Catheter-tip mass mimicking a spinal epidural hematoma: Case report

Journal of Neurosurgery: Spine

Volumn 12, Issue 1, 2010, Pages 66-71

  Medel, Ricky ^a   Pouratian, Nader ^a   Elias, W Jeffrey ^a  

^a UNIVERSITY OF VIRGINIA HEALTH SYSTEM   (United States)

Author keywords

Bupivacaine; Epidural analgesia; Granuloma; Intrathecal catheter; Pain pump

Indexed keywords

ADULT; ANAMNESIS; ARTICLE; CASE REPORT; CLINICAL FEATURE; DECOMPRESSION SURGERY; FEMALE; HISTOPATHOLOGY; HUMAN; HUMAN TISSUE; LAMINECTOMY; NUCLEAR MAGNETIC RESONANCE IMAGING; SPINAL HEMATOMA;

ADULT; ANALGESIA, EPIDURAL; CATHETERS, INDWELLING; CERVICAL VERTEBRAE; CHRONIC DISEASE; DIAGNOSIS, DIFFERENTIAL; FEMALE; FIBROSIS; HEMATOMA, EPIDURAL, SPINAL; HUMANS; LAMINECTOMY; MAGNETIC RESONANCE IMAGING; NEUROLOGIC EXAMINATION; PAIN, INTRACTABLE; SPINAL CORD COMPRESSION; THORACIC VERTEBRAE;

EID: 74549143817     PISSN: 15475654     EISSN: 15475646     Source Type: Journal    
DOI: 10.3171/2009.7.SPINE08888     Document Type: Article

References (31)

1. Aldrete JA: Epidural fibrosis after permanent catheter insertion and infusion. J Pain Symptom Manage 10:624-631, 1995
2. Aldrete JA, Vascello LA, Ghaly R, Tomlin D: Paraplegia in a patient with an intrathecal catheter and a spinal cord stimulator. Anesthesiology 81: 27A-28A, 1994
3. Bejjani GK, Karim NO, Tzortzidis F: Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature. Surg Neurol 48:288-291, 1997
4. Blount JP, Remley KB, Yue SK, Erickson DL: Intrathecal granuloma complicating chronic spinal infusion of morphine. Report of three cases. J Neurosurg 84:272-276, 1996
5. Brems-Dalgaard E, Just SL, Pedersen H: Encapsulated epidural catheter. Neuroradiology 33:81-82, 1991
6. Cabbell KL, Taren JA, Sagher O: Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery 42:1176-1181, 1998
7. Cherry DA, Gourlay GK: CT contrast evidence of injectate encapsulation after long-term epidural administration. Pain 49:369-371, 1992
8. Classen AM, Wimbish GH, Kupiec TC: Stability of admixture containing morphine sulfate, bupivacaine hydrochloride, and clonidine hydrochloride in an implantable infusion system. J Pain Symptom Manage 28:603-611, 2004
9. Coffey RJ, Allen JW: Not all intrathecal catheter tip MRI findings are inflammatory masses. Anesth Analg 104:1600-1602, author reply 1602, 2007
10. Coffey RJ, Burchiel K: Inflammatory mass lesions associated with intrathecal drug infusion catheters: report and observations on 41 patients. Neurosurgery 50:78-87, 2002
11. Coombs DW, Fratkin JD, Meier FA, Nierenberg DW, Saunders RL: Neuropathologic lesions and CSF morphine concentrations during chronic continuous intraspinal morphine infusion. A clinical and post-mortem study. Pain 22:337-351, 1985
12. Dahm P, Nitescu P, Appelgren L, Curelaru I: Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps. Clin J Pain 14:4-16, 1998
13. Deer T, Krames ES, Hassenbusch SJ, Burton A, Caraway D, Dupen S, et al: Polyanalgesic Consensus Conference 2007: Recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 10:300-328, 2007
14. Deer TR: A prospective analysis of intrathecal granuloma in chronic pain patients: a review of the literature and report of a surveillance study. Pain Physician 7:225-228, 2004
15. Hildebrand KR, Elsberry DD, Deer TR: Stability, compatibility, and safety of intrathecal bupivacaine administered chronically via an implantable delivery system. Clin J Pain 17: 239-244, 2001
16. Jhas S, Tuli S: Intrathecal catheter-tip inflammatory masses: an intraparenchymal granuloma. J Neurosurg Spine 9:196-199, 2008
17. Johnston MK, Harland SP: Spinal cord compression from precipitation of drug solute around an epidural catheter. Br J Neurosurg 12:445-447, 1998
18. Jourdain V, Cantin L, Prud'Homme M, Fournier-Gosselin MP: Intrathecal morphine therapy-related granulomas: faster to grow than thought. Neuromodulation 12:164-168, 2009
19. Krakovsky AA: Complications associated with intrathecal pump drug delivery: a retrospective evaluation. AJPM 17:4-10, 2007
20. Langsam A: A case of spinal cord compression syndrome by a fibrotic mass presenting in a patient with an intrathecal pain management pump system. Pain 83:97-99, 1999
21. Miele VJ, Price K, Bloomfield S, Hogg J, Bailes J: Intrathecal morphine therapy related granulomas: two case reports. W V Med J 102:16-18, 2006
22. Murphy PM, Skouvaklis DE, Amadeo RJJ, Haberman C, Brazier DH, Cousins MJ: Intrathecal catheter granuloma associated with isolated baclofen infusion. Anesth Analg 102:848-852, 2006
23. North RB, Cutchis PN, Epstein JA, Long DM: Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. Neurosurgery 29:778-784, 1991
24. Perren F, Buchser E, Chédel D, Hirt L, Maeder P, Vingerhoets F: Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain. Pain 109:189-194, 2004
25. Phillips JA, Escott EJ, Moossy JJ, Kellermier HC: Imaging appearance of intrathecal catheter tip granulomas: report of three cases and review of the literature. AJR Am J Roentgenol 189:W375-W381, 2007
26. Rodan BA, Cohen FL, Bean WJ, Martyak SN: Fibrous mass complicating epidural morphine infusion. Neurosurgery 16:68-70, 1985
27. Shields DC, Palma C, Khoo LT, Ferrante FM: Extramedullary intrathecal catheter granuloma adherent to the conus medullaris presenting as cauda equina syndrome. Anesthesiology 102:1059-1061, 2005
28. Sjöberg M, Karlsson PA, Nordborg C, Wallgren A, Nitescu P, Appelgren L, et al: Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 76:173-186, 1992
29. Toombs JD, Follett KA, Rosenquist RW, Benton LM: Intrathecal catheter tip inflammatory mass: a failure of clonidine to protect. Anesthesiology 102:687-690, 2005
30. Wadhwa RK, Shaya MR, Nanda A: Spinal cord compression in a patient with a pain pump for failed back syndrome: a chalk-like precipitate mimicking a spinal cord neoplasm: case report. Neurosurgery 58:E387, 2006
31. Yaksh TL, Horais KA, Tozier NA, Allen JW, Rathbun M, Rossi SS, et al: Chronically infused intrathecal morphine in dogs. Anesthesiology 99:174-187, 2003