Closed spinal dysraphism (prenatal and postnatal ultrasound)

Case contributed by Dr Maulik S Patel

Presentation

2nd gradiva asymptomatic female for anomaly scan.

Patient Data

Age: 35 years
Gender: Female

Antenatal scan

Ultrasound

There is a single intrauterine fetus with growth corresponding to the period of amenorrhea. There is a spinal posterior arch defect at the lumbosacral junction region associated with an echogenic lesion in the spinal canal. The lesion shows an extraspinal extension into the subcutaneous fat plane. The overlying skin is intact. The lesion shows calcification at its base. The lesion measures about 4 x 3 x 3 mm. The spinal cord is tethered to the lesion. There is no cord splitting. There is no syrinx cranially. There is no dilatation of the cerebral ventricle. Cisterna magna is normal. Both lower limbs, as well as upper limbs, show normal movements.

Post natal 4th day ultrasound

Ultrasound

D12 vertebra is labeled at the last pair of ribs. There is an L5 spina bifida. Overling soft tissue is intact. There is a triangular-shaped echogenic lesion (about 12 x 7 x 6 mm) in the spinal canal at the L5 level. Its apex extends into soft tissue through the spinal defect. There is a linear calcification at the base of the lesion in the spinal canal. The cauda equina is adherent to the lesion. The conus medullaris is at the L3 level. There is an anechoic cyst in the spinal canal at mid-sacral ( S3, S4 ) level. It measures about 16 x 11 x 6 mm. This is an additional finding in comparison to the pre-natal scan.

Case Discussion

The case shows pre-natal and post-natal ultrasound findings of occult spinal dysraphism. There is presence of fatty tissue with calcification at the level of spinal canal defect along with extension of the fatty tissue in the subcutaneous plane.

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