Thoracic Radiculopathy Unveiling Giant Bilateral Thoracic Tarlov Cysts

Background Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that typically arise between the covering layers of the perineurium and endoneurium at the junction of the dorsal root ganglion. They are usually asymptomatic and typically located at the lumbosacral spine. Thoracic localization is rarely reported and is a challenging condition both clinically due to its misleading wide range of symptoms and therapeutically, given the lack of management guidelines. Case We report a case of a man in his seventies complaining of chronic back pain with worsening bilateral thoracic radiculopathy with tingling and burning sensations following T11-T12 dermatomes. The neurological examination was without abnormalities. Magnetic resonance imaging revealed bilateral, extradural, and large cystic formations. The diagnosis of thoracic bilateral giant cysts was established. The patient denied surgical treatment. Topical non-steroidal anti-inflammatory drugs and acetaminophen led to partial improvement of symptoms. Conclusion This case highlights clinical and imaging features of thoracic Tarlov cysts. The MRI is considered the gold standard for diagnosing Tarlov cysts and effectively ruling out differential diagnoses. The initial therapeutic approach for Tarlov cysts typically involves conservative management.