Developmental disorders

II./3.4.: Radiologic imaging of developmental disorders related to sacral teratoma

II./3.4.1.: Skeletal disorders

We should be also aware on the course of radiologic imaging that in appr. 1/5 of the cases teratomas is concomitant with other developmental disorders. Among skeletal disorders, radiologic signs of open spine, sacrum agenesis (caudal regression syndrome) or hip dislocation should be looked for. The applicable imaging methods are:

II./3.4.1.1.: X-ray examination

All the three skeletal abnormalities can be imaged unequivocally.

II./3.4.1.2.: Ultrasound examination

Recommended examination of newborns. This imaging modality has an extraordinary importance in newborns because of the further accompanying complications (e.g. tethered cord, lipoma, cauda equina cyst). Never forget that the descent („ascensus”) of the myelon has not occured at that time, and the conus is in the level of L. III. vertebra. US can also image the filum terminale and the motion of the caudal fibers as well.

II./3.4.1.3.: Magnetic resonance imaging

If US cannot be performed because of ossification any more (appr. after the 4th week) MRI examination can applied. T1 weighted images show the anatomic relations (intraspinal, too), whileas T2 weighting orientates towards the tissue consistency (e.g. lipoma: high signal on T1).

II./3.4.2.: Renal abnormalities

Renal abnormalities develop partly sui generis (renal cystic dysplasia, Potter-syndrome /with polycystic kidney/), partly mechanic reason can be in the background (hydronephrosis, vesicoureteral reflux).

II./3.4.2.1.: Ultrasound examination

Typical finding of the polycystic kidney: numerous hypoechoic/echolucent lesions possibly with distal acoustic enhancement. Vesicoureteral reflux can be also examined by ultrasound (contrast enhanced examination).

II./3.4.2.2.: Nuclear medicine examinations (NM)

It is able to detect vesicoureteral reflux.

II./3.4.3.: Gastrointestinal abnormalities

Anorectal stenosis, anal atresia, gastroschisis might coexist in the gastrointestinal tract: X-ray, barium enema (irrigoscopy).