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      Apéndice cutáneo sacro asociado a lipoma del filum terminal y médula anclada: un caso de diagnóstico prenatal Translated title: Sacral cutaneous appendage associated with lipoma of the filum terminale and anchored medulla: a case of prenatal diagnosis

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          Abstract

          RESUMEN Los disrafismos espinales cerrados tienen una prevalencia aún desconocida e involucran una gran variedad de formas. El lipoma del filum terminal es considerado dentro de los lipomas espinales y suele asociarse a médula anclada. Los estigmas cutáneos lumbosacros no siempre son indicadores de disrafismo espinal cerrado. Reportamos un caso de diagnóstico prenatal de apéndice cutáneo sacro con sospecha de médula anclada, confirmado al nacer como lipoma del filum terminal con médula anclada.

          Translated abstract

          ABSTRACT Closed spinal dysraphisms have a still unknown prevalence and involve a wide variety of forms. Lipoma of the filum terminale is considered within spinal lipomas and is usually associated with tethered medulla. Lumbosacral cutaneous stigmata are not always indicative of closed spinal dysraphism. We report a case of prenatal diagnosis of sacral cutaneous appendage with suspected tethered cord, confirmed at birth as lipoma of the filum terminale with tethered cord.

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          Most cited references19

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          Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification.

          Our purpose was to review the neuroradiological features of spinal dysraphism and to correlate them with clinical findings and up-to-date embryological theory. We also aimed to formulate a working classification which might prove useful in clinical practice. We reviewed series of 986 children referred to our Spina Bifida Centre in the past 24 years. There were 353 children with open spinal (OSD) and 633 with closed (skin-covered) spinal (CSD) dysraphism. By far the most common open abnormality was myelomeningocele, and all patients with OSD had a Chiari II malformation. CSD was categorised clinically, depending on the presence of a subcutaneous mass in the back. CSD with a mass mainly consisted of lipomas with dural defects and meningoceles, and accounted for 18.8 % of CSD. CSD without a mass were simple (tight filum terminale, intradural lipoma) or complex (split cord malformations, caudal regression). Our suggested classification is easy to use and to remember and takes into account clinical and MRI features; we have found it useful and reliable when making a preoperative neuroradiological diagnosis in clinical practice.
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            Human tails and pseudotails.

            A case of a tail in a 2-week-old infant is reported, and findings from a review of 33 previously reported cases of true tails and pseudotails are summarized. The true, or persistent, vestigial tail of humans arises from the most distal remnant of the embryonic tail. It contains adipose and connective tissue, central bundles of striated muscle, blood vessels, and nerves and is covered by skin. Bone, cartilage, notochord, and spinal cord are lacking. The true tail arises by retention of structures found normally in fetal development. It may be as long as 13 cm, can move and contract, and occurs twice as often in males as in females. A true tail is easily removed surgically, without residual effects. It is rarely familial. Pseudotails are varied lesions having in common a lumbosacral protrusion and a superficial resemblance to persistent vestigial tails. The most frequent cause of a pseudotail in a series of ten cases obtained from the literature was an anomalous prolongation of the coccygeal vertebrae. Additional lesions included two lipomas, and one each of teratoma, chondromegaly , glioma, and a thin, elongated parasitic fetus.
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              US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases.

              Ultrasonography (US) of the spinal cord is performed in newborns with signs of spinal disease (cutaneous lesions of the back, deformities of the spinal column, neurologic disturbances, suspected spinal cord injury due to traumatic birth, and syndromes with associated spinal cord compression). The examination is performed with high-frequency linear- and curved-array transducers in the sagittal and axial planes from the craniocervical junction to the sacrum. Normal variants such as transient dilatation of the central canal and ventriculus terminalis can be demonstrated with US. US allows detection of congenital malformations, such as myelocele or myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, terminal myelocystocele, lateral meningocele, caudal regression syndrome, and hydromyelia or syringomyelia. Acquired intraspinal diseases following birth trauma and transient alterations after lumbar puncture can also be detected with US. US can demonstrate the entire spectrum of intraspinal anatomy and pathologic conditions with high geometric resolution. Therefore, US should be considered the initial imaging modality of choice for investigating the spinal cord in newborns.
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                Author and article information

                Journal
                rgo
                Revista Peruana de Ginecología y Obstetricia
                Rev. peru. ginecol. obstet.
                Sociedad Peruana de Obstetricia y Ginecología (Lima, , Peru )
                2304-5132
                July 2022
                : 68
                : 3
                : 00008
                Affiliations
                [2] Lima orgnameClínica Santa Isabel Perú
                [1] Callao orgnameHospital Nacional Daniel Alcides Carrión Perú
                [3] Lima orgnameClínica Delgado- AUNA Perú
                Article
                S2304-51322022000300008 S2304-5132(22)06800300008
                10.31403/rpgo.v68i2432
                beea3136-0f18-4719-83e8-f9219f8f4b90

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 07 March 2022
                : 11 May 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 0
                Product

                SciELO Peru

                Categories
                Caso Clínico

                Apéndice cutáneo,Defectos del tubo neural,lipoma,Filamento terminal,Espina bífida,Síndrome de cauda equina,Cauda equina,Neural tube defects,Filum terminale,Spina bífida,Cauda equina syndrome,Skin appendage,human,Tail

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