Clinics in diagnostic imaging (150).

Spontaneous spinal epidural haematoma is a rarely encountered cause of back pain. It often leads to cauda equina syndrome, necessitating emergency spinal surgery. We report the case of a 19-year-old Chinese man who presented with pain in the lower back, which started after he had carried some heavy boxes. He denied a history of fall or trauma. Magnetic resonance (MR) imaging showed a hyperintense biconvex-shaped lesion in the posterior epidural space on both T1- and T2-weighted sequences, diagnostic of a spinal epidural haematoma. The patient, who was admitted and managed conservatively, had gradual resolution of his pain. No neurological deficit was detected on discharge or on follow-up. Repeat MR imaging showed total resolution of the lumbar spinal epidural haematoma. The clinical characteristics, MR imaging features, diagnosis and management of spontaneous spinal epidural haematoma are discussed.