Coccygeal dermal sinus
A girl with a hole in her intergluteal region since birth. No discharge from it. Neurologically normal. Normal development.
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A curvilinear tract extending from the integluteal region in midline, to the tip of the coccyx. It is lined by T2 hypointense (fibrosed/epithelised tissue), with no fluid within. No horse-shoe tracking/abscess. Some cortical irregularity in coccyx posterior surface but no marrow oedema/acute osteomyelitis.
Coccygeal pits or coccygeal dermal sinuses are relatively common entities, often referred to the paediatric neurosurgeon. Usually they are not of concern, as they have an epithelial layer with no secretions. MRI is however recommended to rule out any intradural communication and to differentiate them from fistula-in-ano or an inflammatory sinus.