PMC8318213_01
Midsagittal T2-weighted MR image showing the epidural hematoma (red arrow) with compression of the thoracic spinal cord at the level of the vertebral bodies Th4 and Th5.
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The MRI showed an epidural hematoma at the level of the thoracic vertebral bodies Th4 and Th5 (extension cranio-caudal: 33 mm, extension antero-posterior: left side 10 mm, right side 15 mm) with compression of the myelon (Figure 1).
PMC8318213_02
Detail enlargements of axial (A-C) and sagittal (D) thoracic CT scans in a soft tissue window at level Th9. Red arrows indicate epidural catheter (white dot). (A) (left upper panel): The catheter is shown passing the ligamentum flavum ventral to the spinous process. (B) (right upper panel): Imaging of the catheter in the epidural space. (C) (left lower panel): Catheter position almost in the middle of the dural sac, suggesting a position inside the spinal cord. (D) (right lower panel): Entry of the epidural catheter into the dural sac. The terminal 4 centimeters of the catheter are not shown. Additional findings: consolidations (atelectasis) of the posterior lower lobes, nasogastric tube.
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After re-intubation, a cerebral lesion (eg a basilar artery thrombosis) was suspected and, after intravenous application of an iodine-containing contrast medium (iomeprol), CT scans of the head and neck and of the thoracic spine were performed (Figures 2 and 3).
Shaded surface display volume rendering (SS-VRT) of the thoracic vertebral column in head-feet-orientation: central, slightly right paramedian, position of the catheter inside the spinal canal. Red arrows indicate catheter.
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After re-intubation, a cerebral lesion (eg a basilar artery thrombosis) was suspected and, after intravenous application of an iodine-containing contrast medium (iomeprol), CT scans of the head and neck and of the thoracic spine were performed (Figures 2 and 3).