J Korean Soc Radiol.  2011 May;64(5):503-507. 10.3348/jksr.2011.64.5.503.

Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

• Chung SE
• Lee SH
• Kim TH
• Choi G
• Paeng SS

• KMID: 2040820
• DOI: http://doi.org/10.3348/jksr.2011.64.5.503

Abstract

A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

MeSH Terms

Aged
Back Pain
Dura Mater
Female
Hematoma
Hemorrhage
Humans
Lower Extremity
Membranes
Myelography
Polyradiculopathy
Radiculopathy
Spine
Zygapophyseal Joint

Figure

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  Fig. 1 The CT scan demonstrated a high-attenuated Rt. epidural lesion (arrow heads) with degenerative change of the adjacent facet joint.

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  Fig. 2 Axial magnetic resonance images showed a mass located in the right posterolateral spinal canal with heterogeneous high signal intensity on a T1-weighted image (A) and T2-weighted image (B). Rt. posterior epidural lesion (arrow head) was attached to the Rt. facet joint and compressed the posterolateral surface of the spinal cord at the same level.

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  Fig. 3 MR myelography showed heterogeneous epidural mass lesion continuing to the neighboring facet joint at the same level (arrow head).

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  Fig. 4 Histological finding Microscopically examination revealed a degenerated collagenized wall (A), proliferation of small blood vessels (B), and many red blood cells (C) inside of the wall. Synovial lining cells were not seen (Hematoxylin & Esosin staining, ×400).

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