currarino syndrome ( cs ) is a hereditary pathology that is characterized by a triad of malformations : sacrococcygeal bone defect , presacral mass , and anorectal malformation .
radiologic imaging modalities such as ultrasonography ( us ) , computed tomography ( ct ) , and magnetic resonance imaging ( mri ) play a vital part in diagnosis and follow - up of this pathology . in this report , we aim to present the magnetic resonance imaging ( mri ) findings of a case with complete cs recognized in adulthood .
a 20-year - old male patient who underwent anal atresia operation in childhood was referred to our department for evaluation of anal sphincter status with transrectal us .
calibration of one - third of the inferior rectum was observed to be very thin , while one - third of the superior and middle segments of the rectum was seen to be dilated .
the left half of s2 and s3 vertebrae , more distal sacral vertebrae , and coccyx were not seen .
we also detected anterior meningocele related to spinal canal that originated from the neural foramen of s2 and s3 vertebrae .
the lesion was isointense with cerebrospinal fluid in all of the sequences and its size was 4.5  3.5 cm .
20-year - old man with anal atresia operation history in childhood diagnosed with currarino syndrome .
( a ) t2-weighted sagittal magnetic resonance image shows calibre of one - third of inferior rectum is very thin ( thick white arrows ) , while superior and middle segments of the rectum are dilated ( arrowheads ) . also , the images demonstrate anterior meningocele ( asterisk ) at the posterior of the rectum related to spinal canal that originated from the neural foramen of s2 and s3 vertebrae .
( b ) fat - saturated t2-weighted axial magnetic resonance image shows partial cleft at l5 vertebra corpus ( thin white arrow ) and dilated rectum in front of it . on ( c )
t1-weighted and ( d ) fat - saturated t2-weighted axial magnetic resonance images , left half of the sacrum is not seen . in this part , spinal canal relationship of anterior meningocele ( asterisk ) and its indentation to the adjacent rectum is also observed .
( e ) t2-weighted coronal magnetic resonance images demonstrate the contiguity of the sacral defect and anterior meningocele ( asterisk ) more clearly ( r = rectum , b = bladder ) .
currarino syndrome is a rare inherited disorder that is characterized by sacrococcygeal bone defect , presacral mass , and anorectal malformation .
the complete form of this syndrome shows all three abnormalities and is rarer than the incomplete form which includes one or two of the disease components mentioned above .
although the patients with this syndrome may present with complex conditions like recurrent urinary system infections or meningitis , chronic constipation is the most common finding .
some of the cases are asymptomatic and can be diagnosed during adulthood only on x - rays and us examinations that are performed for different reasons .
in addition to rectal digital examination , x - rays , us , ct , and mri are very helpful in the diagnosis of the syndrome .
sacrococcygeal bone defect is a prerequisite for the diagnosis of cs and its spectrum changes from mild lateralization of the coccyx to multilevel hypoplasia of the sacral segments (  scimitar sacrum  ) . in our case
, there was partial cleft at l5 vertebra corpus and s1 vertebra was partially deformed . also ,
the left half of s2 and s3 vertebrae , more distal sacral vertebrae , and coccyx were absent .
rectal and/or anal stenosis which may be fistulized to ascending spinal canal is the most common anorectal malformation which is seen in cs .
anal atresia or ectopy , imperforated anus , rectal duplication , and rectourethral , rectovaginal , and rectovesical fistulas may be also associated with the syndrome . in our patient ,
there was heterogeneity of the cutaneous and subcutaneous soft tissue around the anus secondary to earlier anal atresia operation .
enteric cyst , lipoma , hamartoma , dermoid and epidermoid cysts may be seen as well .
us , ct , and mri are frequently used for diagnosing the mass lesion and determining its nature .
mri is an invaluable technique to recognize accompanying additional pathologies like tethered cord , syringomyelia , and intradural lipoma . in our patient
, we detected a 4.5  3.5 cm size anterior meningocele related to the spinal canal .
cloacal malformation with anal atresia , double vagina , rectovesical fistula , urogenital sinus , neurogenic bladder , vesicoureteral reflux , and multicystic kidney are other related pathologies of cs .
mri is a very useful imaging modality to diagnose cs and accurately detect all the three components .
besides , it can show the different aspects of other cloacal malformations including the uterus , vagina , maldeveloped puborectalis , and external anal sphincter .
although these anomalies are not surgically correctable , early detection almost always provides better prognosis and helps in patient management .
another major advantage of mri over other imaging modalities is the ability to detect associated anomalies of anorectal malformations , especially of the spinal cord , spine , and urogenital system .
kassir et al . , also reported that mri is a specific and sensitive non - invasive diagnostic tool in patients with anorectal malformations .
mri provides excellent information about the postoperative anatomy of anorectal malformations . due to its superior soft tissue characterization , multiplanar imaging ability , and lack of ionizing radiation exposure
these unique features make mri a very appropriate modality in follow - up of patients treated for anorectal abnormalities .
the treatment strategy changes based on the type of pathology . the management of the anorectal anomaly and presacral mass may be performed with single - stage surgical procedure .
if the mass is a meningocele , a staged operation must be preferred due to the risk of meningitis .
cs should be obviously considered in patients with sacrococcygeal bone defect , presacral mass , and anorectal malformation .
mri may be used safely in diagnosis of the syndrome , in detecting the accompanying mass lesions and other pathologies , and in the follow - up investigations after treatment in patients with cs .
 currarino syndrome is a hereditary pathology that is characterized by sacrococcygeal bone defect , presacral mass , and anorectal malformation . 
 sacrococcygeal bone defect is almost always a part of the syndrome . 
 the complete form of this entity displays all three abnormalities and is very uncommon . in this report , 
 we present the magnetic resonance imaging findings of a case with complete form of currarino syndrome recognized in adulthood . 