Idiopathic herniation of the thoracic spinal cord an often mis-diagnosed clinical entity
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Keywords
Idiopathic Spinal Cord Herniation, Brown-Séquard Syndrome, Magnetic Resonance Imaging
Abstract
Since 1974, when Wortzman et al were the first to describe a case of idiopathic spinal cord herniation (ISCH), the number of reported cases has increased owing to magnetic resonance imaging (MRI) now is routinely available for patients with myelopathy and spinal surgeons are becoming more familiar with this clinical entity. This extremely rare herniation occurs exclusively in the thoracic spine, causing slowly progressive myelopathy. Diagnosis is based on ventral displacement of the spinal cord in the thoracic spine. MRI is the technique of choice to exclude a posterior arachnoid cyst, the most common mistaken diagnosis, and to recognize a spinal cord herniation when an anterior dural defect is present. A case of ISCH is reported and a Literature review of this clinical entity often mis-diagnosed has been obtained.
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References
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5. Adams RF and Anslow P (2001) The natural history of transdural herniation of the spinal cord: case report. Neuroradiology 43: 383-387
6. Alvisi C, Cerisoli M, Giulioni M and Guerra L (1987) Long-term results of surgically treated congenital intradural spinal arachnoid cysts. J Neurosurg 67: 333-335
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8. Andrews BT, Weinstein PR, Rosenblum ML and Barbaro NM (1988) Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts. J Neurosurg 68: 544-549
9. Aquilina K, Nanra JS and Rawluk D (2004) Idiopathic spinal cord hernia. Ir Med J 97: 115-116
10. Barbagallo GM, Marshman LA, Hardwidge C and Gullan RW (2002) Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis? Case reports and review of the literature. J Neurosurg 97: 369-374
11. Bartolomei J, Wong J, Awad IA, et al. (2000) Case problems conference: thoracic spinal cord hernia. Neurosurgery 46: 1408-1415
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15. Brugieres P, Malapert D, Adle-Biassette H, et al. (1999) Idiopathic spinal cord herniation: value of MR phase-contrast imaging. AJNR Am J Neuroradiol 20: 935-939
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17. Dix JE, Griffitt W, Yates C and Johnson B (1998) Spontaneous thoracic spinal cord herniation through an anterior dural defect. AJNR Am J Neuroradiol 19: 1345-1348
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20. Hausmann ON and Moseley IF (1996) Idiopathic dural herniation of the thoracic spinal cord. Neuroradiology 38: 503-510
21. Henry A, Tunkel R, Arbit E, Ku A and Lachmann E (1997) Tethered thoracic cord resulting from spinal cord herniation. Arch Phys Med Rehabil 78: 530-533
22. Inoue T, Cohen-Gadol AA and Krauss WE (2003) Low-pressure headaches and spinal cord herniation. Case report. J Neurosurg 98: 93-95
23. Miyasaka K, Isu T, Iwasaki Y, et al. (1983) High resolution computed tomography in the diagnosis of cervical disc disease. Neuroradiology 24: 253-257
24. Iyer RV, Coutinho C and Lye RH (2002) Spontaneous spinal cord herniation. Br J Neurosurg 16: 507-510
25. Kumar K, Malik S and Schulte PA (2003) Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine 28: E25-29
26. Kumar R, Taha J and Greiner AL (1995) Herniation of the spinal cord. Case report. J Neurosurg 82: 131-136
