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2001-05-11-10 Answer to the case of the week #49 © Malinger www.TheFetus.net

Answer to case #49

April 27-May 11,  2001

Submitted by Gustavo Malinger, MD*, Tally Lerman-Sagie#, Dorit Lev^, Mordechai Tamarkin+ and Debora Kidron%.

* Department of Obstetrics and Gynecology, # Pediatric Neurology Unit, 
^ Genetics Institute. The Edith Wolfson Medical Center, Holon; + Kupat Holim Maccabi, Tel Aviv and % Department of Pathology, Sapir Medical Center Kfar Saba. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

This fetus was scanned at 16 weeks, and a cervical mass was observed. Note the spine on the first image: it is remarkable for the normal appearance of the posterior arch and the small posterior cystic lesion

 

 

The posterior fossa is normal, with no evidence of Arnold-Chiari malformation.

 

3D pictures clearly demonstrate that the mass was attached to the fetus. 

  

 

A coronal 3D reconstruction of the cervical spine is also provided. 

There is also a short (200K) videoclip.

No associated anomalies were identified at this time. The cerebral anatomy, including the infratentorial structures was considered normal, without an Arnold-Chiari malformation. Nuchal translucency performed at 13 weeks, maternal serum AFP, amniotic fluid AFP and fetal karyotype were normal. 

Findings:

The findings are limited to:

  • a small cystic lesion
  • posterior to the cervical spine
  • without alteration of the posterior neural arch
  • without intracranial findings

Although many readers got the answer of meningocele correct very few noticed or suspected that there was only a filiform connection between the meningocele and the spinal canal. This form of meningocele with a filiform connection is very rare to my knowledge and I have only seen one before at the lumbar level.

 

Sagittal and axial views of a different fetus with a similar lumbar meningocele with a filiform connection.

These are the views of the fetus.

 

The X-ray of the neck is normal.

The probe is in the filiform connection

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