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Chronic spinal subdural abscess mimicking an intradural–extramedullary tumor

 Hyo-Yeol Lim  ;  Hong-Jun Choi  ;  SungJun Kim  ;  Sung-Uk Kuh 
 EUROPEAN SPINE JOURNAL, Vol.22(Suppl3) : 497-500, 2013 
Journal Title
Issue Date
Adult ; Chronic Disease ; Diagnosis, Differential* ; Empyema, Subdural/diagnosis* ; Empyema, Subdural/microbiology* ; Humans ; Injections, Epidural/adverse effects ; Male ; Spinal Cord Diseases/microbiology* ; Spinal Cord Neoplasms/diagnosis* ; Staphylococcal Infections/diagnosis* ; Staphylococcus aureus ; Subdural Space/microbiology ; Subdural Space/pathology
Spinal subdural abscess ; Chronic spinal subdural abscess ; Intradural–extramedullary tumor ; Spinal cord tumor
Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy man with chronic subdural abscess referred to our hospital as an intradural-extramedullary (IDEM) tumor. The patient presented with voiding difficulty and pain in the back and left leg. In a contrast MRI scan, a rim-enhanced mass-like lesion was seen at the L5/S1 level. But adjacent ill-defined epidural fat enhancement that are unusual imaging manifestation for IDEM tumors was seen. He had no fever and normal WBC, ESR, and CRP. In addition, the patient had no previous infection history or other disease, but he did have an epidural block for back pain at another hospital 2 years previously. So, we repeated the MRI with a high-resolution 3-T scanner. The newly taken MR images in our hospital revealed a clear enlargement of lesion size compared to the previous MRI taken 1 week before in other hospital. We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kim, Sungjun(김성준) ORCID logo https://orcid.org/0000-0002-7876-7901
Choi, Hong Jun(최홍준)
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