Multilocular disseminated Tarlov cysts: Importance of imaging and management options
Our patient is a 62-year-old Indian male who presented to orthopedics department with a vague history of low back ache, gradually increasing in intensity with no other associated symptoms. Bowel and bladder habits were normal. There is no history of trauma. Patient was otherwise healthy and well nourished. On local examination, no pelvic bone tenderness was elicited. No motor deficits were noted on neurological examination. A whole body bone scan was advised to rule out any skeletal pathology. 99mTc methylene diphosphonate (Technetium MDP) three-phase whole body bone scan was performed with 555 megabecqueral of 99mTc MDP intravenous injection. Initial dynamic images of pelvis followed by 3 hrs delayed high-resolution anterior and posterior whole body images were acquired using a dual head variable angle E Cam Gamma camera. An abnormal focal site of MDP uptake was noted in the sacrum S2 level indicating sacral osteoblastic activity of uncertain etiology. On further evaluation with contrast-enhanced MRI of lumbosacral spine, a cystic lesion was reported in right neural foramen of S2 of 25 × 15 × 25 mm size whose intensity was the same as cerebrospinal fluid (CSF) suggesting TC. No contrast-enhanced findings were observed. Similar lesions were also noted in S1, right T3-T4, right T7-T8, and left T6-T7 neural foramina but with no corresponding hot spots in MDP bone scan. Initial and a 6-h delayed CT myelography showed no free communication between cyst and subarachnoid space. However, there was surrounding sacral bony erosion around this cyst [Figures –].