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

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.

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

Tailgut duplication cyst Retrorectal cystic hamartoma Develop from remnants of the embryonic hindgut Affects females, usually 30-60 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

Usually cystic, multiloculated Bright on T2 May see calcs

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

references Weerakkody, Yuranga. "Tailgut Duplication Cyst." Radiopaedia, 01 Jan. 2017. 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

Questions?