| Popis: |
A 39-week-male infant is born to a 35-year-old, gravida 4 now para 4 mother whose pregnancy is uncomplicated. He is born by spontaneous vaginal delivery at an outside hospital, and no resuscitation is required. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. Birth weight, occipital circumference, and length are all in the 90th percentile. On initial examination, there is a 4 × 5-cm midline mass at the level of the lumbosacral spine (Figure 1). The mass is well circumscribed, has a smooth surface except for the protruding ‘tail,” is covered by normal skin, is not pulsatile, and slips under the palpating finger. Protruding from the mass is a 1-cm-long skin tag. He moves all 4 extremities spontaneously. Tone in the legs is normal, and deep tendon reflexes in the lower extremities are 2+. He withdraws all extremities to pain. The findings of the rest of the neurologic examination, including cranial nerves and motor examination, are normal. His anus is patent with normal sphincter tone and a normal anal reflex (anal wink is present). He has a sexual maturity rating of 1 for male genitalia, and both testes are palpable. The remainder of the examination findings are unremarkable. He is transferred to a neonatal intensive care unit for further evaluation and management. He has voided and stooled before transport. An additional bedside test gives a clue to the diagnosis. Figure 1. Lumbosacral mass with appendage. ### Diagnosis The differential diagnosis of a midline lumbosacral mass includes sacrococcygeal teratoma with or without the Currarino triad, hemangioma, spinal hamartoma, congenital ependymoma, caudal regression syndrome, and occult spinal dysraphism (OSD). Our patient lacks obvious anorectal … |
