Jawad Susan, Ejindu Vivian, Johnson Declan, Shah Mohammad Ali, Abbasi Maaz Ali, Ojha Kamal, Papadakos Nikolaos
Department of Clinical Radiology, St. George's Hospital NHS Foundation Trust, London, UK.
Department of Neuroradiology, St. George's Hospital NHS Foundation Trust, London, UK.
BJR Case Rep. 2016 Sep 3;3(1):20160037. doi: 10.1259/bjrcr.20160037. eCollection 2017.
Anterior sacral meningoceles (ASMs) have a recognized association with a number of connective tissue disorders, including Marfan's syndrome, neurofibromatosis Type 1 and Ehlers-Danlos syndrome. We present the case of a patient with Marfan's syndrome and ASMs who was referred to gynaecology owing to dysmenorrhoea and left-sided pelvic pain radiating to the left leg. A transvaginal ultrasound scan (TVUS) detected a left pelvic cystic tubular structure, attributed to a hydrosalpinx, which, in retrospect, likely corresponded to the ASM. The patient went on to have TVUS-guided drainage of this cystic structure, resulting in an ASM abscess. It is difficult to distinguish ASM from the vastly more common hydrosalpinx using TVUS alone, and in patients with an atypical appearing posteriorly positioned cystic pelvic lesion or in the presence of underlying conditions known to be associated with ASMs, MRI should be considered before any interventional procedure to drain the suspected hydrosalpinx transvaginally. The patient was successfully treated using a minimally invasive CT-guided posterior trans-sacral drainage technique.
骶前脑脊膜膨出（ASMs）与多种结缔组织疾病相关，包括马凡综合征、1型神经纤维瘤病和埃勒斯-当洛综合征。我们报告一例马凡综合征合并ASMs的患者，因痛经和放射至左腿的左侧盆腔疼痛转诊至妇科。经阴道超声扫描（TVUS）发现左侧盆腔有一囊性管状结构，归因于输卵管积水，回顾来看，可能与ASMs相符。该患者随后接受了TVUS引导下对该囊性结构的引流，导致ASM脓肿。仅使用TVUS很难将ASM与更为常见的输卵管积水区分开来，对于盆腔后部出现非典型囊性病变的患者或存在已知与ASMs相关的基础疾病的患者，在经阴道对疑似输卵管积水进行任何介入引流操作之前，应考虑进行MRI检查。该患者采用微创CT引导下经骶后引流技术成功治愈。
