Delayed symptomatic presentation of epidural hematoma after epidural catheter anesthesia: case report.
METHODS
The authors present a case report of a 70-year-old woman who presented with delayed symptoms of epidural hematoma after epidural catheter anesthesia.


OBJECTIVE
We intend to report a unique case of delayed presentation of epidural hematoma after epidural catheter anesthesia.


BACKGROUND
The authors present a case of a 70-year-old woman who received epidural anesthesia via spinal catheter infusion before right knee replacement surgery. After an unremarkable postoperative course, she presented 6 weeks later with worsening middle and lower back pain, prompting a workup and lumbar MR imaging. MRI of her lumbar spine demonstrated a lower thoracic epidural fluid collection with significant radiographic mass effect on the thoracic spine. The fluid was diagnosed as chronic breakdown of an initially asymptomatic epidural hematoma. Symptomatic epidural hematoma formation after epidural block is rare but commonly reported in the literature. The incidence of asymptomatic hematoma formation is probably much higher and unrecognized.


METHODS
This is a retrospective review of a case seen at our institution.


RESULTS
A persistent epidural fluid collection in a normocoagulable patient presenting with symptoms of back pain more than a month after spinal block has not been reported in the literature.


CONCLUSIONS
In the absence of focal neurologic symptoms, conservative therapy and observation are appropriate.
Boco
Tibor
T
Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA. tibor_boco@rush.edu
Deutsch
Harel
H
D000368:Aged; D000700:Analgesics; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D004824:Epidural Space / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D013115:Spinal Canal / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000293:injuries / Q000473:pathology / Q000503:physiopathology
D000700:Analgesics