Epidural venous thrombosis is a rare clinical entity with a characteristic constellation of findings in contrast-enhanced MRI, which should be considered in the differential diagnosis in the case of clinical symptoms that are initially indicative of disc herniation. The most important distinctive feature between epidural venous thrombosis and disc herniation is their topographical location in relation to the vertebral venous plexus. Particularly where morphological imaging shows a space-occupying lesion in close proximity to the internal vertebral venous plexus and a central contrast medium defect, epidural venous thrombosis should be taken into consideration.