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FIG 1. Images from the case of patient 1, a 4-year-old girl who presented to an outside hospital with a history of nonradiating sharp upper thoracic back pain.
A, Sagittal view fast spin-echo T2-weighted MR image. Dorsal epidural hematoma extending between the C4 and T2 levels results in compression of the spinal sac (arrows) but no abnormal intramedullary T2 hyperintensity. Relatively decreased T2 signal intensity in the C3–C6 intervertebral discs may be related to the neighboring epidural AVF and hematoma.
B, Frontal view maximum intensity projection 2D time-of-flight MR angiogram shows an enlarged left thyrocervical trunk (arrow).
C, Posteroanterior projection of a selective injection of the left costocervical artery (arrowhead) shows a fistula into a large epidural venous pouch (white arrow) that drains into the epidural and paravertebral venous plexuses (black arrows).
D, Radiograph shows the cast of the liquid adhesive (arrows) within the venous pouch.
E, Postembolization left costocervical angiogram shows that the dominant fistula is closed but that a separate small epidural fistula (black arrow) remains. The catheter tip is located at the left origin of the left costocervical trunk (white arrow). Reflux of contrast material results in opacification of the left vertebral artery (asterisk). Additional small epidural AVF were revealed when the right costocervical trunk was injected (not shown).
F, Postoperative sagittal view fast spin-echo T2-weighted MR image shows enlargement of cervical dorsal epidural hematoma (arrows), with mild cord compression and new intramedullary T2 hyperintensity (arrowhead).
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