Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of ...Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of vertebral origin, and cases that are non-vertebral in origin are rare. We encountered a patient with a relatively rare spinal epidural cavernous hemangioma of the thoracic spine that was non-vertebral in origin. The patient was a 63-year-old man. He had become aware of bilateral leg pain and numbness about 2 months earlier, and gait disturbance appeared gradually thereafter. On MRI, a lesion showing iso-intensity on T1-weighted imaging and high intensity on T2-weighted imaging was detected at the 7th thoracic vertebra. On gadolinium contrast-imaging, the lesion was found to be a homogenously-enhanced dumbbell-shaped extradural spinal neoplasm protruding from the left 7th/8th thoracic intervertebral foramen. A neurogenic tumor was suspected based on myelography and MRI findings, and complete tumorectomy was performed, which improved the lower limb symptoms and gait disturbance. The histopathological diagnosis was cavernous hemangioma. Epidural hemangiomas arise from the vertebra in many cases, and pure spinal epidural cavernous hemangiomas are rare. It is difficult to make a preoperative diagnosis because there are no specific imaging findings that can differentiate these tumors. It may be important to consider this disease before surgery in the differential diagnosis of epidural tumors.展开更多
Septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection. We treated an immunocompetent patient who developed septic arthritis of the shoulder after...Septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection. We treated an immunocompetent patient who developed septic arthritis of the shoulder after suprascapular nerve block for pain due to rotator cuff tear. An 80-year-old man with no underlying disease visited a nearby orthopedics clinic with complaint of left shoulder joint pain. Left suprascapular nerve block was performed, but the pain gradually aggravated. On the day after the block, he had a fever of 39°C and came to our department. On examination, enlargement and tenderness were present at the injection site. Cellulitis at the site was suspected. He was admitted and administration of a cephem anti-biotic was started. Pain subsequently decreased. Magnetic resonance imaging (MRI) performed 4 days after hospitalization showed massive effusion close to the injection site. The effusion spread into the joint cavity through the tear site of the supraspinatus. Septic arthritis of the shoulder was strongly suspected, open irrigation and debridement were performed 11 days after hospitalization. After surgery, pain immediately improved. In our case the extra-articular infection caused by suprascapular nerve block considered to spread into the shoulder joint cavity through the site of rotator cuff tear, although there have been no reports of such cases. This case suggests the possibility that patients with rotator cuff tear may easily develop septic arthritis because extra-articular infection may spread into the joint cavity through the site of tear.展开更多
Complex regional pain syndrome (CRPS) complicated with septic arthritis of the hand has not previously been described. We treated a patient in whom swelling of the wrist recurred during treatment of CRPS and septic ar...Complex regional pain syndrome (CRPS) complicated with septic arthritis of the hand has not previously been described. We treated a patient in whom swelling of the wrist recurred during treatment of CRPS and septic arthritis of the hand was induced by group G hemolytic streptococcus. There are case reports of tuberculous arthritis of the hand during treatment of CRPS;however, the causal relationship of wrist joint inflammation with CRPS is unclear. Careful follow-up is necessary for wrist joint inflammation if a patient with CRPS relapses with swelling of the wrist.展开更多
We encountered a patient with thoracic disc herniation that extruded to the dorsal epidural space. The patient was a 78-year-old man in whom listlessness of the lower limbs developed without an inducer and walking bec...We encountered a patient with thoracic disc herniation that extruded to the dorsal epidural space. The patient was a 78-year-old man in whom listlessness of the lower limbs developed without an inducer and walking became difficult. The patient was diagnosed as having a thoracic spinal cord tumor on MRI by a physician, and was referred to our hospital. Since ring enhancement was observed on contrast MRI performed at our hospital, the patient was diagnosed with disc herniation and surgery was performed. A hernia continuous with the intervertebral space that extruded to the dorsal epidural space was excised. At the final follow up, 1 year and 4 months after surgery, the patient could walk with a cane. Among thoracic disc herniation cases, hernia extruded to the dorsal epidural space is rare and difficult to diagnose by imaging before surgery, but evaluation using contrast MRI is useful in the diagnosis. When a space-occupying lesion is observed in the spinal canal in the lower thoracic spinal region, it is necessary to evaluate it by contrast MRI in consideration of thoracic disc herniation.展开更多
