title: Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor.
abstract: Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy man with chronic subdural abscess referred to our hospital as an intradural-extramedullary (IDEM) tumor. The patient presented with voiding difficulty and pain in the back and left leg. In a contrast MRI scan, a rim-enhanced mass-like lesion was seen at the L5/S1 level. But adjacent ill-defined epidural fat enhancement that are unusual imaging manifestation for IDEM tumors was seen. He had no fever and normal WBC, ESR, and CRP. In addition, the patient had no previous infection history or other disease, but he did have an epidural block for back pain at another hospital 2 years previously. So, we repeated the MRI with a high-resolution 3-T scanner. The newly taken MR images in our hospital revealed a clear enlargement of lesion size compared to the previous MRI taken 1 week before in other hospital. We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required.
authors: Department of Neurosurgery, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 146-92, Dogok-dong, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Hyo-Yeol
authors: HY
authors: Lim
authors: Hong-Jun
authors: HJ
authors: Choi
authors: Sungjun
authors: S
authors: Kim
authors: Sung-Uk
authors: SU
authors: Kuh
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D013354:Empyema, Subdural / Q000175:diagnosis* / Q000382:microbiology*; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D008297:Male; D013118:Spinal Cord Diseases / Q000382:microbiology*; D013120:Spinal Cord Neoplasms / Q000175:diagnosis*; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus; D013355:Subdural Space / Q000382:microbiology / Q000473:pathology
references: J Clin Neurosci. 2008 Mar;15(3):292-4
references: 17433690
references: World J Emerg Surg. 2009 Aug 06;4:31
references: 19660120
references: Eur Spine J. 2011 Jul;20 Suppl 2:S330-5
references: 21465290
references: Spine (Phila Pa 1976). 1989 Dec;14(12):1415-7
references: 2575799
references: Lancet. 1949 Jul 30;2(6570):193-5
references: 18136273
references: J Neurosurg. 1994 Jul;81(1):160
references: 7911521
references: J Clin Neurosci. 2010 Feb;17(2):263-5
references: 20036548
references: J Neurosurg. 1992 Feb;76(2):307-11
references: 1346157
references: Radiol Clin North Am. 2012 Jul;50(4):777-98
references: 22643395
references: J Clin Neurosci. 2004 Nov;11(8):909-11
references: 15519876
references: Acta Neurol Scand. 2005 Nov;112(5):343-6
references: 16218919
references: Surg Infect (Larchmt). 2011 Aug;12(4):333-4
references: 21859339
references: World Neurosurg. 2011 Sep-Oct;76(3-4):361.e15-9
references: 21986440
references: J Neurosurg. 2001 Jul;95(1 Suppl):100-4
references: 11453406