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Transient Traumatic Spinal Venous Hypertensive Myelopathy

Mark A. Aulera, Radh Al-Okailia and Zoran Rumboldta

a From the Department of Radiology, Medical University of South Carolina, Charleston



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  		FIG 1. CT angiogram of the chest at admission.

A, The left brachiocephalic vein (arrow) is compressed by a brachiocephalic artery dissection (not shown) and associated mediastinal hematoma (black arrowheads). An endotracheal tube, enteric tube, right thoracostomy tube (white arrowheads), right pneumothorax, and pneumomediastinum (asterisks) are present.

B, Note dilation of the accessory hemiazygos vein (white arrowhead) and enlarged vein within the neural foramen (black arrowhead).

C, Maximum-intensity-projection image of the CT angiogram demonstrates constriction of the brachiocephalic vein (arrowhead) and dilation of the accessory hemiazygos vein (large arrow) and epidural venous plexus (small arrows).



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  		FIG 2. Thoracic spine MR imaging.

A, Sagittal T2-weighted MR image of the thoracic spine shows increased signal intensity within the spinal cord (arrows). There are prominent low-signal-intensity structures (arrowheads) along the posterior surface of the cord that represent flow voids from the dilated perivertebral plexus. The increased signal intensity of the T3 and T4 vertebral bodies is consistent with bone contusions, without loss of vertebral body height.

B, Axial T2-weighted MR image of the spine demonstrates tubular flow voids in the epidural space (arrowheads) that represent the dilated epidural venous plexus. There is increased signal intensity within the central portion of the spinal cord (arrow) compatible with edema. Pleural effusion is also noted on the right (asterisk).



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  		FIG 3. Follow-up CT angiogram of the chest obtained 10 days after the initial CT angiogram.

A, Note interval resolution of the brachiocephalic vein compression.

B, Previously identified dilated accessory hemiazygos vein (arrowhead) and epidural venous plexus have resolved.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X