EPIDURAL SPACE INVADERS: SPINE MRI EPIDURAL LIPOMATOSIS PART 2

Thoracic Epidural lipomatosis is not uncommon to see but has a different appearance to Lumbar Epidural Lipomatosis

With thoracic epidural lipomatosis there is excess fat accumulated in the epidural space.

There is an increased risk of developing epidural lipomatosis with:

• Chronic corticosteroid use.
• Cushing syndrome.
• Obesity.

• Epidural lipomatosis in the thoracic spine has a different appearance to Lumbar Epidural Lipomatosis.
   
• In the lumbar spine we look for a trefoil appearance of the thecal sac.
   
• However in the thoracic spine we look for Increased epidural fat.
   
• The fat accumulation is posterior and lateral.
   
• This results in the Cord being displaced anteriorly and thecal sac effaced.
   
• There is no trefoil appearance.

Posterior epidural fat measuring >6mm in AP diameter is abnormal.

1. Epidural lipomatosis in the thoracic spine has a different appearance to Lumbar Epidural lipomatosis. (See Here)

1. Look for increased fat in the epidural space and cord displacement.