Evaluate cyst at the level of the nasopharynx and oropharynx. There is a non-enhancing T2 hyperintense lesion that measures up to approximately 20 mm in the midline of the posterior oropharynx with associated obliteration of the airway. The lesion communicates with the spinal canal via a narrow channel through the dysmorphic basiclivus, which may represent a form of canalis basilaris medianus. In addition, the upper spinal cord, brainstem, and cerebellum are markedly dysmorphic. There are also extensive segmentation anomalies of the upper cervical spine with associated scoliosis. There is no evidence of solid mass lesion or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is fluid within the bilateral mastoid air cells and middle ears. A tracheostomy is in position.
1. A midline posterior pharyngeal cystic lesion measuring up to 20 mm that communicates with the intracranial compartment via a narrow defect in the clivus likely represents a developmental meningocele or neurenteric cyst, perhaps as a manifestation of split notochordal syndrome associated with the cervical spine segmentation anomalies and hindbrain malformation. A cervical spine CT may be useful for further delineation of the abnormal bony anatomy.2. Nonspecific fluid within the bilateral mastoid air cells and middle ears.Findings discussed with Dr. Baroody on 3/2/2015 at 2:30pm by Dr. Wu.