Spinal Non-Hodgkin Lymphoma Mimicking Epidural Hematoma

A patient, recently diagnosed with non-Hodgkin lymphoma, presented with acute tetraplegia after surgical cervical lymph node biopsy. MRI of the cervical spine demonstrated an epidural space-occupying lesion with compressive myelopathy. While epidural hematoma was the tentative diagnosis, intra-operatively non-Hodgkin lymphoma was found. Several factors may have accounted for the inaccurate interpretation of the MRI: the acute clinical presentation appearing shortly after surgery, the non-specific signal intensities of (hyper-) acute hematomas, the lack of contrast-enhanced images, and the absence of the FDG-avid spinal mass in the PET/CT-report. Without radiological features of invasiveness and contrast-enhanced images, careful interpretation is mandatory for space-occupying epidural lesions. TEACHING POINT: Caution is needed when interpreting an epidural space-occupying lesion in the absence of contrast-enhanced images.