Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases
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Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases Debasmita Mandal1,2 • Prasanna Roy1 • Shankar Dey1
Received: 24 February 2020 / Accepted: 26 August 2020 Ó The Author(s) 2020
Abstract The filum terminale (FT) is an extension of pia mater, a fibrous band that connects the conus medullaris and the posterior body of the coccyx.Current advanced technology in ultrasonography has enabled visualisation of the FT and small structures like a FT cyst can be diagnosed prenatally. Reports pf these cysts are rare. We report three cases of a FT cyst diagnosed prenatally. The objective of reporting these is to make clinicians aware of the importance of the relevance of this clinical entity. Keywords Filum terminale Cyst Prenatal Ultrasound Diagnosis
Case Report Case 1 A 34 year old second gravida presented at 21 weeks 5 days with a previous history of a child with Arnold Chiari type II malformation. She had an appropriate BMI. Antenatal records were unremarkable except for a subclinical hypothyroidism. No structural abnormality was observed in a detailed anomaly scan. A unilocular cystic structure, 2 9 2 mm in the FT at the level of L2 just above the conus medullaris (Fig. 1) was observed transvaginally.
Using 3D static imaging the cyst was again scrutinized in coronal, sagittal and axial sections (Fig. 1a). The cyst was anechoic and without septations or solid components. A detailed neurosonography was carried out on each follow up. The cyst remained unchanged, in three successive follow ups at 26, 32 and 36 weeks of gestational age. A 2.8 kg female baby was born at term by spontaneous vaginal delivery. Follow up with a pediatric neurologist showed normal milestones and an unchanged FT cyst on ultrasonography. Case 2 The 28 year old primigravidae with an uneventful antenatal record presented for a routine anomaly scan at 21 weeks 2 days. Biochemical markers for aneuploidies were normorange. The scan revealed no major abnormality. There was an anechoic lesion at the level of the 3rd lumbar segment of the spinal cord towards the conus medullaris deep inside the FT (Fig. 2) on a transvaginal scan. This cyst was thin walled, clean and unilocular. Neurosonography did not reveal any associations. Her antenatal period was uneventful and she delivered a 3.2 kg baby at term. The FT cyst could be visualised on ultrasound at the 8th month follow up. Follow up at the neurodevelopmental clinic did not show any abnormality. Case 3
& Debasmita Mandal [email protected]; [email protected] 1
Ultra Clinic, Asansol, West Bengal, India
2
IPGMER and SSKM Hospital, Flat No: 16D, Tower 5, Active Acres, 54/10 DC Dey Road, Kolkata, West Bengal 700015, India
A 30 year old second gravida was referred for a growth scan at 32 weeks. A FT cyst was observed. The cyst measured 5 mm in length and 2 mm in width (Fig. 3). It stretched from S4 to S2 vertebrae. Transvaginal ultrasound confirmed the finding. Associated findings, in this case, were early growth restriction with umbilic
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