Delayed symptomatic presentation of epidural hematoma after epidural catheter anesthesia - Case report

Study Design. The authors present a case report of a 70-year-old woman who presented with delayed symptoms of epidural hematoma after epidural catheter anesthesia. Objective. We intend to report a unique case of delayed presentation of epidural hematoma after epidural catheter anesthesia. Summary of Background Data. The authors present a case of a 70-year-old woman who received epidural anesthesia via spinal catheter infusion before right knee replacement surgery. After an unremarkable postoperative course, she presented 6 weeks later with worsening middle and lower back pain, prompting a workup and lumbar MR imaging. MRI of her lumbar spine demonstrated a lower thoracic epidural fluid collection with significant radiographic mass effect on the thoracic spine. The fluid was diagnosed as chronic breakdown of an initially asymptomatic epidural hematoma. Symptomatic epidural hematoma formation after epidural block is rare but commonly reported in the literature. The incidence of asymptomatic hematoma formation is probably much higher and unrecognized. Methods. This is a retrospective review of a case seen at our institution. Results. A persistent epidural fluid collection in a normocoagulable patient presenting with symptoms of back pain more than a month after spinal block has not been reported in the literature. Conclusion. In the absence of focal neurologic symptoms, conservative therapy and observation are appropriate.