Unusual appearance of spontaneous spinal intradural hematoma mimicking a meningioma

Spontaneous spinal intradural hematoma is uncommon. It can mimic vascular or hemorrhagic neoplasms, as certain imaging features overlap. The distinction between spinal hematoma and neoplasm is crucial for the approach to management and might determine the outcome. The purpose of this report is to outline the radiological and pathological features of spinal hematoma. We present a case of a 62-year-old male patient presented with a short history of lower-limb weakness, back pain and both fecal and urinary incontinence. An examination revealed that his lower limb power was 0/5 bilaterally with his sensory level at T6. An enhanced MRI of the spine revealed a hemorrhagic posterior extramedullary mass at the level of T6-T7, which was thought to be a hemorrhagic meningioma or angiolipoma. Laminectomy and spinal cord decompression were performed with excision of the presumed tumor. The final pathology results revealed spinal hematoma. This case highlights that spinal hematoma should be considered in the differential diagnosis of hemorrhagic spine neoplasms, as the imaging features can overlap.