A seven year old boy was brought by his mother with a midline swelling over the lower back since birth. The boy has been unable to walk and has urinary incontinence,
The clinical photograph shows a 'meningocele"
Ultrasonography of the swelling and the lower spine shows divergence of the posterior elements of the S2 vertebra that does not have a spinous process. A well-defined, anechoic, cystic lesion with posterior acoustic enhancement & communication with the spinal canal is seen deep to the dermis. The lesion measures 3 x 4.2 x 4.2 cm. There are thick echogenic septae in the lesion exiting from the communication with the spinal canal. These are attached to the cyst wall - likely neural elements. The overlying dermis is intact.