PMC3205498_01
(a) A non-contrast axial CT scan shows a large left-sided retroperitoneal hematoma (arrows) extending from T12 to L4 levels, and measuring 9.2 x 6.8 cm. (b) A sagittal T2-weighted MR image shows the paraspinal vascular lesion (arrowhead), and a hematoma in and around the left psoas muscle (black arrows) resulting from rupture of the left L1 feeding-artery aneurysm (thin arrow)
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F1
A computed tomography (CT) scan showed a large retroperitoneal hematoma [Figure 1a], and computed tomography angiography (CTA) revealed several large, dilated vascular structures in the left retroperitoneum [Figure 2a]. Magnetic resonance imaging (MRI) of the spine confirmed a large hematoma in the left psoas muscle extending from the T12 to L4 vertebral levels and numerous flow-voids in the left paraspinal muscles [Figures 1b and 2b].
(a) A 3D CT angiography reveals large aneurysms originating from the left T11, T12, and L1 segmental arteries (arrows). (b) Sagittal T2-weighted MR showing a paraspinal vascular malformation with multiple flow-voids, and a direct communication (arrow) between the malformation and a T12 high-flow artery aneurysm
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F2
A computed tomography (CT) scan showed a large retroperitoneal hematoma [Figure 1a], and computed tomography angiography (CTA) revealed several large, dilated vascular structures in the left retroperitoneum [Figure 2a]. Magnetic resonance imaging (MRI) of the spine confirmed a large hematoma in the left psoas muscle extending from the T12 to L4 vertebral levels and numerous flow-voids in the left paraspinal muscles [Figures 1b and 2b].
Digital subtraction angiography of the left segmental arteries T11 (a), T12 (b), and L1 (c) showing large high-flow aneurysms
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F3
T12, and L1 segmental arteries [Figure 3].
Post-embolization angiogram (unsubtracted view) showing the mass of coils in the L1 segmental artery (arrow), and Onyx-34 in the aneurysms originated from T11, T12, and L1 segmental arteries
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F4
Therapeutics Inc.; Irvine, CA). The left T11 and T12 aneurysms were embolized with intra-aneurysmal injection of Onyx-34 [Figure 4]. The postoperative course was uneventful, and there was no recurrence of hemorrhage. The patient was seen for clinical follow-up 1 month after treatment and had no residual back or leg pain.
MR images obtained at 6 months after embolization. Axial T2-weighted MR image showing increased signal on T2 in the left paraspinal region from numerous flow-voids largely resolved secondary to embolization
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F5
Six months following the procedure, the patient underwent an MRI [Figure 5] and a conventional spinal angiography [Figure 6].
Digital subtraction angiogram 6 months following embolization, showing a residual vascular malformation in the paraspinal muscles with a feeding artery coming off the left T11 segmental artery
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F6
Six months following the procedure, the patient underwent an MRI [Figure 5] and a conventional spinal angiography [Figure 6].