CSF leak from meningocoele in Marfan's disease
Headaches worse on standing.
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Diffuse dural ectasia presumably related to the patient's known Marfan's syndrome expands the central vertebral canal. This expansion is most pronounced in the sacral spine, where it is continuous with large CSF intensity structures extending through the sacral foramina. The sacrum is thinned as a result. Some of the structures extend beyond the sacral foramina anteriorly, most pronounced at S1 on the right.
The likely site of CSF leak is on the left, with fluid tracking along the left S1, and to a lesser degree L5, nerve roots.