PMC4149775_01
(a and b) A three-phase whole body 99mtechnetium labeled methylene diphosphanate bone scan showing focal hot spot in sacrum (arrow) with no increased vascularity. There were no other abnormal hot spots in rest of skeletal survey
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F1
An abnormal focal site of MDP uptake was noted in the sacrum S2 level indicating sacral pathology from uncertain etiology [Figure 1].
(a and b) Lumbo-sacral contrast enhanced magnetic resonance imaging and Tarlov cyst methylene diphosphanate bone scan images showed a cystic lesion in right neural foramen lesion at S2 level, 25 mm x 15 mm x 25 mm in size with hot spot in bone scan, whose intensity was the same as cerebrospinal fluid. Similar lesions were also noted in S1, right T3-T4, right T7-T8 and left T6-T7 neural foramina but with no hot spots in methylene diphosphanate bone scan
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F2
On further evaluation with contrast enhanced MRI of the lumbosacral spine, cystic lesion was reported in right neural foramen of S2 of 25 mm x 15 mm x 25 mm size whose intensity was the same as cerebrospinal fluid (CSF) suggesting TC [Figure 2].
Myelo computerized tomography (CT) of pelvis. Initial and a 6-h delayed CT scans, revealed no free communication between the Tarlov cyst (TC) and subarachnoid space. However, surrounding sacral bony erosion around TC in S2 level produced the increased methylene diphosphanate uptake in the bone scan as a result of new bone formation
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F3
Initial and a 6-h delayed CT myelography showed no free communication between cyst and subarachnoid space [Figure 3].