Unmasking the Source: Spinal Epidural Lipomatosis as a Hidden Cause of Recurrent Chest Pain and Neurological Deficits
Poster #: 058
Session/Time: A
Author:
Zachary Lawrence, BS
Mentor:
Bhargavi Madhu, BS, MD
Research Type: Case Report
Abstract
INTRODUCTION:
SEL is a rare condition characterized by a pathologic accumulation of adipose tissue within the epidural space, often linked to excess corticosteroid use. Significant compression of the thecal sac can result in nonspecific symptoms of spinal stenosis such as in our case.
CASE INFORMATION:
A 59-year-old male with a history of hypertension, obesity, hyperlipidemia, heart failure, and lumbar spinal stenosis s/p numerous epidural steroid injections presented with sudden onset bilateral lower extremity weakness and neurogenic bladder. His symptoms began abruptly at 5 a.m. when the patient attempted to use the restroom, but was unable to get back up. His medical history was notable for recurrent chest pain that had prompted multiple cardiac catheterizations across different hospitals, all of which were negative for ischemic heart disease. On admission, thoracic MRI revealed a large epidural mass at T3, along with severe lumbar stenosis at L2-3 and L4-5. The patient underwent T2-7 laminectomy for decompression, biopsy, and mass removal. Pathology confirmed spinal epidural lipomatosis without evidence of malignancy. The patient's chest pain was ultimately attributed to dermatomal radiculopathy involving the T3-4 nerve root. Following surgical decompression and rehabilitation, he experienced marked improvement in lower extremity strength, complete resolution of bowel and bladder dysfunction, and cessation of chest pain.
DISCUSSION:
This case illustrates the diagnostic complexity of recurrent chest pain in patients with multiple comorbidities. After repeated negative cardiac evaluations, the patient's symptoms were ultimately linked to spinal pathology. The dermatomal distribution of his pain, combined with its resolution following decompression, supported a neurogenic rather than cardiac etiology. SEL is an uncommon but important cause of spinal cord compression, often presenting with progressive neurologic decline or nonspecific pain syndromes. In this case, prolonged corticosteroid exposure from repeated epidural injections likely contributed to disease development. Recognition of SEL is critical because it may mimic more common pathologies and delay diagnosis.
CONCLUSION:
This case emphasizes the need to broaden the differential diagnosis of chest pain when initial cardiac investigations are unrevealing. Physicians should consider spinal etiologies, including SEL, particularly in patients with chronic steroid use and dermatomal pain patterns. Comprehensive evaluation and a multidisciplinary approach are essential to avoid misdiagnosis and ensure timely intervention.
SEL is a rare condition characterized by a pathologic accumulation of adipose tissue within the epidural space, often linked to excess corticosteroid use. Significant compression of the thecal sac can result in nonspecific symptoms of spinal stenosis such as in our case.
CASE INFORMATION:
A 59-year-old male with a history of hypertension, obesity, hyperlipidemia, heart failure, and lumbar spinal stenosis s/p numerous epidural steroid injections presented with sudden onset bilateral lower extremity weakness and neurogenic bladder. His symptoms began abruptly at 5 a.m. when the patient attempted to use the restroom, but was unable to get back up. His medical history was notable for recurrent chest pain that had prompted multiple cardiac catheterizations across different hospitals, all of which were negative for ischemic heart disease. On admission, thoracic MRI revealed a large epidural mass at T3, along with severe lumbar stenosis at L2-3 and L4-5. The patient underwent T2-7 laminectomy for decompression, biopsy, and mass removal. Pathology confirmed spinal epidural lipomatosis without evidence of malignancy. The patient's chest pain was ultimately attributed to dermatomal radiculopathy involving the T3-4 nerve root. Following surgical decompression and rehabilitation, he experienced marked improvement in lower extremity strength, complete resolution of bowel and bladder dysfunction, and cessation of chest pain.
DISCUSSION:
This case illustrates the diagnostic complexity of recurrent chest pain in patients with multiple comorbidities. After repeated negative cardiac evaluations, the patient's symptoms were ultimately linked to spinal pathology. The dermatomal distribution of his pain, combined with its resolution following decompression, supported a neurogenic rather than cardiac etiology. SEL is an uncommon but important cause of spinal cord compression, often presenting with progressive neurologic decline or nonspecific pain syndromes. In this case, prolonged corticosteroid exposure from repeated epidural injections likely contributed to disease development. Recognition of SEL is critical because it may mimic more common pathologies and delay diagnosis.
CONCLUSION:
This case emphasizes the need to broaden the differential diagnosis of chest pain when initial cardiac investigations are unrevealing. Physicians should consider spinal etiologies, including SEL, particularly in patients with chronic steroid use and dermatomal pain patterns. Comprehensive evaluation and a multidisciplinary approach are essential to avoid misdiagnosis and ensure timely intervention.