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Answers on p 761.
A 45 year old man complained of pain in the lower back for one year. He presented with constipation and hesitation in passing urine for one month. The pain had been increasing in severity over the past three months. The patient had to take regular enemas for complete bowel evacuation. There was no history of weight loss, anorexia, or trauma. He had no weakness or radiation of pain to the lower limbs and had no symptoms of neurogenic claudication. The patient also noticed that he could not lie down straight on the lower back. On examination, there was diffuse swelling in midline over sacrum of size 4 × 4 cm with no local rise in temperature. He had sensory deficit in the perineal region. The knee and ankle jerks were normal with no motor weakness of the lower limbs. The haemogram and serum chemistry was within normal limits. Plain radiographs and magnetic resonance imaging (MRI) of the lumbosacral spine were performed (figs 1 and 2).
Describe the radiographic and MRI findings.
What is the most likely diagnosis?
What is its management?