27. Maira G, Denaro L, Doglietto F, Mangiola A and Colosimo C (2006) Idiopathic spinal cord herniation: diagnostic, surgical, and follow-up data obtained in five cases. J Neurosurg Spine 4: 10-19
28. Marshman L (2000) Progressive spontaneous spinal cord herniation: case report. Neurosurgery 47: 1469
29. Marshman LA, Hardwidge C, Ford-Dunn SC and Olney JS (1999) Idiopathic spinal cord herniation: case report and review of the literature. Neurosurgery 44: 1129-1133
30. Masuzawa H, Nakayama H, Shitara N and Suzuki T (1981) Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Sequard syndrome. Case report. J Neurosurg 55: 983-986
31. Matsumura T, Takahashi MP, Nozaki S and Kang J (1996) [A case of idiopathic spinal cord herniation]. Rinsho Shinkeigaku 36: 566-570
32. Miura Y, Mimatsu K, Matsuyama Y, Yoneda M and Iwata H (1996) Idiopathic spinal cord herniation. Neuroradiology 38: 155-156
33. Miyaguchi M, Nakamura H, Shakudo M, Inoue Y and Yamano Y (2001) Idiopathic spinal cord herniation associated with intervertebral disc extrusion: a case report and review of the literature. Spine 26: 1090-1094
34. Miyake S, Tamaki N, Nagashima T, et al. (1998) Idiopathic spinal cord herniation. Report of two cases and review of the literature. J Neurosurg 88: 331-335
35. Mizuno J, Nakagawa H and Iwata K (1986) [Postoperative spinal cord herniation diagnosed by metrizamide CT: a case report]. No Shinkei Geka 14: 681-685
36. Morokoff AP, Tress BM and Kaye AH (2001) Idiopathic spinal cord herniation. J Clin Neurosci 8: 180-183
37. Najjar MW, Baeesa SS and Lingawi SS (2004) Idiopathic spinal cord herniation: a new theory of pathogenesis. Surg Neurol 62: 161-170; discussion 170-161
38. Nakagawa H, Kamimura M, Uchiyama S, et al. (2003) Idiopathic spinal cord herniation associated with a large erosive bone defect: a case report and review of the literature. J Spinal Disord Tech 16: 299-305
39. Nakazawa H, Toyama Y, Satomi K, Fujimura Y and Hirabayashi K (1993) Idiopathic spinal cord herniation. Report of two cases and review of the literature. Spine 18: 2138-2141
40. Oe T, Hoshino Y and Kurokawa T (1990) [A case of idiopathic herniation of the spinal cord associated with duplicated dura mater and with an arachnoid cyst]. Nippon Seikeigeka Gakkai Zasshi 64: 43-49
41. Pereira P, Duarte F, Lamas R and Vaz R (2001) Idiopathic spinal cord herniation: case report and literature review. Acta Neurochir (Wien) 143: 401-406
42. Sagiuchi T, Iida H, Tachibana S, et al. (2003) Idiopathic spinal cord herniation associated with calcified thoracic disc extrusion--case report. Neurol Med Chir (Tokyo) 43: 364-368
43. Sahl H, Forsting M and Sartor K (1995) [Post-traumatic herniation of the spinal cord: a rare cause of slowly progressing transverse spinal cord syndrome]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 162: 350-352
44. Saito T, Anamizu Y, Nakamura K and Seichi A (2004) Case of idiopathic thoracic spinal cord herniation with a chronic history: a case report and review of the literature. J Orthop Sci 9: 94-98
45. Sasaoka R, Nakamura H and Yamano Y (2003) Idiopathic spinal cord herniation in the thoracic spine as a cause of intractable leg pain: case report and review of the literature. J Spinal Disord Tech 16: 288-294
46. Sioutos P, Arbit E, Tsairis P and Gargan R (1996) Spontaneous thoracic spinal cord herniation. A case report. Spine 21: 1710-1713
47. Slavotinek JP, Sage MR and Brophy BP (1996) An unusual spinal intradural arachnoid cyst. Neuroradiology 38: 152-154
48. Spissu A, Peltz MT, Matta G and Cannas A (2004) Traumatic transdural spinal cord herniation and the nuclear trail sign: case report. Neurol Sci 25: 151-153
