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Dermal Sinus Tracts in the Pediatric Population: Imaging Features and Diagnostic Pearls 2013

Category General Spine Sarah Rogers
Jeffrey Cagley
Adam Figi
Nathan Selden
Jeffrey Michael. Pollock
Purpose Dermal sinus tracts have a variety of imaging appearances ranging from the clinically and radiographically obvious to the occult. In this imaging based review we use a pictorial format to present the common imaging features and diagnostic pearls. Materials & Methods A retrospective search of the radiologic information system was utilized to search for mention of a dermal sinus tract on all MRI spine reports in a pediatric population at our institution for the last 10 years. The results of this search were reviewed by a neuroradiologist. Dermal sinus tracts were classified on type, location, and imaging features. Results 7000 exams were searched yielding 614 instances of words associated with dermal sinus tracts. The 700 cases were reviewed by the authors yielding 25 cases. 22 Cases were seen in the lumbar spine, 2 cases were in the thoracic spine, and 1 case was in the sacrum. Common associations included dermoid or lipomas, diastematomyelia, and cord tethering. Most dermal sinus tracts were identified in the subcutaneous tissues on T1 and T2 sagittal imaging. The dura in most cases demonstrated a small notch at the point of communication between the dermal sinus tract and the thecal sac. A range of cases from the most illustrative to the occult  will be presented here, highlighting the imaging features and diagnostic pearls. Conclusion Dermal sinus tracts are an important entity in the pediatric population as delay in diagnosis may result in increased morbidity. In this poster we have reviewed the common imaging features and diagnostic pearls identified from a retrospective search. Awareness of these imaging features and pearls may allow the practicing radiologist to more confidently diagnose these entities and associated pathologic features. References
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  3. Barkovich AJ, Edwards M, Cogen PH. MR evaluation of spinal dermal sinus tracts in children. AJNR Am J Neuroradiol 1991;12:123-9.
  4. Ackerman LL, Menezes AH. Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 2003;112:641-7.