PMC4131088_01
CT exam after intravenous contrast injection: axial (a) and (b), coronal (c), and sagittal (d) planes demonstrate cystic tissue localized in the chest and in the paravertebral muscles on the right (arrow head) and bone erosion of second rib and D1 and D2 vertebrae.
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fig1
T2 images (a) and (b) show a cystic inhomogeneous tissue localized in the chest and the paravertebral muscles on the right that erodes second rib and D1 and D2 vertebrae compressing the spinal cord at that level. T1 after gadolinium intravenous injection images (c) and (d) demonstrates a predominantly cystic component that presents peripheral enhancement after contrast medium.
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fig2
Cervicodorsal spine MRI with intravenous injection of gadolinium (Figure 2) showed multiple and heterogeneous lesions located in the intraspinal extradural space at D1-D2 level, with severe spinal cord compression and involvement of the transverse processes, spinous processes, the left laminae, the second rib, the mediastinum on the right side, and cervical paraspinal muscles from C4 to D2.
(a) Single hydatid training (2 x 5 cm) and (b) multiple hydatid cysts removed.
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fig3
The patient underwent a first surgical approach by right sided paramedian longitudinal incision from C4 to D2 with the removal of the hydatid cyst (2 x 5 cm) located within the paraspinal muscle (Figure 3(a)); the second surgical approach was performed in the same surgical procedure to remove numerous smaller hydatid cysts (Figure 3(b)) with a median posterior approach, performing decompressive laminectomy and spinal stabilization from C6 to D4 with Universal Clamp Spinal Fixation System-Zimmer (Figure 4).
T2 images sagittal and axial planes (a) and (b) show the placement of a vertebral spacer, the successful decompression of the spinal cord, and a residual tissue in the chest on the right.
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fig4
The patient underwent a first surgical approach by right sided paramedian longitudinal incision from C4 to D2 with the removal of the hydatid cyst (2 x 5 cm) located within the paraspinal muscle (Figure 3(a)); the second surgical approach was performed in the same surgical procedure to remove numerous smaller hydatid cysts (Figure 3(b)) with a median posterior approach, performing decompressive laminectomy and spinal stabilization from C6 to D4 with Universal Clamp Spinal Fixation System-Zimmer (Figure 4).
CT exam axial, sagittal, and coronal planes (a), (b), and (c) reveal a recurrence at the level of D1 and D2 vertebrae and the presence of cystic tissue in the chest on the right.
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fig5
CT (Figure 5) and MRI with intravenous injection of gadolinium (Figure 6) showed a recurrence of multiple intraspinal extradural cystic lesions, with the spinal cord compression involving the body of D2 and minimally the body of D1.
T2 images (a), (c), and (e), T1 images after intravenous gadolinium injection (b), (d), and (f), and MR myelography (g) reveal the presence of a cystic tissue in the chest on the right and severe spinal cord compression due to the presence of multiple hydatid cysts involving the body of D2 and minimally the body of D1.
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fig6
CT (Figure 5) and MRI with intravenous injection of gadolinium (Figure 6) showed a recurrence of multiple intraspinal extradural cystic lesions, with the spinal cord compression involving the body of D2 and minimally the body of D1.