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Evaluation of Dorsal Midline Discolorations with Physical Examination and Ultrasound
Liat Ben-Sira1, Penina Ponger2, Shlomi Constantini3
1Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Israel.
Insights
Dorsal midline skin discolorations in infants are often benign, with vascular types rarely indicating serious spinal cord issues. Ultrasound screening remains recommended for these stigmata.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Dermatology
Background:
- Dorsal midline skin stigmata in infants can be associated with spinal cord tethering.
- The clinical significance of various stigmata, particularly vascular lesions, requires further assessment.
Purpose of the Study:
- To evaluate the association between dorsal midline skin discolorations and spinal cord tethering.
- To determine the utility of ultrasound screening for these stigmata, with a focus on vascular lesions.
Main Methods:
- Prospective observational study of infants under 6 months with suspicious dorsal midline skin stigmata.
- Evaluation included physical examination, ultrasound scan, and magnetic resonance imaging in a subset of cases.
- Specific focus on the association between red-shaded discolorations and imaging findings.
Main Results:
- Out of 100 infants with vascular-type discolorations (isolated or with low-risk stigmata), none exhibited clinically significant findings requiring surgery.
- Small, red-shaded discolorations showed a low association with pathological conditions.
Conclusions:
- Midline lumbar discolorations are generally benign, contrary to previous assumptions.
- Despite low surgical implications, routine ultrasound scanning for these stigmata is advised.
Objective:
To assess the association between dorsal midline skin discolorations, tethering of the spinal cord, and the role of ultrasound screening of these stigmata, focusing specifically on vascular lesions.
Study Design:
We conducted a prospective observational study of infants <6 months of age with suspicious dorsal midline skin stigmata. All were evaluated by physical examination and ultrasound scan. A subset also had a magnetic resonance imaging examination. We examined the association between small, red-shaded discolorations and their respective imaging findings.
Results:
Among 100 cases with discolorations of vascular types, either isolated or combined with low-risk simple dimples or deviated gluteal folds, none had clinically significant pathologic findings requiring surgical intervention.
Conclusions:
Midline lumbar discolorations are more benign than previously thought. Despite the very low association of this group of stigmata with surgical implications, we still recommend the routine use of ultrasound scanning.
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