Meningocele or Meningomyelocele

DEFINITION: Meningocele and meningomyelocele are rare anomalies that consist of herniation of the
leptomeninges through an intervertebral foramen.
IMAGING

DIAGNOSTIC PEARLS

Radiography

n C
 ontinuity

Findings

n W
 ell-demarcated mass, with round or elliptical, smooth

margins.

Utility

n A
 bnormality

n R
 adiographic

tumor

often first detected on the radiograph

findings similar to those of neurogenic

between the cerebrospinal fluid in the

thecal sac and the meningocele
n E
 nlargement of the intervertebral foramen
n M
 eningocele: contains cerebrospinal fluid only
n M
 eningomyelocele: contains neural tissue
n M
 ajority of patients have neurofibromatosis

CT

Findings

n C
 ontinuity

between cerebrospinal fluid in thecal sac

and meningocele
n K
 yphoscoliosis and meningocele usually at apex of
curvature on its convex side
n E
 nlargement of intervertebral foramen
n A
 ssociated vertebral and rib anomalies common
Utility
n C
 T

usually diagnostic

MRI

Findings

between cerebrospinal fluid in thecal sac

and meningocele

PATHOLOGY
n M
 eningocele

and meningomyelocele are rare anomalies that consist of herniation of leptomeninges through
an intervertebral foramen.
n M
 eningocele
contains cerebrospinal fluid only,
whereas meningomyelocele also contains neural tissue.
n A
 bnormalities occur slightly more often on right side
than on the left and are situated anywhere between
thoracic inlet and diaphragm.

n C
 ontinuity

Utility

n D
 iagnostic

method of choice; provides best visualization of spinal cord, meninges, and adjacent structures

CLINICAL PRESENTATION
n P
 ain

and neurologic symptoms

DIFFERENTIAL DIAGNOSIS
n N
 erve

sheath tumors (neurilemoma, neurofibroma, and

malignant nerve sheath tumor)
n S
 ympathetic ganglia tumors (ganglioneuromas, ganglioneuroblastomas, and neuroblastomas)

INCIDENCE/PREVALENCE AND
EPIDEMIOLOGY
n A
 pproximately

75% of patients present between ages

of 30-60 years.
n S
 ixty percent to 80% of patients have neurofibromatosis.

Suggested Readings
Cabooter M, Bogaerts Y, Javaheri S, et al: Intrathoracic meningnocele.
Eur J Respir Dis 63:347-350, 1982.
Glazer HS, Siegel MJ, Sagel SS: Low-attenuation mediastinal masses
on CT. AJR Am J Roentgenol 152:1173-1177, 1989.
Rainov NG, Heidecke V, Burkert W: Thoracic and lumbar meningocele in neurofibromatosis type 1: Report of two cases and review
of the literature. Neurosurg Rev 18:127-134, 1995.
Strollo DC, Rosado-de-Christenson ML, Jett JR: Primary mediastinal
tumors: II. Tumors of the middle and posterior mediastinum.
Chest 112:1344-1357, 1997.

WHAT THE REFERRING PHYSICIAN NEEDS TO KNOW

n Association

n Majority

688

with vertebral and rib anomalies is common and should suggest the diagnosis.
of patients have neurofibromatosis.
n MRI is the diagnostic method of choice.

PARAVERTEBRAL MASSES

Meningocele or Meningomyelocele 689

Figure 1. Meningocele in a 29-year-old man. Posteroanterior

chest radiograph shows paraspinal mass (arrows) at level of T10.

Figure 2. Meningocele in a 29-year-old man. Lateral chest

radiograph shows paraspinal mass (arrows) at level of T10.

Figure 3. Meningocele in a 29-year-old man. CT scan demonstrates characteristic fluid attenuation of meningocele, which communicates
with the thecal sac (arrows).