A Newborn Infant With a Lumbar Lesion and Dermal Defect

Dan Beardmore, DO; Saba Fatima, MD


May 15, 2018

Physical Examination and Workup

The remainder of the infant's examination is normal, including normal results on full neurologic examination. The parents are asked to bring the baby to a nearby children's hospital for a first-step ultrasound of the lesion.

The spinal canal ultrasonography performed at 8 days of life to evaluate for underlying or associated defects shows that the conus medullaris terminates at spinal segment L3, which is low-lying for a full-term infant but nonspecific. No evidence suggests a tethered cord. No subdermal abnormality is seen at the area of the lumbosacral lesion. Given these results, the parents were told that a neurosurgery referral appointment is less urgent than was previously discussed.

At follow-up with the pediatrician at 28 days of life, the infant continues to do well at home according to his parents. The only concern is a change in appearance of the lesion. The parents report that it has enlarged, darkened, and become more raised; however, it stopped changing altogether about 1 week ago (Figure 2).

Figure 2.

The entirety of the lesion is now approximately 6 cm × 3 cm and darker red, with a well-demarcated but irregular border. It is all now slightly raised and still nonblanching, with no areas of breakdown nor ulceration. The centralmost 2 cm × 3 cm area surrounding the dermal pit remains the most raised and is also the darkest shade of red.


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