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Title : case 230

Age / Sex : 11 / M




Age / Sex : 11/M





Chief complaint : recent lower back pain at morning





1) What is your impression?



Two weeks later, you can see the final diagnosis with a brief discussion of
this case.



* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)



Courtesy : Lee
Seunghun, Hanyang
University Seoul
Hospital




Diagnosis:

tethered cord syndrome



Discussion




Findings: Sagittal T1W and T2W scans show a low-lying tether
cord with fibrolipoma inserting into a terminal lipoma. Lipoma is contiguous
with subcutaneous fat through dorsal dysraphism.



 



 



Differential Diagnosis: no



 



Diagnosis:
low conus (tethered conus, tight filum
terminale, cord traction) syndrome



Discussion:



 Genetal features



-      
Conus ends
below L2 inferior endplate; tethered by thickened filum with/without
fibrolipoma, terminal lipoma



-      
Location;
T-L junction à sacrum



-      
Size; filum
thickened (>2mm at L5-S1, axial MRI)



-      
Scoliosis
(20%)에서 동반



Clinical
issues



-      
Lower back
pain and leg pain; worst in morning, exacerbated by exertion



-      
Urinary
bladder dysfuntion



 



 



References:



 Jeffrey S. Ross et al. Diagnostic imaging
(Spine). I136-39.

Correct Answer
Name Institution
total applicants 17
correct answer 13
김현주 순천향대학교부속 서울벼원
김성윤 동대문 튼튼병원
조신영 웰튼병원
손범석 (전공의) 세브란스병원
최희석 부평세림병원
김건우 (전공의) 강동경희대학교병원
안경식 고대안암병원
정유미 가천의대길병원
김승수 (전공의) 순천향병원 춘천병원
배소영 (전공의) 순천향대학교 부천병원
홍새롬 (전공의) 세브란스병원
윤민아 서울대병원
정진영 삼성서울병원
이름:소속병원

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