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Congenital dermal sinus tract

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Presented with upper back skin tag since birth.

Patient Data

Age: 3-year-old
Gender: Female
mri

Dermal sinus tract extends from the skin surface to the thoracic spinal cord opposite T3 via the widened T2/3 interspinous space, the thoracic spinal cord opposite T3 shows intramedullary increased signal (cord malacia).

Association: unfused posterior arches (spinous processes) of C6 down to T4 vertebrae (spina bifida occulta).

Dermal sinus tract extends from the skin surface to the thoracic spinal cord opposite T3 via the widened T2/3 interspinous space, the thoracic spinal cord opposite T3 shows intramedullary increased signal (cord malacia).

Association: unfused posterior arches (spinous processes) of C6 down to T4 vertebrae (spina bifida occulta).

x-ray

Unfused posterior arches (spinous processes) of C6 down to T4 vertebrae (spina bifida occulta).

Photo

Photo: skin tag.

Annotated images show: dermal sinus tract extends from the skin surface to the thoracic spinal cord opposite T3 via the widened T2/3 interspinous space (Red arrows), the thoracic spinal cord opposite T3 shows intramedullary increased signal (cord malacia).

Association: unfused posterior arches (spinous processes) of C6 down to T4 vertebrae (spina bifida occulta).

Case Discussion

Spinal dorsal dermal sinus is a rare entity, which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection 1.

Spinal dorsal dermal sinus tract (DST) is a rare congenital dysraphism that occurs in approximately one in every 2500 live births.

It includes a tract lined by epithelium, which traverses for a variable depth into the underlying structures and in many instances, terminates within the thecal sac.

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