49. Srinivasan A, Bourque P and Goyal M (2004) Spontaneous thoracic spinal cord herniation. Neurology 63: 2187
50. Sugimoto T, Kasai Y, Takegami K, et al. (2005) A case of idiopathic spinal cord herniation with duplicated dura mater. J Spinal Disord Tech 18: 106-111
51. Tekkok IH (2000) Spontaneous spinal cord herniation: case report and review of the literature. Neurosurgery 46: 485-491; discussion 491-482
52. Tronnier VM, Steinmetz A, Albert FK, Scharf J and Kunze S (1991) Hernia of the spinal cord: case report and review of the literature. Neurosurgery 29: 916-919
53. Uchino A, Kato A, Momozaki N, Yukitake M and Kudo S (1997) Spinal cord herniation: report of two cases and review of the literature. Eur Radiol 7: 289-292
54. Urbach H, Kaden B, Pechstein U and Solymosi L (1996) Herniation of the spinal cord 38 years after childhood trauma. Neuroradiology 38: 157-158
55. Vallee B, Mercier P, Menei P, et al. (1999) Ventral transdural herniation of the thoracic spinal cord: surgical treatment in four cases and review of literature. Acta Neurochir (Wien) 141: 907-913
56. Verny C, Mercier P, Hayek G, et al. (1999) [Spontaneous spinal cord herniation: a little-known cause of Brown-Sequard syndrome. Report of two cases and review of the literature]. Neurochirurgie 45: 225-231
57. Wada E, Yonenobu K and Kang J (2000) Idiopathic spinal cord herniation: report of three cases and review of the literature. Spine 25: 1984-1988
58. Watanabe M, Chiba K, Matsumoto M, et al. (2001) Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect. J Neurosurg 95: 169-172
59. Watters MR, Stears JC, Osborn AG, et al. (1998) Transdural spinal cord herniation: imaging and clinical spectra. AJNR Am J Neuroradiol 19: 1337-1344
60. White BD and Firth JL (1994) Anterior spinal hernia: an increasingly recognised cause of thoracic cord dysfunction. J Neurol Neurosurg Psychiatry 57: 1433-1435
61. Burres KP and Conley FK (1978) Progressive neurological dysfunction secondary to postoperative cervical pseudomeningocele in a C-4 quadriplegic. Case report. J Neurosurg 48: 289-291
62. Hosono N, Yonenobu K and Ono K (1995) Postoperative cervical pseudomeningocele with herniation of the spinal cord. Spine 20: 2147-2150
63. Cheng MH (1996) Intraspinal extradural arachnoid cyst with spinal cord herniation. J Formos Med Assoc 95: 712-714
64. Lee ST, Lui TN and Jeng CM (1997) Spinal cord herniation after stabbing injury. Br J Neurosurg 11: 84-86
65. Karadeniz-Bilgili MY, Castillo M and Bernard E (2005) Transdural spinal cord herniation: pre- and postoperative MRI findings. Clin Imaging 29: 288-290
66. Barrenechea IJ, Lesser JB, Gidekel AL, Turjanski L and Perin NI (2006) Diagnosis and treatment of spinal cord herniation: a combined experience. J Neurosurg Spine 5: 294-302
67. Ellger T, Schul C, Heindel W, Evers S and Ringelstein EB (2006) Idiopathic spinal cord herniation causing progressive Brown-Sequard syndrome. Clin Neurol Neurosurg 108: 388-391
68. Nabors MW, Pait TG, Byrd EB, et al. (1988) Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68: 366-377
2. Aizawa T, Sato T, Tanaka Y, et al. (2001) Idiopathic herniation of the thoracic spinal cord: report of three cases. Spine 26: E488-491
3. Massicotte EM, Montanera W, Ross Fleming JF, et al. (2002) Idiopathic spinal cord herniation: report of eight cases and review of the literature. Spine 27: E233-241
