Presentation
Lower limb paresthesia.
Patient Data
Epidural lipomatosis and dilated anterior epidural venous plexus at the L4-5 and L5-S1 levels.
No intervertebral disc herniation. Spinal canal and neural exit foramina are capacious.
Diffuse low T1 and low T2 bone marrow signal, noting bone marrow T1 signal is higher than skeletal muscle. No aggressive focal osseous lesion.
Case Discussion
There is a long list of causes of spinal epidural venous plexus dilatation. In this case, it is most likely related to epidural lipomatosis, which in turn is likely secondary to obesity. Also likely related to obesity is the prominent red bone marrow signal (diffuse homogeneous low T1 signal but still higher signal than skeletal muscle) - at this age, at least some fatty bone marrow conversion would be expected.
These findings are both incidental to the presentation, of which no cause is seen on this MRI.
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