Presentation
30 weeks pregnant, prenatal ultrasound revealed a cystic lesion related to the fetal neck
Patient Data
Age: 40 years
Gender: Female
From the case:
Occipital meningocele
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- a large cystic lesion is seen at fetal occiput with a small defect about 1 cm related to lambdoid suture. It measures 6.7x5 cm in CC and AP diameters, showing thin septum, no brain tissue is seen within
- the ventricular system showed mild lateral ventricle dilatation (17mm in the atrium). Normal 3rd and 4th ventricle
- a small defect is seen in the sacral spine with small cyst likely small meningocele 1 cm (red arrow). Intact cervical spine
- the subarachnoid space is compatible with the gestational age
- the degree of gyration and sulcation is as expected for the stated gestational age
- no structural abnormalities are noted in the cerebral hemispheres
- the cavum septum pellucidum is normally formed
- Corpus callosum is seen normal (compatible with the gestational age)
- the craniocervical junction is unremarkable with no sign of Chiari or other malformation
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Sagittal image demonstrates the sacral spinal defect (red arrow) with no mass protruding through the defect and intact overlying skin.
Case Discussion
Findings are suggestive of occipital meningocele herniating through a small cranial defect with moderate ventriculomegaly and a suspected small sacral meningocele.
Prenatal MRI is valuable in cases of cystic lesions related to the head & neck as it delineates findings that can't be accurately assessed using ultrasound and helps to differentiate between cervical cysts (e.g cystic hygroma) and occipital meningocele.