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).
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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Cite this: Dan Beardmore, Saba Fatima. A Newborn Infant With a Lumbar Lesion and Dermal Defect - Medscape - May 15, 2018.