PMC9551272_01
T2-weighted magnetic resonance imaging before the thoracoscopic surgery. Axial image (A) and sagittal image (B) showing a hyperintense oval lesion, with signal intensity similar to fluid, originating in the posterior mediastinum, protruding into the apical thorax at the level of the right T1-T2 intervertebral foramen (white arrows).
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F1
The lesion was hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI (Figure 1). The lesion was thought to be a schwannoma and a complete surgical resection of the lesion under thoracoscopy was then performed.
Images of the brain, chest and spine. (A) The upper figure of the axial computed tomography (CT) showing pneumocephalus in the cranial cavity of the lateral ventricle and right frontal, parietal and temporal and ventricular dilatation 5 days after the thoracoscopic surgery (thick arrows) and the lower figure showing resolution of these findings and presence of right frontal subdural effusion 25 days after the thoracoscopic surgery (arrowheads). (B) The upper figure of axial T2-weighted magnetic resonance imaging of the brain showing subdural hematomas in the left frontal region, right frontotemporal parietal occipital region before the epidural blood patch (EBP) therapy (arrowheads) and the lower figure showing complete absorption of these subdural hematomas 2 months after EBP therapy. (C) The upper figure of axial chest CT demonstrating a moderate amount of right-sided pleural effusion before the EBP therapy and the lower figure showing decrease of it 2 months after EBP therapy. (D) T2-weighted magnetic resonance myelography imaging of the spine showing subarachnoid-pleural fistula connection of the left pleural effusions and the spinal canal before EBP therapy (white arrow).
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F2
On day 5 postoperatively, a brain CT was performed, and it showed intracranial pneumatosis (Figure 2A) and she was discharged after her symptoms improved. Back to the local hospital, a brain CT showed the absorption of intracranial pneumatosis and presence of right frontal subdural effusion, a further MRI examination of the brain showed that the patient had bilateral subdural hematomas (SDHs), and a chest CT showed a moderate amount of right-sided pleural effusion (Figures 2A-C). T2-weighted MRI imaging of the entire spine showed no abnormal results within the operative areas (Figure 2D). The screenings for cancerous and immunological disorders revealed no abnormalities. Two months after EBP therapy, a follow-up brain MRI showed bilateral SDHs size reduction with complete disappearance, and a chest CT showed a marked reduction in the amount of pleural effusion (Figures 2B,C and timeline in Figure 3).
Timeline of the patient's clinical courses.
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F3
Two months after EBP therapy, a follow-up brain MRI showed bilateral SDHs size reduction with complete disappearance, and a chest CT showed a marked reduction in the amount of pleural effusion (Figures 2B,C and timeline in Figure 3).