CincyKidsRad

Cincinnati Children's Radiology

Dorsal dermal tract

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.

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Sagittal T1 with fat saturation (image 1), sagittal T2, axial T1, and sagittal diffusion weighted MRI in a patient with a previously repaired myelomeningocele shows a lipoma (arrow) and dermoid/epidermoid (dashed arrow) leading to a tethered spinal cord (arrowhead). Lipomas can be identified by the presence of signal loss on fat saturated images. Dermoids have restricted diffusion. Spinal dermoids are uncommon but account for a large percentage of intradural tumors in infants. They typically occur in the lumbosacral region.

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 complication 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.

Sag CT of the abd 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 fast spin gradient-echo (image 1) and axial T1-weighted postcontrast (image 2) MRI in a child with meningitis shows a dorsal dermal sinus (arrowhead) extending to a small epidermoid cyst (arrow, image 1). There are also imaging findings of meningitis with enhancement of the cerebral sulci (arrow, image 2). A dorsal dermal sinus tract isn't an epithelium line track extending from the skin to the arachnoid space. Most dorsal dermal sinus tracts occur in the lumbar spine.

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