Inadvertent Intrathecal Contrast Injection during Percutaneous Epidural Neuroplasty: Two Autopsy Cases

Abstract

Percutaneous epidural neuroplasty (PEN) is an interventional technique used to manage spinal pain. However, the procedure may lead to various complications, such as dural puncture and inadvertent intrathecal injection of contrast agents. Conventional autopsy techniques may have limitations in identifying these complications, but postmortem computed tomography (PMCT) scans may be helpful in this respect. The pseudosubarachnoid hemorrhage sign on a PMCT scan is an important finding that suggests an inadvertent intrathecal injection of a contrast agent during the procedure. Here, we report on two rare cases of intrathecal contrast injection that mimicked a subarachnoid hemorrhage after PEN. These rare cases should be considered during autopsies of PEN-related deaths, and a PMCT scan should always be performed prior to such autopsies.