Anterior sacral Meningocele Associated with Tethered Cord Syndrome Presenting with Constipation: US, CT, MRI and X-Ray Findings

Abstract

Anterior sacral meningocele is characterized by the herniation of the thecal sac into the retroperitoneal space. A 33-year-old man was referred to our hospital with the complaints of a longlasting constipation and nonspecific lower abdominal pain. At ultrasound, a cystic mass was detected at the presacral space. Computed Tomography revealed a defect at the anterior aspect of the sacrum, together with a presacral cystic mass which showed a connection with the dural sac. At Magnetic Resonance Imaging, it was demonstrated that the cystic mass made an impression on the rectum, and did not possess any solid components. An anteroposterior pelvis radiogram demonstrated a sacral deformity and the scimitar sign. Upon these imaging findings, the patient got the diagnosis of an anterior sacral meningocele. The possibility of an anterior sacral meningocele must always be kept in mind in the differential diagnosis of a pelvic cystic mass.

X-ray, US, CT, and MRI imaging findings of an anterior sacral meningocele: a case report

“…The combined use of different imaging modalities has been described in the literature [1][2][3][4][5][6][7][8] . US is usually the imaging modality used for the initial study of pelvic masses; however, it has limitations such as a narrow field of view, the presence of bowel gas, difficult assessment of large patients, and it is operator dependent 10 .…”

“…MRI has greater diagnostic accuracy, with multiplanar capability and excellent soft tissue contrast, allowing for better characterization of pelvic masses when US is indefinite 10,11 . Soker et al 5 reported a case of ASM associated with a tethered spinal cord and constipation, demonstrating a multimodality approach including X-ray, US, CT, and MR for the first time. In our case report, US showed the cystic features of the pelvic tumor, but it was impossible to determine its origin.…”

“…An ASM is usually asymptomatic if it is less than 5 cm in diameter 1 or has nonspecific manifestations such as constipation 5 or urinary symptoms, such as urgency and pollakiuria, dysmenorrhea, and lumbar or pelvic pain 6 . Pressure on the nerve roots may manifest as paresthesia in the lower sacral dermatomes 7 .…”

“…Imaging modalities such as conventional radiography (X-ray), ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), have been described for the diagnosis of ASM [1][2][3][4][5][6][7][8] . Since the description of the first patient 9 in 1837, fewer than 300 cases of ASM have been reported in the literature.…”