Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2–L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. Received: 23 August 1999; Revised: 13 January 2000; Accepted: 4 February 2000     

Delayed epidural hematoma

Summary A case of delayed epidural hematoma is described who had an initial computerized tomography (CT) scan reported as normal. Repeat CT scan at 48 h demonstrated a right temporal epidural hematoma. A skull fracture was not observed radiographically or at surgery. The world literature is reviewed and the criteria for repeat CT scanning is discussed.     

Delayed posttraumatic adrenal hematoma

Posttraumatic adrenal hemorrhage is a frequent finding after severe abdominal trauma and can have important clinical implications if it is bilateral. With the increased use of helical CT in the evaluation of trauma patients, posttraumatic adrenal hematoma is more frequently diagnosed. We present the CT findings of a unilateral posttraumatic adrenal hemorrhage where the diagnostic findings only appeared in the follow-up study. We think that mild enlargement of the adrenal gland in a trauma patient can be an early sign of an impending adrenal hemorrhage. Received: 10 May 1999; Revised: 28 July 1999; Accepted: 18 August 1999     

Helical CT: a useful technique in the evaluation of aortic intramural hematoma

Purpose: To investigate the diagnostic role of helical CT in aortic intramural hematoma. Material and methods: We retrospectively evaluated CT images obtained during a 6-year period, between 1994 and 2000, in 427 patients who underwent helical CT. Only 21 patients had typical findings of aortic intramural hematoma. All studies were performed with helical technique before and after a power injection of nonionic contrast material. Results: Twenty-one patients had aortic wall thickening (9 type A and 12 type B in Stanford's classification). Wall thickening was more than 4 mm in all cases, it was irregular in shape in 16/21 patients (76 %) and had a regular concentric shape in the remaining 5/21 patients (24 %). One patient with type A hematoma died soon after CT diagnosis because of arrhythmia caused by hemopericardium. Five patients (4 type B and one type A) underwent pharmacological therapy and radiological follow-up. Fifteen patients (7 type A and 8 type B) underwent prosthetic surgery and six of these died of postoperative complications. Conclusion: Helical CT represents the first step in the early diagnosis of aortic intramural hematoma before complications develop. In our experience, which agrees with the reports of other authors, helical CT is an accurate and valuable investigation for identifying the location and extent of an aortic intramural hematoma.     

Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. Received: 14 January 1999; Revised: 21 May 1999; Accepted: 9 June 1999     

MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

Summary Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography.     

急性颅内血肿清除后继发迟发性血肿临床分析

目的探讨急性颅内血肿清除术后,如何及时发现颅内迟发性血肿并及时治疗、提高疗效.方法对12例颅内血肿清除术后有瞳孔和意识改变的患者及时行CT检查,均发现迟发性颅内血肿.结果再次手术清除颅内血肿11例,保守治疗1例,治愈8例,植物生存2例,死亡2例.结论手术后颅内血肿的发生机理与脑血管舒缩功能障碍及手术前后颅内压变化有关.对首次CT提示颅内血肿伴脑挫裂伤或小出血灶、术后病情有变化者应考虑有迟发性颅内血肿形成,宜动态复查CT,早诊早治以改善预后.     

Nontraumatic spine disorders: part I

This article discusses several critical nontraumatic emergencies that involve the spine. Metastatic disease, infection of the disc and epidural space, acute disc herniation, epidural hematoma, and epidural lipomatosis may all present with symptoms ranging from localized pain to more severe neurologic sequelae. Several of these entities may progress to irreversible myelopathy or death if the diagnosis is not made in a timely manner. Appropriate radiologic evaluation and accurate interpretation are required to guide necessary treatment for these entities. Clinical presentation, etiology, radiologic findings, and pitfalls of interpretation of these conditions and related entities will be presented.     

彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...     

Right adrenal hematoma following hepatectomy

We present the findings and possible causes in three cases of postoperative adrenal hematomas. In 16 cases of 45 consecutive patients, following segmental right or left lobe hepatectomy, CT was performed in order to evaluate possible fluid collection or other complications. In all cases imaging findings and a correlation with preoperative CT scans were done. Follow-up CT examinations were also reviewed. In three cases solid suprarenal masses with attenuation values consistent with adrenal hematomas were found. Preoperative scans at the same level indicated normal adrenal glands. Follow-up scans revealed the hematoma, stable in size, for up to 12 weeks, although lower attenuation values were evident. Right adrenal hematoma is a possible postoperative complication following hepatectomy; if it remains stable in size, it can be left alone. Received: 29 December 1998; Revised: 25 March 1999; Accepted: 18 May 1999     

Acute epidural hematoma following decompressive surgery of a subdural hematoma

We report a patient with acute epidural hematoma diagnosed using computed tomography shortly after decompressive surgery of a contralateral subdural hematoma not resulting in clinical evidence of improvement. The patient underwent successful second emergency decompressive surgery. Prompt recognition is essential for a successful outcome, and poor recovery, when not otherwise anticipated, should alert immediately to a possible contralateral hematoma.     

