case_images: PMC10666676_01
case_images: (a) Contrast-enhanced MRI at the level of the renal veins demonstrates a beaked appearance of the left renal vein (white arrow) as it crosses between the superior mesenteric artery and aorta. (b) Time-resolved contrast-enhanced MRI angiogram demonstrates retrograde flow through the left lumbar vein (white arrow) with opacification of the EVP (yellow arrow). (c) Left renal vein venogram demonstrates retrograde flow through the left second lumbar vein with opacification of the EVP (white arrow). (d) Venography with the catheter tip in the left second lumbar vein demonstrates retrograde flow with opacification of the EVP (black arrows). (e) Post-embolization venogram from the left renal vein demonstrates no further opacification of the lumbar vein or the epidural venous plexus. Microcoils are seen in the lumbar vein (black circle).. EVP, epidural venous plexus.
case_images: 10.1177_17562864231213243-fig1.jpg
case_images: PMC10666676_01_10.1177_17562864231213243-fig1.jpg
case_images: fig1-17562864231213243
case_images: Trendelenburg for NP. The patient underwent a time-resolved MR angiography of the abdomen which demonstrated a moderate compression of the LRV by the superior mesenteric artery with evidence of retrograde flow through the L2LV and opacification of the EVP suggesting spinal EVP congestion [Figure 1(a)-(b)]. On venography, the L2LV demonstrated retrograde flow into the spinal EVP [Figure 1(c)-(d)]. Post-embolization of L2LV, no further retrograde flow was demonstrated [Figure 1(e)].
case_images: (a) Contrast-enhanced MRI at the level of the renal veins demonstrates compression of the left renal vein (white arrow) as it crosses between the superior mesenteric artery and aorta. (b) Time-resolved sagittal contrast-enhanced MRI angiogram demonstrates retrograde flow through the left lumbar vein (yellow arrow) and early opacification of the EVP (white arrow). (c) Axial reformat of the time-resolved dynamic contrast-enhanced MRI angiogram demonstrates retrograde flow through the L2LV (white arrow). (d) Axial reformat of the time-resolved dynamic contrast-enhanced MRI angiogram demonstrates early opacification of the EVP (white arrow). (e) Venography with the catheter tip in the left second lumbar vein demonstrates retrograde flow with opacification of the EVP (white arrow). (f) Venography from the left renal vein demonstrates no further opacification of the lumbar vein or the EVP. Coils can be seen within the lumbar vein (black circle). (g) Lateral radiograph demonstrates coils along the length of the lumbar vein (white arrow).. EVP, epidural venous plexus; L2LV, left second lumbar vein.
case_images: 10.1177_17562864231213243-fig2.jpg
case_images: PMC10666676_01_10.1177_17562864231213243-fig2.jpg
case_images: fig2-17562864231213243
case_images: A specialized MR angiography of the abdomen showed severe compression of the LRV as it traversed beneath the superior mesenteric artery [Figure 2(a)]. There was an enlarged L2LV with marked opacification of the spinal EVP suggesting congestion [Figure 2(b)-(d)]. She was 4 years and 2 months since the onset of her headaches [Figure 2(e)-(g)] The day after embolization, she awoke headache free (the first time in four plus years), and she continued with pain freedom for about 2 weeks with immediate headache recurrence back to her baseline.
case_images: (a) Venography from the left renal vein near the origin of the left second lumbar vein (previously embolized) demonstrates development of a new collateral vein (black arrows) providing retrograde flow to the EVP. (b) Post-embolization lateral radiograph demonstrates the previous microcoils in the left second lumbar vein (white arrow). The new collateral vein was embolized with GELFOAM (black arrow).. EVP, epidural venous plexus.
case_images: 10.1177_17562864231213243-fig3.jpg
case_images: PMC10666676_01_10.1177_17562864231213243-fig3.jpg
case_images: fig3-17562864231213243
case_images: A catheter into the very proximal non-embolized portion of the second lumbar vein did however demonstrate a small amount of flow toward the spine from a venous collateral with possible opacification of the EVP; thus, this vein was embolized with GELFOAM [Figure 3(a) and (b)].