Sagittal fast spin gradient-echo (image 1) and axial T1-weig | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

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 lined track extending from the skin to the arachnoid space. Most dorsal dermal sinus tracts occur in the lumbar spine. #NeuroWednesday

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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.

Axial (image 1) and sagittal (image 2) T2 MRI of the wrist show a ganglion cyst (arrow) arising from the dorsal surface of the wrist. Ganglion cysts represent the most common mass of the hand. They most commonly occur along the dorsal aspect of the wrist. The cysts are usually asymptomatic. Patients typically present to their doctor because they feel a firm, well-circumscribed, painless mass. On exam, the ganglion cyst is usually fixed to deep structures but not the skin. #MSKMonday

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.

Coronal CT (image 1) and T1 postcontrast weighted MRI (images 2) show opacification of the left mastoid air cells (arrow, image 1), thickening and enhancement of the adjacent dura (arrow, images 2 and 3), and thrombus (arrowhead, image 2; arrow, image 3) within the left sigmoid sinus. Mastoiditis is a bacterial infection of the mastoid air cells. Complications of mastoiditis include epidural abscess, meningitis, and dural venous sinus thrombosis. #NeuroWednesday

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