Spinal Extradural Granulomas

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CHRONIC epidural inflammatory tumors are uncommon. Browder and Meyers,1 in a review of the literature from 1820 to 1937 found 52 cases. In a survey of all epidural compressive lesions at the Hospital of the University of Pennsylvania from 1934 to 1944, Shenkin, Horn and Grant2 discovered three lesions of this type. There is no doubt that some cases have been unrecognized or unreported. The literature on epidural granulomas during the past ten years has been sparse and the roentgenologic features have not been stressed. We are reporting observations in two chronic extradural granulomas in order to emphasize the roentgenologic manifestations.

Case Reports

Case 1. A 42-year-old man entered the Cleveland Clinic on May 10, 1945 complaining of rheumatism of two years’ duration. His pain began in the left hip and radiated down his left leg to the ankle. Although constant, it was intensified by coughing, sneezing and laughing. Physical examination demonstrated restriction of motion in the back. Routine laboratory studies were normal. A dental examination disclosed no focus of infection. A roentgeno-graphic examination of the lumbar spine indicated moderate osteoarthritis. Fibrositis, rheumatoid arthritis of the spine and disk herniation were tentatively considered as possible diagnoses and thiamin chloride was advised as well as a firm mattress and a course of diathermy and massage. The patient was asked to return in two months if there was no improvement in his condition.

He returned on November 16, 1945 unimproved. A neurologic examination revealed tenderness over L-l. On lumbar puncture between L-2. . .



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