Complex Radiology Case: Multiple Traumatic Injuries in an Elderly Female
A 77-year-old female presented with multiple traumatic injuries after falling headfirst down stairs. Imaging revealed a comminuted inferior orbital wall fracture, facial lacerations, spinal fractures, and cervical cord syndrome. Lab findings indicated preexisting conditions like osteopenia, hypertension, hyperlipidemia, and diabetes. A differential diagnosis included a large presacral cystic lesion and discussions on tailgut duplication cyst were also highlighted, emphasizing the need for surgical intervention.
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CASE PRESENTATION Shikha Bhatia Radiology Elective 06/02/17
I.L. 77 Y/O F TX from OSH after falling down multiple steps head first while visiting family from Italy Extensive OSH imaging showed: No abdominopelvic signs or symptoms Comminuted inferior orbital wall blowout fracture Labs on arrival: Minimally displaced left nasal bone fracture WBC 12.1 Facial lacerations (repaired at OSH) Hgb 10.9 & Hct 34.2 Mildly displaced C6 spinous process fracture BUN 31, Cr 1.2 Preexisting severe C5/C6 stenosis H/o HTN, HLD, DM Ligamentous cervical injury with central cord syndrome Medications: Amlodipine, Atorvastatin, HCTZ, Naproxen, Pioglitazone Diffuse osteopenia
THE DIFFERENTIAL 11.5 CM MULTILOCULAR PRESACRAL CYSTIC LESION Developmental cysts: Cystic Lymphangioma Epidermoid Dermoid Abscess Neurenteric Tailgut duplication Sacral Chordoma Cystic sacrococcygeal teratoma Anterior sacral meningocele Extraperitoneal adenomucinosis Anal gland cyst
TAILGUT DUPLICATION CYST Retrorectal cystic hamartoma Develop from remnants of the embryonic hindgut Affects females, usually 30-60 y.o. but can occur at any age Often found incidentally, but ~50% of patients develop compressive symptoms Located in retrorectal space almost always Complications: Infection, inflammation, malignant transformation Treatment: Surgical Excision, even if ASx
HOSPITAL COURSE Plastics: no indication for operative repair, supportive care to lacerations Admitted to STBICU Neurosurgery, Ophthalmology, and Plastic Surgery consulted Ophtho recs: fracture limited to orbit, no need for acute intervention, supportive care and f/u PRN NSGY recs: no acute intervention needed Tail Gut Cyst: F/u PCP for eventual surgical removal C-collar x6 weeks f/u flexion, extension films Discharged HD3 to SNF
REFERENCES Weerakkody, Yuranga. "Tailgut Duplication Cyst." Radiopaedia, 01 Jan. 2017. Web. 31 May 2017. Abdelbaki S, Vahora N, Kaur H, et al. "Tailgut Cysts; Shedding Light on an Increasingly Identified Entity and Selected Case Review." University of Texas MD Anderson Cancer Center. Web. 31 May 2017
