma on imaging. Differentiating these conditions is crucial, as misdiagnosis can lead to inappropriate treatment, emphasizing the need for accurate diagnostic methods.
Area of Science:
- Radiology
- Neurosurgery
- Infectious Disease
Background:
- Epidural abscess and epidural lymphoma can present with similar imaging findings on magnetic resonance imaging (MRI).
- Accurate differentiation is critical for appropriate patient management and treatment selection.
Observation:
- A case of thoracic epidural abscess mimicking epidural lymphoma on MRI is presented.
- The patient's MRI showed a compressive epidural mass with uniform enhancement, characteristic of lymphoma.
- Key differentiating features included T2 hyperintensity within the facet joint, suggestive of infection.
Findings:
- Typical MRI for epidural abscess: heterogeneously enhancing, isointense/hypointense T1, hyperintense T2.
- Typical MRI for epidural lymphoma: isointense/hypointense T1, variable T2, uniform/diffuse enhancement.
- The presented abscess showed lymphoma-like features but had a crucial infection-related finding on T2 images.
Implications:
- Misinterpreting imaging can lead to incorrect treatment, such as radiation therapy for lymphoma in an infected case, which is contraindicated.
- Definitive diagnosis may require tissue biopsy or open surgical procedures when imaging is inconclusive.
- Highlighting subtle imaging clues aids in distinguishing between these critical conditions.
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