Spinal epidural venous plexus congestion or dilatation is typically a complication of other pathologies.
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Clinical presentation
Radiculopathy caused by the dilated epidural veins is not uncommon 1. More severe symptoms such as cauda equina compression syndrome have been reported 6, 7.
Pathology
Several spinal and pelvic diseases can result in secondary epidural venous engorgement:
pelvic venous congestion due to external compression (e.g. distended bladder) 1
excessive CSF diversion (see: overshunting-associated myelopathy)
inferior vena cava agenesis (rare) 3
venous stenosis/thrombosis up to occlusion6, e.g. May Thurner Syndrome7
As the vertebral venous system is valveless, extraspinal venous congestion can rapidly involve these veins 1. The cause for this can be a significant decrease of local venous drainage due to a multitude of reasons including inferior vena cava thrombosis 6.
Radiographic features
MRI is the method of choice for imaging spinal epidural venous plexus pathology. Axial and sagittal plane T2-weighted sequences usually clearly demonstrate the engorged epidural veins and effacement of CSF spaces 1,2. The distended venous plexus should not be mistaken for mass, disc herniation, or arteriovenous fistulisation.