Diagnostic ultrasound ( PDFDrive )

CHAPTER 49 The Pediatric Spinal Canal 1691
A
B
C
D
FIG. 49.24 Segmental Spinal Dysgenesis in a Newborn With Imperforate Anus, Clubfeet, and Gibbus Deformity. (A) Frontal radiograph
demonstrates a kyphoscoliosis at the thoracolumbar junction with multiple hemivertebrae. There are fused sacral segments. (B) Sagittal view of
the spine at the level of the thoracolumbar vertebral anomalies demonstrates thinning of the spinal cord, syringomyelia (*) above and below the
area of narrowing (white arrow), and a low conus medullaris. (C) Sagittal view of the spine shows a low lying conus medullaris that ends at L4.
Note the dilation of the central canal. The ilum terminale is thickened and echogenic (arrowheads) and showed little movement with respiration.
(D) Sagittal T1-weighted image of the thoracolumbar spine demonstrates vertebral anomalies and marked kyphosis. There is signiicant segmental
thinning of the spinal cord and segmental obliteration of the spinal canal. See also Video 49.8 and Video 49.9.
here are a few reports of primary intramedullary neoplasms,
such as glioibroma. 107
Sacrococcygeal teratomas (Figs. 49.28, 49.29, and 49.30) most
oten are discovered in the fetal or newborn period and are the
most common presacral tumors in that age group. hese heterogeneous
teratomas tend to recur and are generally described
as mature or immature. 108-111 Altman’s classiication of sacrococcygeal
teratomas is helpful for presurgical planning and describes
the extent of the mass, which can be large and external or small
and internal (Table 49.2) 112 hese masses tend to have a very
heterogeneous appearance on ultrasound, including solid, cystic
components, fat, or foci of calciication. 113 Sacrococcygeal teratomas
do not generally enter the vertebral canal, but there have
been rare reports of such extension. 114
TABLE 49.2 Altman’s Classiication of
Sacrococcygeal Teratomas
Type
I
II
III
IV
Description
The bulk of the mass is external, with only a
minimal presacral component.
Both large external and large internal components
are present.
A relatively small amount of tumor is external, but
the bulk of the mass is internal.
There is no external mass because the tumor is
exclusively presacral.