Lateral thoracic meningocele

Case contributed by Dr Wen Jak Ma

Presentation

Slow progressive weakness and paraesthesia in right lower limb.

Patient Data

Age: 45 years
Gender: Male
MRI

T6-10 left lateral thoracic meningocele with complex dural folds. Markedly distorted spinal cord with reduced volume, cord displaced anteriorly and to the left.  Nerve rootlets can be seen transversing the fluid space to reach the right side. Lateral expansion of meningocele through left T8/9 and T9/10 foramina.

Lipoma/entrapped fat seen on dorsal aspect of the cord at the superior aspect, forming a "placode-lipoma interface" within the spinal canal. Lipoma is contiguous with posterior epidural fat, and has a circumferential dural envelop (which becomes thickened and more obvious post-shunting - not shown).

T8 and T9 posterior vertebral body scalloping. Marked enlargement of T9/10 left foramen, lesser degree T8/9.

No lumbar spinal dysraphism. Conus tapers normally at L1. (Lumbar MR images not shown).

No stigmata of NF-1 or Marfan syndrome. No scoliosis.

CT

Patchy dural calcifications around the meningocele.

T8 and T9 posterior vertebral body scalloping. Enlargement of T8/9 and T9/10 left foramina. Intact posterior bony elements.

 

Case Discussion

Findings suggest this being a type of lateral thoracic meningocele.

However, the presence of entrapped fat/lipoma abutting the cord, complex dural folds, as well as deformed and diminished spinal cord suggest that this is more like a developmental/congenital "lipomyeloschisis", rather than dural deformity/ectasia seen in mesenchymal diseases such as neurofibromatosis type 1 and Marfan syndrome. Yet the posterior bony elements are intact.

There is no clear-cut terminology to use - is this a meningocele, lipomeningocele, or lipomyelomeningocele?

There is no recent literature to help.

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Case information

rID: 56105
Case created: 11th Oct 2017
Last edited: 24th Oct 2017
Inclusion in quiz mode: Included

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