Cincinnati Children's Radiology

Dorsal dermal sinus

Multiple sagittal T2-weighted images (image 1) show a dorsal dermal sinus (arrowhead) of the thoracic spine. This is confirmed with ultrasound (image 2). A dorsal dermal sinus is a congenital dysraphism that includes a variable length epithelial-lined tract. In most instances, a dorsal dermal sinus tract extends to the thecal sac. Due to its connection to the skin, patients may present with infectious complications such as meningitis. Other anomalies are common and include a tethered spinal cord, inclusion tumors, and split cord malformation. Most dorsal dermal sinus tracts occur within the lumbosacral region.

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Sagittal T2 weighted (image 1), sagittal T1-weighted postcontrast (image 2), and axial T2 (image 3) MRI of the cervical spine shows a large expansile pilocytic astrocytoma arising from the cervical spinal cord. Pilocytic astrocytoma is the most common spinal cord tumor in children. They most commonly occur in the thoracic portion of the spinal cord causing fusiform enlargement.

Sag CT of the abdomen shows a track extending from the bladder dome to umbilicus. Urachal remnant anomalies are a spectrum of congenital anomalies including patent urachus (open connection between bladder and skin), urachal sinus (blind ending sinus tract from skin), urachal diverticulum (blind ending tract from bladder), and urachal cyst (cyst, no open connection to skin or bladder).

Sagittal T1-weighted images of the lumbar spine reveal a dorsal dermal sinus (arrow) connecting to the skin surface (arrowhead) and a tethered spinal cord (dashed arrow). A dorsal dermal sinus is a type of congenital dysraphism where an epithelial-lined tract extends from the skin to varying depths, potentially to the thecal sac. As this can be a nidus for infection due to the connection to the skin, it can also be associated with other anomalies like tethered cord and split spinal cord malformations.

Diabetic foot infection from 5th met head ulcer with sinus tract on dorsal lateral foot. What do you want to do next?

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