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Table of Contents    
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 834-835

Ecchordosis Physaliphora – Classical MRI Image

Department of Radiodiagnosis, Sree Balaji Medical College and Hospital; Consultant Radiologist, IVR Scans, Chennai, Tamil Nadu, India

Date of Submission07-Jul-2021
Date of Decision09-Sep-2021
Date of Acceptance10-Sep-2021
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Venkatraman Indiran
Consultant Radiologist, IVR Scans, 1, Nellipet Cross Street, Chrompet, Chennai - 600 044
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.344664

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How to cite this article:
Indiran V. Ecchordosis Physaliphora – Classical MRI Image. Neurol India 2022;70:834-5

How to cite this URL:
Indiran V. Ecchordosis Physaliphora – Classical MRI Image. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:834-5. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/834/344664

A 44-year-old female presented with headache for 2 months. She had no aura, vomiting, visual disturbances, nasal discharge, or comorbid conditions. Her pulse rate (74/min) and blood pressure (118/82 mmHg) were normal. Her hemoglobin, white cell counts, and platelets were normal. Magnetic resonance imaging (MRI) of the brain revealed sphenoid sinusitis. A well-defined thin walled about 5 mm T2 hyperintense and T1 hypointense retroclival cystic lesion showing complete suppression of signal on fluid attenuation inversion recovery (T2 FLAIR) images was seen in the prepontine cistern with a T2 FLAIR hyperintense stalk extending into the clivus [Figure 1] and [Figure 2]. This is characteristic for ecchordosis physaliphora (EP). Contrast-enhanced MRI study was not performed, as the patient did not consent for it. This patient was reassured and treated for sinusitis.
Figure 1: Axial T2-weighted MRI section (a) shows a well-defined thin walled 5 mm T2 hyperintense retroclival, prepontine cistern cystic lesion. Sagittal T2 FLAIR image (b) shows complete suppression of the signal in the cystic lesion with a T2 FLAIR hyperintense stalk extending into the clivus

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Figure 2: Axial T1-weighted MRI section shows a well-defined small T1 hypointense retroclival, prepontine cistern cystic lesion

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EP is a small gelatinous midline craniospinal axis notochordal remnant, found anywhere from dorsum sella till sacrococcygeal region.[1] Intracranial classical EP is typically found intradurally in the prepontine cistern, attached to the dorsal wall of clivus via a small stalk.[2] Ecchordoses in this region are usually asymptomatic and are touch-me-not lesions. Though EP is classically intradural, it can be located in extradural, subdural, and subarachnoid spaces.[2] EP is found to occur in about 2% of autopsies.[3] EP greater than 3 cm in diameter or 6 cm3 in volume is called as “giant” EP. An osseous stalklike projection connecting the EP to the dorsal aspect of the clivus is considered the pathological hallmark of EP. T1 hypointense signal, T2 hyperintense signal, and lack of enhancement with gadolinium administration allow us to make a diagnosis of EP based on imaging alone.[2] A T2 hypointense rim along the lesion is an atypical feature of EP.[3] Dermoid, epidermoid cyst, and chordoma are imaging differentials.[1],[2] Chordomas are often extradural, display intratumoral calcification, and enhance upon gadolinium administration. As EP and clival chordoma have completely different prognosis, precise knowledge of the imaging features of EP is very essential.

Ethical approval (animals)

This article does not contain any studies with animals performed by any of the author(s).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from individual participant included in the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Mehnert F, Beschorner R, Küker W, Hahn U, Nägele T. Retroclival ecchordosis physaliphora: MR imaging and review of the literature. AJNR Am J Neuroradiol 2004;25:1851-5.  Back to cited text no. 1
Lagman C, Varshneya K, Sarmiento JM, Turtz AR, Chitale RV. Proposed diagnostic criteria, classification schema, and review of literature of notochord-derived ecchordosis physaliphora. Cureus 2016;8:e547.  Back to cited text no. 2
Park HH, Lee KS, Ahn SJ, Suh SH, Hong CK. Ecchordosis physaliphora: Typical and atypical radiologic features. Neurosurg Rev 2017;40:87-94.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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