Answer for BIR CoW 22 May 2022
Lipomyelocele with tethered spinal cord and Neurogenic bladder
Findings
Evidence of Sacral level dysraphism covered with skin and subcutaneous fatty tissue. Associated with low lying tethered spinal cord at S2 Spinal level. Herniation of myelo components through the dysraphic portion, protrusion of lipid along with myeloportion noted posteriorly into the left gluteal region as well into the left ischiorectal fossa. Left gluteus muscle appears atrophic Sacral vertebrae – S2 (Left lamina) ,S3 (Left lamina)S4 –(body ,Bilateral lamina) not visualised. Neurogenic bladder and Bilateral Hydroureteronephrosis. I
Discussion
Lipomyelocele Also known as lipomyeloschisis Common closed spinal dysraphism Seen in thorocolumbar region Pathology : Premature separation of surface ectoderm before the formation of proper neural tube with the ingress of mesoderm The mesoderm prevents proper neurulation. Radiological findings : Posterior spinal defect which is covered with skin and shows interspersed lipomatous tissue. The neural placode lipoma interface lies within the spinal canal or at its edge with normal anterior subarachnoid space. There is usually associated tethered low lying cord Syrinx of the terminal spinal cord.
Differential diagnosis
Lipomyelomeningocele : the lipoma – placode interface lies outside the spinal canal with resultant enlargement of anterior subarachnoid space. Intradural spinal lipoma : sharply circumscribed masses largely conforming to the duramater but distorting the cord.
Findings
Evidence of Sacral level dysraphism covered with skin and subcutaneous fatty tissue. Associated with low lying tethered spinal cord at S2 Spinal level. Herniation of myelo components through the dysraphic portion, protrusion of lipid along with myeloportion noted posteriorly into the left gluteal region as well into the left ischiorectal fossa. Left gluteus muscle appears atrophic Sacral vertebrae – S2 (Left lamina) ,S3 (Left lamina)S4 –(body ,Bilateral lamina) not visualised. Neurogenic bladder and Bilateral Hydroureteronephrosis. I
Discussion
Lipomyelocele Also known as lipomyeloschisis Common closed spinal dysraphism Seen in thorocolumbar region Pathology : Premature separation of surface ectoderm before the formation of proper neural tube with the ingress of mesoderm The mesoderm prevents proper neurulation. Radiological findings : Posterior spinal defect which is covered with skin and shows interspersed lipomatous tissue. The neural placode lipoma interface lies within the spinal canal or at its edge with normal anterior subarachnoid space. There is usually associated tethered low lying cord Syrinx of the terminal spinal cord.
Differential diagnosis
Lipomyelomeningocele : the lipoma – placode interface lies outside the spinal canal with resultant enlargement of anterior subarachnoid space. Intradural spinal lipoma : sharply circumscribed masses largely conforming to the duramater but distorting the cord.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!