case_images: PMC10246388_01
case_images: The photograph of the patient in posterior view shows a large well-circumscribed mass, which is approximately 14 cm in diameter, over the left side of the lower back.
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case_images: F1
case_images: Physical examination showed a large well-circumscribed mass, which is approximately 14 cm in diameter, over the left side of the lower back [Figure 1].
case_images: (a-d) Sequential sagittal T2-weighted images from midline to left side of the thoracolumbar spine reveal abnormal tortuous and dilated flow voids surrounding the lower spinal cord and conus medullaris, particularly at posterior surface of T10-11 level, and at left-side of L1 and L2 vertebral bodies, neural foramina, and paraspinal muscles. There is no signal intensity change of spinal cord.
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case_images: F2
case_images: The affected muscles from T12 to L4 vertebral levels were hypertrophy and markedly enhanced after administration of contrast material with mild hyperintense T2 signal change on T2-weighted sequence. There was no signal intensity change of the spinal cord [Figures 2-4].
case_images: (a-c) Sequential sagittal and (d) coronal fat-suppressed contrast-enhanced T1-weighted images of the thoracolumbar spine illustrate associated intense enhancement and mild enlargement of epidural venous plexus, psoas, and paravertebral muscles from T12 to L4 vertebral levels.
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case_images: F3
case_images: The affected muscles from T12 to L4 vertebral levels were hypertrophy and markedly enhanced after administration of contrast material with mild hyperintense T2 signal change on T2-weighted sequence. There was no signal intensity change of the spinal cord [Figures 2-4].
case_images: Axial T1-weighted (a) without and (b) with contrast-enhanced, and (c) T2-weighted images at the level of L2 vertebral body disclose multiple abnormal dilated and tortuous flow voids at left side of vertebral body, epidural space, and nearby paraspinal muscles with associated diffuse enlargement and enhancement of affected muscles.
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case_images: F4
case_images: The affected muscles from T12 to L4 vertebral levels were hypertrophy and markedly enhanced after administration of contrast material with mild hyperintense T2 signal change on T2-weighted sequence. There was no signal intensity change of the spinal cord [Figures 2-4].
case_images: Contrast-enhanced magnetic resonance angiography of the thoracolumbar spine. (a) Coronal and (b) sagittal maximum intensity projection images reveal clusters of vascular malformations including intradural spinal cord arteriovenous malformation (arrows) at the level of T10-11 and extradural paravertebral arteriovenous malformation from T12 to L2 vertebral levels with significant enlargement of bilateral T 12 intercostal, L1, and L2 segmental arteries, particularly on the left.
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case_images: F5
case_images: Contrast-enhanced magnetic resonance angiography (MRA) of the thoracolumbar spine disclosed clusters of vascular malformations including intradural spinal cord arteriovenous malformation at the level of T10-11 and extradural paravertebral arteriovenous malformation from T12 to L2 vertebral levels [Figure 5].
case_images: Anteroposterior views of the left (a-c) T11-12 intercostal, (d-f) L1, and (g-i) L2 segmental arteries angiography demonstrate spinal cord arteriovenous malformation (arrowheads) at the T10-11 level, supplied by left posterior spinal arteries that receives radiculopial branches from the left T11intercostal and L1 segmental arteries, and spinal osseous epidural arteriovenous fistula fed by dilated radicular arteries from left T12 intercostal, L1, and L2 segmental arteries converging to the venous lake at the level of L1 and L2 with venous drainage through enlarged epidural and paravertebral venous plexus.
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case_images: PMC10246388_01_SNI-14-163-g006.jpg
case_images: F6
case_images: Another high-flow spinal osseous epidural arteriovenous fistula (SOEAVF) was demonstrated and fed by multiple arterial feeders from bilateral T12 intercostal, L1 segmental, and left L2 segmental arteries converging into the venous lake at the level of L1 and L2 with venous drainage through enlarged epidural and paravertebral venous plexus and subsequent drainage to the inferior vena cava [Figures 6-8].
case_images: Spinal angiography of (a and b) the right T11-12 intercostal and (c and d) L1 segmental arteries in arterial and venous phases reveals associated arterial feeders from contralateral T12 and L1 converging to the left dilated venous lake at the level of L1 and L2.
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case_images: PMC10246388_01_SNI-14-163-g007.jpg
case_images: F7
case_images: Another high-flow spinal osseous epidural arteriovenous fistula (SOEAVF) was demonstrated and fed by multiple arterial feeders from bilateral T12 intercostal, L1 segmental, and left L2 segmental arteries converging into the venous lake at the level of L1 and L2 with venous drainage through enlarged epidural and paravertebral venous plexus and subsequent drainage to the inferior vena cava [Figures 6-8].
case_images: (a) Anteroposterior view of the left T9 intercostal artery angiography demonstrates spinal cord arteriovenous malformation (SCAVM) (black arrow) at the T10-11 level supplied by an anterior spinalartery (black arrowheads) with a characteristic hairpin turn (asterisk). Another feeding artery from the radiculomedullary branch (white arrowheads) from the left L1 segmental artery is identified. Anteroposterior views of the left L1 segmental artery angiography in (b) arterial and (c) venous phases reveal the same SCAVM (black arrow) fed by the radiculomedullary branch (white arrowheads) and dilated radiculopial artery. There is a high-flow spinal osseous arteriovenous fistula supplied by enlarged radicular arteries from the left L1 segmental artery with caudal drainage into perimedullary veins and subsequent drainage to the dilated left sacral radicular vein (white arrows). (d) Coronal multiplanar reconstruction image of angiographic computerized tomography clearly illustrates the enlarged left radicular vein (white arrows).
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case_images: PMC10246388_01_SNI-14-163-g008.jpg
case_images: F8
case_images: Another high-flow spinal osseous epidural arteriovenous fistula (SOEAVF) was demonstrated and fed by multiple arterial feeders from bilateral T12 intercostal, L1 segmental, and left L2 segmental arteries converging into the venous lake at the level of L1 and L2 with venous drainage through enlarged epidural and paravertebral venous plexus and subsequent drainage to the inferior vena cava [Figures 6-8].
case_images: Computed tomography scan of the lumbar spine. (a) Coronal, (b) sagittal, and axial views at the level of (c) L1 and (d) L2 reveal dextroscoliosis and decrease of left sided L1 vertebral height with associated sclerotic change. There are multiple well-defined tubular and round-shaped osteolytic lesions and erosion with sclerotic rims involving particularly left-sided vertebral bodies and posterior elements of L1 and L2, corresponding with the dilated venous lake.
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case_images: F9
case_images: Computed tomography scan of the lumbar spine revealed multiple well-defined tubular and round-shaped osteolytic lesions and erosion with sclerotic rims involving particularly left-sided vertebral bodies and posterior elements of L1 and L2, corresponding with the dilated venous lake [Figure 9].
case_images: Spinal angiography obtained 8 years after initial angiography. Anteroposterior views of the (a and b) left T11-12, (c and d) left L1 segmental, (e and f) left L2 segmental, (g) right T11-12 intercostal, and (h) right L1 segmental arteries angiography demonstrate significant regression of the spinal osseous epidural arteriovenous fistula at the level of L1 and L2. Spinal cord arteriovenous malformation at the level of T 10-11 remains stable in size and angioarchitecture.
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case_images: F10
case_images: Spinal angiography obtained 8 years after initial angiography surprisingly showed significant regression of extradural component of SAMS and stable intradural SCAVM [Figure 10].