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Could this atypical image be an unexpected combination? A visual vignette
Ridvan Isik1, Sena Unver2, Savas Sencan3
1Sakarya Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Sakarya, Turkey.
Interventional Pain Medicine
|July 31, 2025
Summary
This case highlights unusual contrast spread and pulsation during transforaminal epidural steroid injection (TFESI). Recognizing these atypical images is crucial for pain management physicians to prevent complications.
Area of Science:
- Interventional Pain Management
- Neuroradiology
- Spinal Procedures
Background:
- A case report detailing a patient undergoing transforaminal epidural steroid injection (TFESI).
- Observation of concurrent intradural contrast media spread and dural pulsation during the procedure.
Purpose of the Study:
- To increase awareness regarding the recognition of atypical imaging findings in interventional pain procedures.
- To emphasize the importance of understanding contrast media behavior during TFESI.
Main Methods:
- A 67-year-old female patient with lumbar spinal stenosis received L3 TFESI under C-arm fluoroscopy.
- Initial contrast distribution suggested subdural spread, followed by observation of localized, pulsatile contrast accumulation.
- Procedure was terminated, and further imaging (MRI, CT angiography) was performed.
Main Results:
- The patient experienced no neurological deficits post-procedure.
- Subsequent imaging ruled out other potential causes for the observed contrast patterns.
- Medical management was initiated for the patient's persistent pain.
Conclusions:
- Atypical contrast media distribution patterns can occur during TFESI.
- Physicians must possess comprehensive knowledge of contrast behavior to mitigate potential procedural complications.
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