Рентгенология & Радиология, 2018, LVII 163-166

Spinal epidural lipomatosis – rare case of cauda equine compression

I-V Malla Huesh, M. Mateva, D. Zlatareva, H. Huesh, S. Zhelyazkova,I. Tarnev


Spinal epidural lipomatosis is a rare condition described as the accumulation of fat deposition in the epidural space of the spinal canal and often causes dural impingement. The purpose of this report is to show a rare case of сauda equina compression. We report a case of an obese 84-year-old male with a history of chronic back, irradiating to the front and back of right thighs, who has developed spinal epidural lipomatosis due to long-term use of inhaled steroids. There was a history of previous spine trauma. Spinal magnetic resonance imaging (MRI) was performed on a 3T Verio machine. The protocol included sagittal and axial T1-weighted images T2-weighted image, sagittal STIR. The examination was performed without contrast. MRI of the lumbar spine revealed evidence of fracture at the level of L4 and spondylolisthesis at the level of L4-L5. We found abnormal deposition of epidural fat tissue visible as hyperintense signal on T1W images and as hypointense on T2W images leading to high grade compression of the thecal sac caudal to the level L3. A STIR sequence was performed and it showed complete suppression of fat tissue. The finding was consistent with epidural lipomatosis. An additional finding was spondyloarthrosis. The features of MRI of visualizing fat tissue providing the opportunity of distinguishing between fatty lesions, make MRI an essential tool in diagnosing rare condition such as epidural lipomatosis.