1. Shikha Bhatia Radiology Elective 06/02/17
Case Presentation
Shikha Bhatia
Radiology Elective
06/02/17

2. I.L. 77 y/o F
TX from OSH after falling down multiple steps head first while visiting family from Italy
Extensive OSH imaging showed:
Comminuted inferior orbital wall blowout fracture
Minimally displaced left nasal bone fracture
Facial lacerations (repaired at OSH)
Mildly displaced C6 spinous process fracture
Preexisting severe C5/C6 stenosis
Ligamentous cervical injury with central cord syndrome
Diffuse osteopenia
No abdominopelvic signs or symptoms
Labs on arrival:
WBC 12.1
Hgb 10.9 & Hct 34.2
BUN 31, Cr 1.2
H/o HTN, HLD, DM
Medications: Amlodipine, Atorvastatin, HCTZ, Naproxen, Pioglitazone
CT Chest/Abd/Pelvis with T and L reconstructions ordered to complete OSH imaging
IMPRESSION:
THORACIC SPINE:
1. Age indeterminate anterior wedging and superior endplate irregularity of the T6 vertebral body. Correlation with point tenderness at this location is recommended, and if there is persistent clinical concern for acute fracture, consider MRI for further evaluation.
2. Diffuse, advanced osteopenia.
LUMBAR SPINE:
1. Diffuse, advanced osteopenia without evidence of acute lumbosacral spine fractures.
2. Advanced multilevel degenerative disc disease and facet arthropathy with severe central canal stenosis from L2-L3 through L4-L5 as well as multilevel neural foraminal stenosis.

13. The Differential 11.5 cm multilocular presacral cystic lesion
Developmental cysts:
Epidermoid
Dermoid
Neurenteric
Tailgut duplication
Cystic sacrococcygeal teratoma
Anal gland cyst
Cystic Lymphangioma
Abscess
Sacral Chordoma
Anterior sacral meningocele
Extraperitoneal adenomucinosis

14. Tailgut duplication cyst
Retrorectal cystic hamartoma
Develop from remnants of the embryonic hindgut
Affects females, usually y.o. but can occur at any age
Often found incidentally, but ~50% of patients develop compressive symptoms
Located in retrorectal space almost always
Complications: Infection, inflammation, malignant transformation
Treatment: Surgical Excision, even if ASx

15. Usually cystic, multiloculated
Bright on T2
May see calcs

16. Hospital course Admitted to STBICU
Neurosurgery, Ophthalmology, and Plastic Surgery consulted
NSGY recs: no acute intervention needed
C-collar x6 weeks
f/u flexion, extension films
Plastics: no indication for operative repair, supportive care to lacerations
Ophtho recs: fracture limited to orbit, no need for acute intervention, supportive care and f/u PRN
Tail Gut Cyst: F/u PCP for eventual surgical removal
Discharged HD3 to SNF

17. references
Weerakkody, Yuranga. "Tailgut Duplication Cyst." Radiopaedia, 01 Jan Web. 31 May 2017.
Abdelbaki S, Vahora N, Kaur H, et al. "Tailgut Cysts; Shedding Light on an Increasingly Identified Entity and Selected Case Review." University of Texas MD Anderson Cancer Center. Web. 31 May 2017

18. Questions?