4. Abe M, Komori H, Yamaura I and Kayano T (1999) Spinal cord herniation into an extensive extradural meningeal cyst: postoperative analysis of intracystic flow by phase-contrast cine MRI. J Orthop Sci 4: 450-456
5. Adams RF and Anslow P (2001) The natural history of transdural herniation of the spinal cord: case report. Neuroradiology 43: 383-387
6. Alvisi C, Cerisoli M, Giulioni M and Guerra L (1987) Long-term results of surgically treated congenital intradural spinal arachnoid cysts. J Neurosurg 67: 333-335
7. Ammar KN, Pritchard PR, Matz PG and Hadley MN (2005) Spontaneous thoracic spinal cord herniation: three cases with long-term follow-up. Neurosurgery 57: E1067; discussion E1067
8. Andrews BT, Weinstein PR, Rosenblum ML and Barbaro NM (1988) Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts. J Neurosurg 68: 544-549
9. Aquilina K, Nanra JS and Rawluk D (2004) Idiopathic spinal cord hernia. Ir Med J 97: 115-116
10. Barbagallo GM, Marshman LA, Hardwidge C and Gullan RW (2002) Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis? Case reports and review of the literature. J Neurosurg 97: 369-374
11. Bartolomei J, Wong J, Awad IA, et al. (2000) Case problems conference: thoracic spinal cord hernia. Neurosurgery 46: 1408-1415
12. Baur A, Stabler A, Psenner K, Hamburger C and Reiser M (1997) Imaging findings in patients with ventral dural defects and herniation of neural tissue. Eur Radiol 7: 1259-1263
13. Berbel A, Porta-Etessam J, Martinez-Salio A, et al. (2001) [Idiopathic spinal cord herniation. Presentation of a new case and review of the literature]. Rev Neurol 32: 54-57
14. Borges LF, Zervas NT and Lehrich JR (1995) Idiopathic spinal cord herniation: a treatable cause of the Brown-Sequard syndrome--case report. Neurosurgery 36: 1028-1032; discussion 1032-1023
15. Brugieres P, Malapert D, Adle-Biassette H, et al. (1999) Idiopathic spinal cord herniation: value of MR phase-contrast imaging. AJNR Am J Neuroradiol 20: 935-939
16. Cellerini M, Bayon S, Scazzeri F, et al. (2002) Idiopatic spinal cord herniation: a treatable cause of Brown-Sequard syndrome. Acta Neurochir (Wien) 144: 321-325
17. Dix JE, Griffitt W, Yates C and Johnson B (1998) Spontaneous thoracic spinal cord herniation through an anterior dural defect. AJNR Am J Neuroradiol 19: 1345-1348
18. Eguchi T, Yokota H, Nikaido Y, Nobayashi M and Nishioka T (2001) Spontaneous thoracic spinal cord herniation--case report. Neurol Med Chir (Tokyo) 41: 508-512
19. Ewald C, Kuhne D and Hassler WE (2000) Progressive spontaneous herniation of the thoracic spinal cord: case report. Neurosurgery 46: 493-495; discussion 495-496
20. Hausmann ON and Moseley IF (1996) Idiopathic dural herniation of the thoracic spinal cord. Neuroradiology 38: 503-510
21. Henry A, Tunkel R, Arbit E, Ku A and Lachmann E (1997) Tethered thoracic cord resulting from spinal cord herniation. Arch Phys Med Rehabil 78: 530-533
22. Inoue T, Cohen-Gadol AA and Krauss WE (2003) Low-pressure headaches and spinal cord herniation. Case report. J Neurosurg 98: 93-95
23. Miyasaka K, Isu T, Iwasaki Y, et al. (1983) High resolution computed tomography in the diagnosis of cervical disc disease. Neuroradiology 24: 253-257
24. Iyer RV, Coutinho C and Lye RH (2002) Spontaneous spinal cord herniation. Br J Neurosurg 16: 507-510
25. Kumar K, Malik S and Schulte PA (2003) Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine 28: E25-29
26. Kumar R, Taha J and Greiner AL (1995) Herniation of the spinal cord. Case report. J Neurosurg 82: 131-136
27. Maira G, Denaro L, Doglietto F, Mangiola A and Colosimo C (2006) Idiopathic spinal cord herniation: diagnostic, surgical, and follow-up data obtained in five cases. J Neurosurg Spine 4: 10-19
