EPIDURAL HEMATOMA OF THE LUMBAR SPINE, SIMULATING EXTRUDED LUMBAR-DISK HERNIATION - CLINICAL, DISCOGRAPHIC, AND ENHANCED MAGNETIC-RESONANCE-IMAGING FEATURES - A CASE-REPORT

Study Design. This case report describes a patient with epidural hemat oma of the lumbar spine and progressive intermittent claudication whos e imaging findings were similar to those of a patient with extruded di sk herniation. Objectives. To highlight the diagnosis and cause of the lumbar epidural hematoma. Summary of Background Data. The characteris tics of imaging of lumbar epidural hematomas have been reported. To th e authors' knowledge, a case of epidural hematoma with leakage of the contrast medium into the mass at discogram has never been reported. Me thods. A case of a lumbar epidural hematoma with 10-15 minutes of inte rmittent claudication was described. There was no history of major tra uma or coagulation disorders. Diagnosis was made using magnetic resona nce imaging, myelography, discography, and computed tomography. The ma gnetic resonance image demonstrated a relatively large, rounded mass p osterior to the S1 vertebral body with L5-S1 disc protrusion. A gadoli nium-enhanced magnetic resonance image showed a rim-enhancing lesion. A discogram revealed leakage of the contrast medium into the mass. The mass was diagnosed as extruded disk herniation, and surgery was perfo rmed. Results. At surgery no evidence of obvious disk herniation was d etected, but the encapsulated hematoma was found. Conclusions. A case of chronic lumbar epidural hematoma in which clinical and imaging find ings were similar to those of an extruded lumbar disk herniation was r eported. Clinical information and results of imaging studies should be analyzed carefully because the imaging findings of contained epidural hematomas are often quite specific to this condition and can be diffe rentiated from those of extruded disc herniations. Management of chron ic lumbar epidural hematoma may be altered by a specific diagnosis.