创伤性后颅窝血肿

目的：总结创伤性后颅窝血肿（THPF）的临床特点。方法：对我科1999年3月-2001年10月间收治并接受手术治疗的9例THPF的病例资料进行回顾性分析。结果：（1）9例均有枕部着力的致伤机制，其中跌倒和低高度坠落伤7例；硬膜外血肿8例，小脑挫裂伤伴小脑血肿1例；（2）就诊时GCS13-15分6例，7例头部外伤后有短暂的昏迷史或创伤后遗忘，4例有头痛或呕吐主诉；（3）8例接受硬膜外血肿清除后颅减压术，1例行小脑血肿清除后颅减压加侧脑室外引流术；其中7例恢复良好，1例中残，1例死亡。结论：THPF有着不同于幕上创伤性颅内血肿的临床特点，及时准确地诊断和积极地治疗是改善预后的关键。     

Spinal subdural hematoma

 We report the case of a 68-year-old patient with a traumatic spinal subdural hematoma. MRI demonstrated an area of abnormal intensity and a black line in the inner part of the intradural space. We anti-cipate that MRI will help to make one more confident in the preoper-ative diagnosis of spinal subdural hematoma. The symptoms complet-ely disappeared immediately after the operation. Spinal subdural he-matoma requires immediate surgical evacuation. The prognosis for func-tional recovery is good if the condi-tion is appropriately diagnosed and treated before development of irre-versible paralysis. We recom-mend MRI to make an early diagnos-is and early evacuation of spinal subdural hematoma.     

Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty

We are the first to report a case that showed spontaneous resolution of epidural hematoma which was related to a steroid-induced osteoporotic compression fracture.The patient had a painful fracture with an intravertebral cleft at L1 accompanying an epidural hematoma posteriorly.Immediate pain relief was achieved after percutaneous vertebroplasty.Complete resolution of hematoma was noted three months after procedure.We theorized that intravertebral stability after treatment might have played a role in this patient.     

Extravasation of constrast-enhanced blood in an epidural hematoma

Summary A case is reported in which there was a large extravasation of contrast medium into an epidural hematoma during contrast-enhanced CT.     

自发性椎管内硬膜外血肿的MRI诊断

目的探讨自发性椎管内硬膜外血肿（SSEH）的MRI特征,旨在提高对此病的认识水平。方法回顾性总结我院6例SSEH的MRI特征和相关临床资料,其中4例经手术和病理确诊,2例保守治疗随访有效。结果血肿位于颈胸段2例,胸段3例,腰段1例。5例血肿位于硬脊膜外腔后方,1例位于硬脊膜外腔侧后方,血肿累及l～3个脊髓节段。T1加权像呈等信号、Tz加权像呈高信号1例;T1加权像呈等信号、L加权像呈低信号3例;T1加权像呈高信号、T1加权像呈低信号2例。其中4例采用钆喷酸葡甲胺（Gd—DTPA）对比剂增强扫描,1例轻中度条片状强化;2例边缘轻度强化,其中1例类似环状;1例无明显强化。结论MRI易于检出自发性椎管内硬膜外血肿,可以准确显示其部位、形态、大小及周围组织的关系,可以作出定性诊断,对临床诊治具有重要价值。     

Spinal epidural hematoma in an infant as the initial presentation of severe hemophilia

We describe the clinical manifestations, radiographic features, and management options of an extensive spontaneous spinal epidural hematoma in a 7-month boy who had severe hemophilia that had not been previously diagnosed, despite a baseline factor VIII level less than 1% of normal. We believe this to be the youngest reported case of a symptomatic spontaneous spinal epidural hemorrhage in an infant subsequently initially establishing a diagnosis of hemophilia.     

Delayed epidural hematoma after mild head injury

BACKGROUND: Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a "massive" epidural bleeding. CASE REPORT: We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. CONCLUSION: Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.     

外伤后迟发性脑内血肿的临床分析

目的 探讨外伤后迟发性脑内血肿的诊断、治疗要点。方法 对２８例典型外伤后迟发性脑内血肿进行回顾性分析,总结其诊断依据、影像学特点和治疗方法。结果 随着ＣＴ、ＭＲＩ的临床应用,迟发性脑内血肿诊断较易,关键在于提高警惕。治疗上除手术清除血肿外,应注意改善缺氧、缺血,改善微循环。结论 外伤后脑内血肿是脑外伤后常见的并发症,如果早期诊断,及时合理治疗,预后较好。     

Computed tomography of spinal epidural hematoma

Three cases of spinal epidural hematoma are presented. Computed tomography (CT) was the first diagnostic method used in two patients and demonstrated a surgically confirmed spinal epidural hematoma in both patients. In a third patient who presented with a complete block on myelography, CT was helpful in assessment of the extent of the lesion and suggested a vertebral hemangioma as the cause of the hematoma. CT is a very useful tool in the diagnosis of spinal epidural hematomas.