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Anorectal malformation and spinal dysraphism: the value of diffusion-weighted imaging in detecting associated intradural (epi)dermoid cyst.
- Source :
- Journal of Pediatric Surgery; Oct2008, Vol. 43 Issue 10, p1935-1938, 4p
- Publication Year :
- 2008
-
Abstract
- Abstract: Anorectal malformations (ARMs) are associated with a variety of spinal dysraphisms, of which clinical impact is often underestimated. A 6-year-old girl, with a history of rectovaginal fistula, presented with gait disturbance, asthenia, and worsening of fecal incontinence. The spinal magnetic resonance imaging (MRI) at 12 months of age had revealed a tethered cord and a little intradural lipoma. Within the lipoma, a small cystic lesion, interpreted as a cerebrospinal fluid (CSF)-filled loculation, was also described. A consecutive MRI showed a marked increase in size of the CSF-like cyst that was clearly hyperintense on diffusion-weighted imaging (DWI) and presented reduced apparent diffusion coefficient values (855 ± 109 s/mm<superscript>2</superscript>), not compatible with CSF values. This lesion, interpreted as an (epi)dermoid cyst, was removed and histologically confirmed; the spinal cord was untethered. The child''s lower limb motor deficit resolved rapidly after surgery, and the fecal incontinence slowly returned to the previous bowel habit. There is a growing interest in recognizing and defining spinal dysraphism in ARM patients because some abnormalities may carry severe clinical consequences. For this purpose, a standardized MR protocol is required, in which DWI plays a pivotal role to disclose associated dysembriogenetic lesions, in particular when a CSF loculation is detected. [Copyright &y& Elsevier]
- Subjects :
- ANAL diseases
NEURAL tube defects
DIAGNOSTIC imaging
CYSTS (Pathology)
Subjects
Details
- Language :
- English
- ISSN :
- 00223468
- Volume :
- 43
- Issue :
- 10
- Database :
- Supplemental Index
- Journal :
- Journal of Pediatric Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34656573
- Full Text :
- https://doi.org/10.1016/j.jpedsurg.2008.05.015