Case#17

History:  Mother of an 8 year old girl stating "she was born with a hemangioma at the base of her spine; it is only on the surface and doesn't effect her nervous system. The docs did the "wait and see" and after 8 years, the redness is all but gone. The "swell" seems to be getting larger. Is this a secondary abnormality (fibrofatty tissue) or something else, like a tumor? No one seems to know anything here about these vascular birthmarks."

Imaging Studies:

• MRI is suggested for further investigation of the spine. Reportedly, MRI (not shown here) showed lipomeningocele. 

Discussion: 

• Association with spinal abnormalities in hemangiomas overlying the lumbosacral spine is well known. The most common malformation in this setting is a tethered cord, often accompanied by an occult lipomeningocele. Rarely, genitourinary abnormalities (imperforate anus, abnormal external genitalis, kidney abnormalities) may be seen. 
• In this patient, at the age of 8 years, it is quite unusual to see any enlargement or swelling in the area. MRI is indicated to assess the spinal structures. Other imaging studies including CT and US, not appropriate at this age.