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Lump in the Back
Question :
Nabamita Chaudhury, Pallab Basu, Jadab Kumar Jana, Nabendu Choudhuri

Department of Medicine, KPC Medical College, Kolkata` Department of Biochemistry, Sagar Dutta Medical College and Hospital, Kolkata` Department of Pediatrics, Malda Medical College, West Bengal, Department of Pediatrics, KPC Medical College, Kolkata.

Address for Correspondence: Dr Pallab Basu, Akriti, 13, Dr Nilmoni Sarkar Street, Kolkata – 90, E-mail: dr.pallab_basu@rediffmail.com

A neonate presented with a lump in the lower back with ulceration over that. What is the diagnosis_?
 
Answer :
Answer: Myelomeningocele with ulceration. Myelomeningocele and other associated malformations of the spinal cord arise from restricted failure of posterior neuropore which usually closes with in 26 weeks of gestation. Myelomeningocele is characterized by herniation of the meninges and spinal cord at the site of the lesion. These lesions are most common in lumber or lumbosacral region. It is very difficult to diagnosis in intra uterine life. Ultrasonography may help but better diagnostic tool is MRI. Alpha feto protein {AFP} is increased in amniotic fluid as well as maternal serum because of leakage of AFP from meningomyelocele. {1} It is not pathognomic as there are other conditions where AFP is raised like esophageal and duodenal atresia, annular pancreas, omphalocele, congenital nephrosis, polycystic kidneys, renal agenesis or fetal demise. Maternal AFP is raised in multiple pregnancies. {2} The optimal time of determination of maternal serum AFP is 16-18 weeks of gestation and in amniotic fluid at 14-16 weeks of gestation. Treatment consists of aggressive surgery for better care.

References:
1. Cuckle HS. Screening for neural tube defects. In Bock G, Marsh J {eds}. Neural Tube Defects. Ciba Foundation Symposium 181. Chicester John Wiley andSons, 1994: 253-267.
2. Brock DJ. Mechanisms by which amniotic –fluid alpha-feto protein may be increased in fetal abnormalities. Lancet 1976` 2:345.

E-published: April 2012 Vol 9 Issue 4 Art # 22

DOI No. : 10.7199/ped.oncall.2012.22