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This was a one day old infant

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who had an abnormal skin discoloration overlying the sacrum.

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And so this patient came to screening spine ultrasound.

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Uh, we're starting at the sacrum

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where the tech has labeled the S five vertebral body,

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and we agree with that labeling because this is a square

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or rectangular shape of the S five vertebral body.

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Um, coming superiorly, uh, they've labeled this L five,

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but let's see what else we can see.

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Um, so coming superiorly, there's, uh, it's hard to tell

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where we are because there's some,

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there's a lot of abnormalities here.

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So they've labeled this the L five vertebral body,

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but there's some something abnormal going on in this

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central spinal canal.

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So if we agree with their labeling, L one, L two, L three,

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L four, L five, this will be S one.

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This, uh, conus mellis does have a nice normal triangular

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shape, but it extends to the inferior aspect

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of the L three vertebral body level.

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So we, if we agree with the labeling

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of the vertebral body levels,

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this will be the L five vertebral body,

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L four vertebral body level.

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So that means this is the L three vertebral body level.

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And although this conus mellis has a nice normal triangular

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shaped, uh, morphology, it extends beyond the mid portion

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of the L three vertebral body level.

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So this is too low,

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but there's some other abnormalities on this image.

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I want to draw your attention to.

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Number one, we're have a decreased amount

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of CSF in this central, uh, spinal canal.

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So, um, you know,

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typically they're CSF extending all the way from the, uh,

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the ventral and, uh, ventral

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and dorsal, uh, uh, central, uh, spinal canal space.

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There's this abnormal agen material at the ventral aspect

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of this spinal canal.

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Um, and I'm having a hard time seeing

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where is phylum terminality, where are nerve rootlets?

1:50

Um, like what else is going on here?

1:53

I think this is the phylum terminality here,

1:55

and it looks a little bit too thick to me.

1:57

In addition to this abnormal genic material in this, um,

2:01

spinal canal concerning for a fat.

2:04

This is what you, what this is what a,

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a motion degraded logic view looks like.

2:07

So this patient moved, which, uh,

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when we went from the thoracic spine level

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to the lumbar spine level, so let's see if we repeated it.

2:14

We did. So let's confirm the vertebral body levels.

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So we'll draw a line, uh, paralleling the sacrum,

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a line paralleling the lumbar, uh, vertebral bodies.

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And so this will be five one.

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And again, we're, we're,

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we have a low line conus mellis here, um,

2:30

in the transverse plane.

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Let's just make sure we don't see anything else wrong in the

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paraspinal regions.

2:35

Both of the kidneys have normal genicity.

2:38

I don't see any hydro necrosis.

2:40

The cord itself looks okay as we're going superior

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to inferior, but again,

2:44

we have abnormal echogenic material here.

2:47

It looks like it's, there's abnormal epigenic material in

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the dorsal aspect of the central, uh, spinal canal.

2:53

Two, definitely abnormal, uh,

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genic material at the dorsal

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Aspect of this, um, central cord.

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Um, and, uh, it's important to label any areas

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of cutaneous abnormalities.

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So we can see if there's any sort

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of underlying like lesion extending from the surface

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of the skin into the central spinal canal.

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And it looks like, it looks like this is, uh, a,

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a tethered cord related to, um, that abnormal kind

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of fatty mass dorsally, so abnormal fat dorsally.

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And in the subcutaneous fat underlying the area

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of skin discoloration.

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Here it is in the transverse plane.

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We see it much better on, on these images than earlier.

3:33

So there's, there's that abnormal epigenic, um, mass.

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So we're gonna recommend an MRI to be able

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to get more detail of what's going on, um,

3:41

in this canal in the, uh, subcutaneous soft tissues,

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and, uh, confirm what level the cord ends at.

3:48

So this patient later went on to MRI

3:50

to confirm the abnormalities we saw at ultrasound.

3:53

So on the left we have a T two non-fat saturated, uh,

3:58

MRI of the lumbosacral junction.

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And on the right we have the corresponding T one weighted

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imaging without fat saturation.

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And this is a nice comparison at MRI to that ultrasound.

4:09

You see this abnormal T one weighted hyperintensity, um,

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kind of follows the signal of the subcutaneous fat.

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And so this is, uh, an example

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of a closed dis di closed DYS raffic defect

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where you have a, uh, a fatty mass within the, uh, central

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canal extending from, it's hard to tell exactly

4:33

where the cutaneous abnormality is,

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but there is some prominent subcutaneous fat in this infant.

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So let's label the levels of the lumbar spine.

4:40

Of course, if we're gonna on a localizer image,

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include the entirety of the spine to be able

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to accurately label.

4:47

But this looks like L five, L four,

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and this, this conus mellis terminates at the inferior

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aspect of L three, which is too low.

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So concerning for tethered cord related to this intradural,

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um, uh, fatty mass, uh, with this like, uh, kind of subtle,

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um, there's maybe some subtle extension

5:08

of this fatty mass towards the dorsal surface of the skin.

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So, uh, abnormal spine MRI, uh,

5:15

confirming the abnormalities we saw at spine ultrasound.