28. Marshman L (2000) Progressive spontaneous spinal cord herniation: case report. Neurosurgery 47: 1469
29. Marshman LA, Hardwidge C, Ford-Dunn SC and Olney JS (1999) Idiopathic spinal cord herniation: case report and review of the literature. Neurosurgery 44: 1129-1133
30. Masuzawa H, Nakayama H, Shitara N and Suzuki T (1981) Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Sequard syndrome. Case report. J Neurosurg 55: 983-986
31. Matsumura T, Takahashi MP, Nozaki S and Kang J (1996) [A case of idiopathic spinal cord herniation]. Rinsho Shinkeigaku 36: 566-570
32. Miura Y, Mimatsu K, Matsuyama Y, Yoneda M and Iwata H (1996) Idiopathic spinal cord herniation. Neuroradiology 38: 155-156
33. Miyaguchi M, Nakamura H, Shakudo M, Inoue Y and Yamano Y (2001) Idiopathic spinal cord herniation associated with intervertebral disc extrusion: a case report and review of the literature. Spine 26: 1090-1094
34. Miyake S, Tamaki N, Nagashima T, et al. (1998) Idiopathic spinal cord herniation. Report of two cases and review of the literature. J Neurosurg 88: 331-335
35. Mizuno J, Nakagawa H and Iwata K (1986) [Postoperative spinal cord herniation diagnosed by metrizamide CT: a case report]. No Shinkei Geka 14: 681-685
36. Morokoff AP, Tress BM and Kaye AH (2001) Idiopathic spinal cord herniation. J Clin Neurosci 8: 180-183
37. Najjar MW, Baeesa SS and Lingawi SS (2004) Idiopathic spinal cord herniation: a new theory of pathogenesis. Surg Neurol 62: 161-170; discussion 170-161
38. Nakagawa H, Kamimura M, Uchiyama S, et al. (2003) Idiopathic spinal cord herniation associated with a large erosive bone defect: a case report and review of the literature. J Spinal Disord Tech 16: 299-305
39. Nakazawa H, Toyama Y, Satomi K, Fujimura Y and Hirabayashi K (1993) Idiopathic spinal cord herniation. Report of two cases and review of the literature. Spine 18: 2138-2141
40. Oe T, Hoshino Y and Kurokawa T (1990) [A case of idiopathic herniation of the spinal cord associated with duplicated dura mater and with an arachnoid cyst]. Nippon Seikeigeka Gakkai Zasshi 64: 43-49
41. Pereira P, Duarte F, Lamas R and Vaz R (2001) Idiopathic spinal cord herniation: case report and literature review. Acta Neurochir (Wien) 143: 401-406
42. Sagiuchi T, Iida H, Tachibana S, et al. (2003) Idiopathic spinal cord herniation associated with calcified thoracic disc extrusion--case report. Neurol Med Chir (Tokyo) 43: 364-368
43. Sahl H, Forsting M and Sartor K (1995) [Post-traumatic herniation of the spinal cord: a rare cause of slowly progressing transverse spinal cord syndrome]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 162: 350-352
44. Saito T, Anamizu Y, Nakamura K and Seichi A (2004) Case of idiopathic thoracic spinal cord herniation with a chronic history: a case report and review of the literature. J Orthop Sci 9: 94-98
45. Sasaoka R, Nakamura H and Yamano Y (2003) Idiopathic spinal cord herniation in the thoracic spine as a cause of intractable leg pain: case report and review of the literature. J Spinal Disord Tech 16: 288-294
46. Sioutos P, Arbit E, Tsairis P and Gargan R (1996) Spontaneous thoracic spinal cord herniation. A case report. Spine 21: 1710-1713
47. Slavotinek JP, Sage MR and Brophy BP (1996) An unusual spinal intradural arachnoid cyst. Neuroradiology 38: 152-154
48. Spissu A, Peltz MT, Matta G and Cannas A (2004) Traumatic transdural spinal cord herniation and the nuclear trail sign: case report. Neurol Sci 25: 151-153
