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FIG 2. Images from the case of patient 2, a 4-year-old boy who presented to an outside clinic with complaints of several days of episodic severe upper thoracic back pain and associated muscle spasm.
A, Contrast-enhanced sagittal view T1-weighted MR image with fat saturation. A homogenously enhancing circumferential epidural mass can be seen from C7–T3 (arrows). No abnormal intramedullary signal intensity was seen on the T2-weighted MR images (not shown). Associated subtle widening of the anteroposterior diameter of the spinal canal suggests a long-standing vascular malformation.
B, Left oblique lateral view maximum intensity projection from a dynamic contrast-enhanced MR angiogram (technique according to Farb et al [7]). Abnormal enhancing enlarged dural branches can be seen arising from the left supreme intercostal artery (arrowhead), with arteriovenous shunt surgery and enhancement of the large epidural venous sac (arrow).
C, Posteroanterior view projection of selective injection of left supreme intercostal artery. Several large dural arteries feeding AVF (arrowheads) and large epidural venous pouch with drainage via left epidural venous plexus and internal jugular vein (arrows) can be seen.
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