Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

RADIOLOGICAL QUIZ
Year
: 1999  |  Volume : 9  |  Issue : 3  |  Page : 147--148

Radiological quiz: Chest


Kavita Saggar, Rekha Goyal, Kushaljit Singh Sodhi 
 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, India

Correspondence Address:
Kavita Saggar
C/o Dental Care and Cure Centre, 132/B, Ranji Jhansi Road, Ludhiana
India




How to cite this article:
Saggar K, Goyal R, Sodhi K. Radiological quiz: Chest.Indian J Radiol Imaging 1999;9:147-148


How to cite this URL:
Saggar K, Goyal R, Sodhi K. Radiological quiz: Chest. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Jul 2 ];9:147-148
Available from: http://www.ijri.org/text.asp?1999/9/3/147/28323


Full Text

A forty-years-old man presented with complaints of fever and generalized bodyache for one month. He had no history of cough, hemoptysis or weight loss. There was a history of tuberculosis ten years ago for which he had been treated.

Chest radiographs [Figure 1],[Figure 2] were obtained followed by a CT Scan [Figure 3].

 View Answer

 RADIOLOGICAL DIAGNOSIS



Intrathoracic Meningocele:

The chest radiographs show a well-defined, posterior mediastinal mass. The CT shows a well-defined, non-enhancing, cystic mass in the right para-vertebral gutter with widening of the intervertebral foramen.

The differential diagnosis of cystic posterior mediastinal masses includes bronchogenic cyst, meningocele, cystic neuromas, pseudocyst of the pancreas and esophageal diverticulum. In view of the complete lack of enhancement and the widening of the intervertebral foramen, the diagnosis of a lateral thoracic meningocele was considered.

During surgery, a cystic, translucent mass was seen in the paravertebral region, outside the pleura. A stalk drained into the adjacent intervertebral foramen. The cyst contained clear cerebrospinal fluid. On histopathology, the diagnosis of meningocele was confirmed.

Intrathoracic meningoceles are an uncommon anomaly of the meninges manifested by lateral extrusion of the dura and arachnoid through an enlarged intervertebral foramen into the extrapleural thoracic gutter [1]. Men and women are equally affected, most commonly between 30-50 years of age [2]. Eight-five percent of paravertebral meningoceles are seen in patients with neurofibromatosis [3]. Moreover, thoracic paraspinal masses are more likely to be meningoceles than neurofibromas in these patients [1],[4],[5]. Seventy percent of lateral thoracic meningoceles are right-sided [1]. They frequently occupy a single neural foramen in the upper thoracic region between T3-T7 and are usually found between T5 and T6 [6]. Their sizes vary and these lesions can be very small or they can occupy nearly the entire hemithorax. In neonates, large meningoceles may cause significant respiratory obstruction [2].

Patients with lateral thoracic meningoceles may present with cough or dyspnea, but more commonly they remain asymptomatic. Some patients may complain of pain, sensory deficits, weakness, hyperreflexia and rarely, severe paresis [7].

Chest radiographs of patients with lateral thoracic meningoceles usually exhibit a short, focal scoliosis of the upper thoracic spine, convex towards the lesion. However, kyphosis may be more prominent than scoliosis [8]. The neural foramina are enlarged, with thinning of the adjacent pedicles, local increase in interpedicular distance, thinned lamina and scalloping of the dorsal surfaces of the adjacent vertebral bodies [6]. The adjacent intercostal space may be widened, with erosion of contiguous rib margins. Fused or hypoplastic ribs and vertebrae may coexist [2],[3]. Adjacent ventral roots may be hypoplastic or absent on the ipsilateral or contralateral side of the meningocele [2].

References

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2Chandler A, Herzberger EE. Lateral intrathoracic meningocele: case report with preoperative diagnosis. AJR 1963; 90: 1216-1219.
3Erkulvrawatr S, EI Gammal T, Hawking J et al . Intrathoracic meningoceles and neurofibromatosis. Arch Neurol 1979; 36: 557-559.
4Kent EM, Blades B, Valle AR, Graham EA. Intrathoracic neurogenic tumors. J Thorac Surg 1944; 13: 116-161.
5Blades B. Mediastinal tumors: report of cases treated at Army thoracic centers in the United States. Ann Surg 1945; 123: 749-765.
6Naidich TP, McLone DG, Harwood-Nash CD. Arachnoid cycts, paravertebral meningoceles and perineural cysts. In: Newton TH. Potts DG, eds. Computed tomography of the spine and spinal cord. San Anselmo, CA: Clavadel Press, 1983: 388-390.
7Miles J, Pennybacker J, Sheldon P. Intrathoracic meningocele: its development and association with neurofibromatosis. J Neurol Neurosurg Psychiatr 1969; 32: 99-110.
8Healy JF, Wells MV, Carlstrom T, Rosenkrantz H. Lateral thoracic meningocoele demonstrated by computerized tomography. Comput Tomogr 1980; 4: 159-163.