No abstract
Skeletal echinococcosis is a relatively rare entity and that of the rib is exceptional. Less than 50 cases of costal echinococcosis have been reported in the literature so far. Accurate pre-operative diagnosis aids in appropriate management and helps to eradicate the disease. This also prevents the dissemination of parasite and further complications. We report a case of echinococcosis of the rib with epidural extension in a young adult who presented with paraparesis and back pain. His laboratory investigations were within normal limits. Plain radiographs of the dorsal spine, CT scan of thorax and MRI of dorsal spine were performed. The imaging features were suggestive of echinococcosis involving the rib with epidural extension. The cyst was completely resected. Histopathology of the resected specimen confirmed the diagnosis of echinococcosis.
Dermal sinus tracts are formed during the 26th day of gestation from the incomplete closure of cutaneous ectoderm from neural ectoderm. [1][2][3][4][5] As remnants of incomplete neural tube closure, they are often associated with dermoid and epidermoid cysts, spinal cord tethering and spinal fluid drainage.1,2,6-8 As such, dermal sinus tracts are diagnosed during early childhood. 2,8 These entities most frequently present in the lumbosacral area and less commonly in the thoracic region. 2,[8][9][10] We present a patient with a thoracic dermal sinus tract and an associated intradural dermoid cyst presenting in late adulthood. CASE REPORTA 60-year-old gentleman presented with a chronic sinus tract and intermittent abscess formation in the mid-thoracic spine. Although the dermal sinus had been present for as long as the patient could remember, it remained asymptomatic until his 20's. At that time, he developed an abscess and was treated with antibiotics for two to three weeks. The affected region demonstrated recurrent bouts of infection over the ensuing two to three years and again was treated with systemic antibiotics. The area was first excised by a general surgeon 11 years prior to presentation. Subsequently, he required additional surgical excisions on three separate occasions, none of which resulted in complete cessation of symptoms.Between episodes, he remained healthy and asymptomatic. The patient's last flare-up occurred one year prior to the current presentation. At that time he became quite unwell and experienced intermittent fevers, generalized myalgias, anorexia, and fatigue. Treatment with ciprofloxacin (500mg po bid) for one week provided no improvement. The area was incised and drained one liter of malodorous pus. Specimen cultures revealed nonspecific gram positive cocci and gram negative bacilli. He has remained relatively well since this incident.Due to the recurrent nature of these infections, the patient underwent plain x-rays as well as ultrasound and was eventually referred to our neurosurgical service. Magnetic resonance study suggested an abnormality in the interspinous space of the T4-5 region with the findings being most consistent with a dermal sinus tract with an intradural dermoid cyst on the dorsal aspect of the spinal cord (Figures 1, 2). No clear spinal cord tethering was noted though thecal sac appeared tented.Preoperatively, the patient demonstrated no neurological abnormalities on examination. His comorbidities included wellcontrolled hypertension, surgically-treated carotid stenosis and hypercholesterolemia. At surgery, an elliptical incision encircling the sinus was made and the sinus tract was followed to the dura. Partial removal of T3 and T5 as well as complete removal of T4 laminae was performed. With the assistance of an intra-operative microscope, a midline dural incision around the Congenital Dermal Sinus and Cyst in AdulthoodAria Fallah, Abhishek Raut, Ryan Rebello, Kesava Reddy Can. J. Neurol. Sci. 2009; 36: 114-116 BRIEF COMMUNICATIONS dermal sinus tract was made...
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