Intrathoracic Meninqocele

Abstract

Because of the rarity of intrathoracic meningocele, only through individual case reports will sufficient information be accumulated to suggest the diagnosis and permit an intelligent handling of the patient. We therefore feel justified in reporting a case and evaluating the findings in those previously described. Review of Literature Pohl (1) is credited with publishing, in 1933, the first case of intrathoracic meningocele. His patient was a 47-year-old female with associated Recklinghausen's disease. The meningocele arose from the intervertebral foramen at the fourth dorsal vertebra and projected laterally at the apex of a were marked kyphoscoliosis. The posterior ribs eroded. Roentgen findings were indicative of widening of the intervertebral foramen. This patient died postoperatively from empyema. In 1938 Schuller and Uiberall (2) reported their findings in a 56-year-old man with Recklinghausen's disease and a rightsided thoracic tumor. On myelography they were able to observe retention of lipiodol in the mediastinal mass and a dimple of the medium at the 6th dorsal vertebra. Thus a correct diagnosis was suggested before surgery and subsequent death. Here again kyphoscoliosis of the spine was described, with the apex of the angulation in the region of the tumor. The widening of the intervertebral foramen was again noted. A third report appeared in 1940, when Ameuille, Wilmoth, and Kudelski (3) added a case occurring in a 48-year-old female. The patient died as a result of empyema following an attempt to remove a meningocele (thought to be a hydatid cyst) on the right side between the eighth and ninth thoracic vertebrae. No evidence of neurofibromatosis is mentioned in this case. In 1946, Campos (4) reported 2 probable cases of intrathoracic meningocele. One of the patients was a 7-year-old Brazilian boy with dorsal scoliosis and a right-sided mass demonstrable on x-ray examination. In addition, there were multiple anomalies of the first six dorsal vertebrae, including bifid vertebrae and synostosis of the fourth and fifth dorsal. The second patient was a Japanese male, fifty-four years old, with neurofibromatosis. A sixth case, in a woman of fifty-one, with Recklinghausen's disease was reported in 1948 by Welch, Ettinger, and Hecht (5). The meningocele was on the right side. In June 1949 Byron et at. (6) added 3 cases to the literature, 2 of which occurred in conjunction with neurofibromatosis. In the discussion of this paper Mendelsohn, Head, and Giaglia each presented a case. In 2 there was an associated neurofibromatosis. In the cases presented by Head and Giaglia the meningocele arose on the left side. The thirteenth case was reported in September of 1949 by Cross, Reavis, and Saunders (7). In a patient with Recklinghausen's disease they were able to demonstrate a thoracic meningocele by air and pantopaque myelography.