文摘Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of vertebral origin, and cases that are non-vertebral in origin are rare. We encountered a patient with a relatively rare spinal epidural cavernous hemangioma of the thoracic spine that was non-vertebral in origin. The patient was a 63-year-old man. He had become aware of bilateral leg pain and numbness about 2 months earlier, and gait disturbance appeared gradually thereafter. On MRI, a lesion showing iso-intensity on T1-weighted imaging and high intensity on T2-weighted imaging was detected at the 7th thoracic vertebra. On gadolinium contrast-imaging, the lesion was found to be a homogenously-enhanced dumbbell-shaped extradural spinal neoplasm protruding from the left 7th/8th thoracic intervertebral foramen. A neurogenic tumor was suspected based on myelography and MRI findings, and complete tumorectomy was performed, which improved the lower limb symptoms and gait disturbance. The histopathological diagnosis was cavernous hemangioma. Epidural hemangiomas arise from the vertebra in many cases, and pure spinal epidural cavernous hemangiomas are rare. It is difficult to make a preoperative diagnosis because there are no specific imaging findings that can differentiate these tumors. It may be important to consider this disease before surgery in the differential diagnosis of epidural tumors.
文摘Septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection. We treated an immunocompetent patient who developed septic arthritis of the shoulder after suprascapular nerve block for pain due to rotator cuff tear. An 80-year-old man with no underlying disease visited a nearby orthopedics clinic with complaint of left shoulder joint pain. Left suprascapular nerve block was performed, but the pain gradually aggravated. On the day after the block, he had a fever of 39°C and came to our department. On examination, enlargement and tenderness were present at the injection site. Cellulitis at the site was suspected. He was admitted and administration of a cephem anti-biotic was started. Pain subsequently decreased. Magnetic resonance imaging (MRI) performed 4 days after hospitalization showed massive effusion close to the injection site. The effusion spread into the joint cavity through the tear site of the supraspinatus. Septic arthritis of the shoulder was strongly suspected, open irrigation and debridement were performed 11 days after hospitalization. After surgery, pain immediately improved. In our case the extra-articular infection caused by suprascapular nerve block considered to spread into the shoulder joint cavity through the site of rotator cuff tear, although there have been no reports of such cases. This case suggests the possibility that patients with rotator cuff tear may easily develop septic arthritis because extra-articular infection may spread into the joint cavity through the site of tear.
文摘Complex regional pain syndrome (CRPS) complicated with septic arthritis of the hand has not previously been described. We treated a patient in whom swelling of the wrist recurred during treatment of CRPS and septic arthritis of the hand was induced by group G hemolytic streptococcus. There are case reports of tuberculous arthritis of the hand during treatment of CRPS;however, the causal relationship of wrist joint inflammation with CRPS is unclear. Careful follow-up is necessary for wrist joint inflammation if a patient with CRPS relapses with swelling of the wrist.
文摘We encountered a patient with thoracic disc herniation that extruded to the dorsal epidural space. The patient was a 78-year-old man in whom listlessness of the lower limbs developed without an inducer and walking became difficult. The patient was diagnosed as having a thoracic spinal cord tumor on MRI by a physician, and was referred to our hospital. Since ring enhancement was observed on contrast MRI performed at our hospital, the patient was diagnosed with disc herniation and surgery was performed. A hernia continuous with the intervertebral space that extruded to the dorsal epidural space was excised. At the final follow up, 1 year and 4 months after surgery, the patient could walk with a cane. Among thoracic disc herniation cases, hernia extruded to the dorsal epidural space is rare and difficult to diagnose by imaging before surgery, but evaluation using contrast MRI is useful in the diagnosis. When a space-occupying lesion is observed in the spinal canal in the lower thoracic spinal region, it is necessary to evaluate it by contrast MRI in consideration of thoracic disc herniation.
