Presentation
Back pain, adrenal insufficiency, diabetes and obesity
Patient Data
MRI shows thickening of the epidural fat (high intensity on T1W, T2W, and suppression on STIR), which is most prominent at the level of the L5 vertebra, measuring about 10mm. The excess epidural fat is causing severe spinal cord compression, which is evident in the 'Y' sign images.
Case Discussion
Spinal epidural lipomatosis is caused by an excessive accumulation of adipose tissue localized in the thoracic and lumbar regions of the spine.
The most common cause of spinal epidural lipomatosis is long-term exogenous steroid therapy.
The 'Y' sign of the dural sac is specific to spinal epidural lipomatosis. This pathognomonic sign on MRI is caused by the compression of the thecal sac due to excess epidural fat.
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