Anterior Sacral Meningocele Masquerading as an Ovarian Cyst: A Rare Clinical Presentation Associated with Marfan Syndrome

Abstract

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions.

Keywords: Abdominal distension; Marfan syndrome; anterior sacral meningocele; ovarian cyst.

Figure 1.

Anterior sacral meningocele in a patient with Marfan syndrome. Coronal T2-weighted magnetic resonance (MR) image (A) shows very large, well-defined multiloculated cystic mass occupying nearly entire pelvis. Sagittal T2-weighted MR image (B), axial T1- (C) and T2-weighted (D) images demonstrate the connection between presacral and intrasacral cysts via two separate broad necks (arrows).