A Sacral Mass in a Newborn: A Variant of Type II Diastematomyelia with Triple Splitting of the Cord

Ultrasonographic (US) evaluation of spinal anomalies is limited. MRI is increasingly being used in the diagnosis of spinal anomalies. MRI has been able to show clearly the detailed anatomy of this rare case of type II diastematomyelia with triple splitting of the cord. 1. Introduction Diastematomyelia, also known as split cord malformation (SCM), is a congenital spinal anomaly in which there is longitudinal splitting of the spinal cord. Females are affected much more commonly than males [1]. This condition occurs in the presence of an osseous (bone), cartilaginous, or fibrous septum in the central portion of the spinal canal which then produces a complete or incomplete sagittal division of the spinal cord into two hemi cords. When the split does not reunite distal to the spur, the condition is referred to as a diplomyelia or true duplication of the spinal cord. MRI is a safe and important tool for confirming the presence of spinal cord abnormalities, when a suspected spinal deformity is detected on US. MRI clearly demonstrated the lesion in this rare case after suspecting spinal abnormality (diastematomyelia) by US [2–10]. 2. Case Report 37-week we have term female delivered by LSCS. APGAR score was 9 and 10 at 1 and 5？min, weight was 1890 grams, length was 43？cm, and head circumference was 31？cm. At birth baby needed no active resuscitation. Ten mins after delivery she developed an episode of apnea which required bagging for 2？min. Baby was shifted to NICU, connected to nasal CPAP for few hours, and then settled. On examination she had a soft midline sacral swelling in the sacral area (Figures 6(a) and 6(b)) with rocker bottom feet (Figure 6(b)), low set ear, and a small PFO with left to right shift diagnosed by echocardiography. Chest X-ray showed abnormal ribs. ultrasonography of the brain and abdomen was normal. Ultrasound spine showed double-spinal cord (diastematomyelia). MRI was done on day 4 of the neonatal period and showed the rare deformity of triple splitting of the cord. Plain skeletal survey (baby gram), US brain, abdomen, spine, and hips, and MRI brain and spines were done for the newborn and demonstrated the followings: (1) partial asymmetrical sacral agenesis with slightly deformed left sacroiliac articulation and partial hypoplasia of the left iliac bone corresponding to the hypoplastic articulating sacral segments. Only the 1st sacral segment is well developed, while the 2nd, 3rd, and 4th segments were poorly developed specially the left aspect, and the 5th segment was absent, this was associated with partially opened posterior sacral