PMC4899866_01
45-year-old woman with Marfan syndrome. Axial, contrast-enhanced image of the pelvis shows a large presacral cyst. Continguity with the sacrum, widening of the neural foramen, dural ectasia involving other nerve root sleeves (not shown), and clinical history enable the appropriate diagnosis of left S1 anterior sacral meningocele.
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At surgery, the cystic mass was discovered to actually represent an anterior sacral meningocele (Fig. 1), which was inadvertently punctured.
Same patient (45-year-old woman with Marfan syndrome) as in Fig. 1, five years after original CT. A: Axial IV contrast-enhanced image of the pelvis shows decrease in size of the presacral cyst with a new air-fluid level. B: Sagittal oblique MPR from IV contrast-enhanced image of the pelvis demonstrates secondary findings of fistula formation, including wall thickening and pericolonic inflammation of the sigmoid colon, absence of a fat plane between the sigmoid and the meningocele, and air within the meningocele.
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CT. CT of the abdomen/pelvis revealed the cause: sigmoid diverticulitis complicated by a fistulous tract to the sacral meningocele (Fig. 2).