Presentation
Paraparesis on the right, especially on the lower right limb.
Patient Data
Computed Tomography demonstrates a hypodense lesion in the vertebral canal at the cervicothoracic junction level, more prominent on the right side.
MRI demonstrates cystic lesions at the cervicothoracic junction without significant enhancement after administration of contrast, located extramedullary and extradural on the right side, which results in mass effect on the cervical cord displacing it anterolaterally towards the left.
No similar lesion was found in the brain parenchyma (not shown).
An excisional biopsy of the cervical spine lesions was performed and resulted as follows:
Hydatid cysts with intact membrane. Foreign body granuloma (by fragments of parasitic ectocis) and fibrosis in soft tissues.
Prior upper thoracic (dorsal) surgical resection evident (preoperative examination of the dorsal spine is not available), demonstrating postoperative changes, as well as cystic, extramedullary and extradural lesions that are T2-hyperintense and T1-hypointense at D4, D5, and D6 levels extending to fourth and fifth costal spaces. Similar lesions at L3 noted.
Case Discussion
The spinal cord is a rare site of Hydatid disease infection, but this hypothesis should be included in the differential diagnosis especially in endemic areas and in patients who have traveled to some of these areas. Clinically, the patient may present with back pain associated with spinal cord compression signs.
Tuberculous spondylodiscitis and lymphoma can be included in differential diagnosis. Other possibilities are included in immunosuppression patients, such as Kaposi sarcoma and other opportunistic infections.
Authors:
Georgia Silva1, Kelly Neves2, Neomir Fabris3, Ronnie Peterson M Alves2, Rene Lenhardt2
1 MD, MSc, Radiologist, 2 MD, Neuroradiologist, 3 MD, Radiologist Resident
Centro de Diagnóstico por Imagem, Hospital Dom Vicente Scherer, Santa Casa de Misericórdia de Porto Alegre
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