Epidural Hematoma of the Lumbar Spine, Simulating Extruded Lumbar Disk Herniation: Clinical, Discographic, and Enhanced Magnetic Resonance Imaging Features

Study Design This case report describes a patient with epidural hematoma of the lumbar spine and progressive intermittent claudication whose imaging findings were similar to those of a patient with extruded disk herniation. Objectives To highlight the diagnosis and cause of the lumbar epidural hematoma. Summary of Background Data The characteristics of imaging of lumbar epidural hematomas have been reported. To the authors' knowledge, a case of epidural hematoma with leakage of the contrast medium into the mass at discogram has never been reported. Methods A case of a lumbar epidural hematoma with 10-15 minutes of intermittent claudication was described. There was no history of major trauma or coagulation disorders. Diagnosis was made using magnetic resonance imaging, myelography, discography, and computed tomography. The magnetic resonance image demonstrated a relatively large, rounded mass posterior to the S1 vertebral body with L5-S1 disc protrusion. A gadolinium-enhanced magnetic resonance image showed a rim-enhancing lesion. A discogram revealed leakage of the contrast medium into the mass. The mass was diagnosed as extruded disk herniation, and surgery was performed. Results At surgery no evidence of obvious disk herniation was detected, but the encapsulated hematoma was found. Conclusions A case of chronic lumbar epidural hematoma in which clinical and imaging findings were similar to those of an extruded lumbar disk herniation was reported. Clinical information and results of imaging studies should be analyzed carefully because the imaging findings of contained epidural hematomas are often quite specific to this condition and can be differentiated from those of extruded disc herniations. Management of chronic lumbar epidural hematoma may be altered by a specific diagnosis.