Lateral thoracic meningocele

Case contributed by Dr Dalia Ibrahim

Presentation

Vague abdominal pain. Incidental left hypochondrial cyst by ultrasound exam for further CT assessment to identify its origin and nature.

Patient Data

Age: 45 years
Gender: Female
CT

Left paraspinal well-defined homogeneous cyst is seen opposite D10, D11 and D12 vertebrae. This cyst shows intraspinal extension via the widened corresponding neural exit foramina. The intraspinal portion causes patulous spinal canal and scalloping of the posterior aspect of the vertebrae.

Case Discussion

Review of the clinical history of the patient and examination findings revealed no evidence of neurofibromatosis or collagen disorder (e.g. Marfan disease).

Lateral or anterior spinal meningoceles are relatively rare congenital anomalies where protrusion of dura mater and arachnoid extending laterally through an enlarged intervertebral foramen into the paraspinal, intrathoracic, or retroperitoneal region 1.​

Lateral meningoceles may be unilateral or bilateral or may be solitary or multiple 1.​

Lateral meningoceles commonly occur in thoracic and lumbar regions followed by the cervical area, and rarely in the sacral region 1.​

It's commonly associated with neurofibromatosis NF 1 (in 69% of patients) 2 or collagen disorder such as Marfan disease or less likely occurs in isolation.

Most patients are asymptomatic, but several clinical manifestations can develop depending on size and location of meningoceles. It can cause paraparesis or pain by involvement of the spinal cord, or may compress the lung and mediastinal structures, causing cough, dyspnoea, and palpitations.

Lateral meningocele syndrome or Lehman syndrome, is characterised by multiple lateral meningoceles in the absence of neurofibromatosis or Marfan syndrome.

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Case information

rID: 56054
Case created: 8th Oct 2017
Last edited: 24th Oct 2017
Inclusion in quiz mode: Included

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