Case of the Month

June 3, 2008 Diagnostic Imaging. Case of the Month -------------------------------------------------------------------------------- CLINICAL HISTORY A 40-year-old man presented with upper and lower back pain. His symptoms worsened over the course of a month. The patient denied any bowel or bladder dysfunction, radiating symptoms, or motor deficits. FINDINGS Axial T2-weighted MR images (Figures 1 and 2) reveal a longitudinally split thoracic spinal cord with cerebrospinal fluid intervening between the two hemicords (arrow). The left hemicord is slightly larger than the right hemicord. No bony spurs were identified along the course of the split cord. A sagittal T1-weighted image (Figure 3) shows bony fusion of the bodies of the T10 and T11 vertebrae. DIAGNOSIS Diastematomyelia of the thoracic spinal cord with associated vertebral body fusion. DIFFERENTIAL DIAGNOSIS The differential diagnosis includes diplomyelia, tethered spinal cord, thickened filum terminale, neurenteric cysts, congenital dermal sinus tract, anterior sacral meningocele, spinal lipomas, and dermoid and epidermoid tumors.

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