Presentation
Recurrent constipation and vague abdominal pain
Patient Data
A well-defined complex cystic lesion of mixed intensity is located in the retrorectal/presacral space in the supralevator location, showing fluid signal at the periphery and an abnormal bright center on T1-weighted images, while a low T2-weighted signal likely denotes hemorrhagic content. It also exhibits diffusion restriction and bright signal on T1 fat-saturation weighted images.
There is no significant post-contrast enhancement.
Mild compression of the surrounding structures is noted.
Closely related deformed/regressed coccygeal segments are noted.
Case Discussion
A non-complicated tailgut duplication cyst usually presents as a fluid-filled cyst located in the retrorectal-presacral space, with internal septation. When complicated by proteinaceous material or blood content, the signal changes, as observed in the current study: it becomes bright on T1-weighted images while remaining low on T2-weighted images. The diffusion restriction may correlate with the subacute stage of the blood content.
Differential diagnosis includes cystic sacrococcygeal teratoma, as well as other developmental cysts in the retrorectal region such as retrorectal epidermoid cyst, retrorectal dermoid cyst, and retrorectal neurenteric cysts.
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