PMC5551415_01
(a) T2 sagittal MRI: extensive loculated fluid collections compressing the spinal cord ventrally at T12-L2 and dorsally at T8-T12 level. Note T2 cord signal change within the distal thoracic cord/conus at T11-T12. (b) T1 sagittal MRI without contrast: anterior displacement of the cord from T9-T12 level. (c) T1 Sagittal MRI with contrast: distinct enhancement of the fluid collections at T8-T12, T12-L2 and leptomeninges/nerve roots in the cauda equina
SNI-8-167-g002.jpg
PMC5551415_01_SNI-8-167-g002.jpg
F1
There were heterogeneous pockets of enhancement along the ventral and dorsal leptomeninges of the cervical and thoracic and lumbar spine (e.g., involving the nerve roots of the cauda equina) [Figure 1].
(a) T2 sagittal MRI: high signal fluid collection compressing/displacing the conus posteriorly. Note the irregularly thickened/clumped together nerve roots. (b) T2 sagittal MRI: irregularly thickened/clumped together nerve roots of the cauda equina
SNI-8-167-g003.jpg
PMC5551415_01_SNI-8-167-g003.jpg
F2
A loculated ventral fluid collection within the spinal canal between T12 down to L1-L2 markedly compressed the conus posteriorly [Figure 2].
Intraoperative images. (a) Tense, thickened dura without any epidural abscess. (b) The dural opening at L2 showed nerve root clumping with very little cerebrospinal fluid egress/phlegmon. (c) Second dural opening at T10 showed purulent discharge. (d) Intradural spinal cord thickening/adhesions
SNI-8-167-g004.jpg
PMC5551415_01_SNI-8-167-g004.jpg
F3
This phlegmon was tightly attached to the spinal cord and neighboring nerve roots by fibrotic gliotic tissue [Figure 3].