Pharyngeal enterogenous cyst associated with canalis basilaris medianus in a newborn
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CASE REPORT
Pharyngeal enterogenous cyst associated with canalis basilaris medianus in a newborn Rosa Morabito & Marcello Longo & Andrea Rossi & Paolo Nozza & Francesca Granata
Received: 21 July 2012 / Accepted: 22 July 2012 / Published online: 9 November 2012 # Springer-Verlag 2012
Abstract We report the CT and MR characteristics of a newborn with a rare, complex malformation characterised by a large rhinopharyngeal and oropharyngeal enterogenous cyst, associated with an osseous defect of the basiocciput, called canalis basilaris medianus (CBM). A partial herniation of the bulb was demonstrated through the bony defect on the midline. The enterogenous cyst occupied the rhinopharynx and oropharynx, narrowing the pharyngeal lumen and making it difficult for the introduction of an orotracheal tube. Keywords Canalis basilaris medianus . Enterogenous cyst . Pharyngeal cyst . MRI
Introduction Canalis basilaris medianus (CBM) is an uncommon variant or mild anomaly of the basiocciput, as first described by Grubber in 1880 [1]. It consists of a well-defined channel originating on the intracranial surface of the basiocciput in the midline, very close to the anterior rim of the foramen magnum [2]. We report the case of a newborn with a complete inferior CBM associated to a rhino-oropharyngeal enterogenous R. Morabito (*) : M. Longo : F. Granata Unit of Neuroradiology, Depertment of Radiological Science, University of Messina, Messina, Italy e-mail: [email protected] A. Rossi Neuroradiology Department, G. Gaslini Children’s Hospital, Genova, Italy P. Nozza Pathology Department, G. Gaslini Children’s Hospital, Genova, Italy
cyst, diagnosed in the first month of life by MRI evaluation and CT scan.
Case report A 1-month-old girl was admitted to the Department of Paediatrics of our institute with a history of growth retardation and vomiting at the end of every feed. During hospitalisation, new symptoms such as nystagmus, serious crisis of desaturation and bradycardia appeared. A nasotracheal intubation was necessary. The procedure was difficult because of a pearly white, translucent and hard-elastic mass occupying pharyngeal lumen. Urgent MRI and CT scans were performed. MRI examination (Magnetom Sensation 1.5 T; Siemens, Erlangen, Germany) was performed with sagittal and axial images, T1-weighted, T2-weighted and PDweighted spin-echo (SE) and fast spin-echo (FSE) sequences. We also obtained multiplanar reconstruction gradient echo (MPR-GE) T1-weighted and half-Fourier acquired single-shot turbo spin-echo (HASTE) T2weighted sequences. MRI showed a median, lengthened, large osseous defect, situated on the basiocciput. Through the bony defect, a partial herniation of the bulb was identified on axial images and even more on the sagittal ones. A large cystic lesion with a coexisting water signal occupied the rhinopharynx and oropharynx, narrowing the pharyngeal lumen and making it difficult for nasotracheal tube introduction. The cyst had a close relationship of contiguity with the endotracheal tube (Fig. 1). The child un
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