49. Srinivasan A, Bourque P and Goyal M (2004) Spontaneous thoracic spinal cord herniation. Neurology 63: 2187
50. Sugimoto T, Kasai Y, Takegami K, et al. (2005) A case of idiopathic spinal cord herniation with duplicated dura mater. J Spinal Disord Tech 18: 106-111
51. Tekkok IH (2000) Spontaneous spinal cord herniation: case report and review of the literature. Neurosurgery 46: 485-491; discussion 491-482
52. Tronnier VM, Steinmetz A, Albert FK, Scharf J and Kunze S (1991) Hernia of the spinal cord: case report and review of the literature. Neurosurgery 29: 916-919
53. Uchino A, Kato A, Momozaki N, Yukitake M and Kudo S (1997) Spinal cord herniation: report of two cases and review of the literature. Eur Radiol 7: 289-292
54. Urbach H, Kaden B, Pechstein U and Solymosi L (1996) Herniation of the spinal cord 38 years after childhood trauma. Neuroradiology 38: 157-158
55. Vallee B, Mercier P, Menei P, et al. (1999) Ventral transdural herniation of the thoracic spinal cord: surgical treatment in four cases and review of literature. Acta Neurochir (Wien) 141: 907-913
56. Verny C, Mercier P, Hayek G, et al. (1999) [Spontaneous spinal cord herniation: a little-known cause of Brown-Sequard syndrome. Report of two cases and review of the literature]. Neurochirurgie 45: 225-231
57. Wada E, Yonenobu K and Kang J (2000) Idiopathic spinal cord herniation: report of three cases and review of the literature. Spine 25: 1984-1988
58. Watanabe M, Chiba K, Matsumoto M, et al. (2001) Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect. J Neurosurg 95: 169-172
59. Watters MR, Stears JC, Osborn AG, et al. (1998) Transdural spinal cord herniation: imaging and clinical spectra. AJNR Am J Neuroradiol 19: 1337-1344
60. White BD and Firth JL (1994) Anterior spinal hernia: an increasingly recognised cause of thoracic cord dysfunction. J Neurol Neurosurg Psychiatry 57: 1433-1435
61. Burres KP and Conley FK (1978) Progressive neurological dysfunction secondary to postoperative cervical pseudomeningocele in a C-4 quadriplegic. Case report. J Neurosurg 48: 289-291
62. Hosono N, Yonenobu K and Ono K (1995) Postoperative cervical pseudomeningocele with herniation of the spinal cord. Spine 20: 2147-2150
63. Cheng MH (1996) Intraspinal extradural arachnoid cyst with spinal cord herniation. J Formos Med Assoc 95: 712-714
64. Lee ST, Lui TN and Jeng CM (1997) Spinal cord herniation after stabbing injury. Br J Neurosurg 11: 84-86
65. Karadeniz-Bilgili MY, Castillo M and Bernard E (2005) Transdural spinal cord herniation: pre- and postoperative MRI findings. Clin Imaging 29: 288-290
66. Barrenechea IJ, Lesser JB, Gidekel AL, Turjanski L and Perin NI (2006) Diagnosis and treatment of spinal cord herniation: a combined experience. J Neurosurg Spine 5: 294-302
67. Ellger T, Schul C, Heindel W, Evers S and Ringelstein EB (2006) Idiopathic spinal cord herniation causing progressive Brown-Sequard syndrome. Clin Neurol Neurosurg 108: 388-391
68. Nabors MW, Pait TG, Byrd EB, et al. (1988) Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68: 366-377
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Apr 30, 2021
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Runza G, Maffei E, Cademartiri F. Idiopathic herniation of the thoracic spinal cord: an often mis-diagnosed clinical entity . Acta Biomed [Internet]. 2021 Apr. 30 [cited 2023 Feb. 27];92(S1):e2021143. Available from: 9947
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Case Reports: Radiology and Imaging
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