Intradural extramedullary cavernous malformation: A common lesion in an uncommon location

Intradural extramedullary cavernous malformations (IECM) are an uncommon manifestation of a typically intracranial vascular lesion, with few reports describing their imaging characteristics. Hemorrhage is a frequent presenting feature, often resulting in subarachnoid blood products and clinical deterioration. We present a 78-year-old female undergoing treatment for low-stage endometrial carcinoma who was found to have layering subarachnoid hemorrhage on lumbar spine MRI. Subsequent contrast-enhanced imaging of the neuroaxis revealed multicompartment intraspinal hemorrhage and a 1.6-cm intradural, extramedullary mass at T7 with cord compression. The lesion was surgically resected for presumed metastasis. However, pathology demonstrated only hemorrhage and fibrous tissue without malignancy, favoring cavernous malformation. Retrospectively, characteristic imaging findings such as lack of internal enhancement and stigmata of prior hemorrhage help differentiate this from metastasis. This case highlights an atypical location and presentation of a common vascular lesion, emphasizing the need to include cavernous malformation in the differential for intradural extramedullary masses.