Pelvic Pain and Genital Prolapse from a Giant Tarlov Cyst in a Patient with Marfan Syndrome

1University of Illinois at Urbana‐Champaign, Urbana, IL
2University of Illinois at Urbana‐Champaign, Champaign, IL

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 670

Case Presentation:

This 67‐year‐old Caucasian MS female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a non‐tender, cyst‐like mass fixed in the midline. Pelvis ultrasound demonstrated a 6.7x 5.4x 6.6 cm solid, fluid‐filled cystic mass with internal septation near the right ovary. Computerized tomography (CT) of abdomen/ pelvis revealed a large (6.7 x 6.4 x 6.6 cm) Tarlov cyst originating from the right S2 nerve root sleeve/ sacral foramen with intrapelvic extension. Magnetic resonance imaging (MRI) showed cystic dilatation of multiple sacral nerve root sleeves consistent with Tarlov cysts. The largest was noted on the right at S2, extending anteriorly into the pelvis and exerting extrinsic mass effect on adjacent loops of bowel and other pelvic contents. She underwent S1‐S2 and S2‐S3 laminectomy with obliteration of the Tarlov cyst using aneurysm clips. Post‐operatively, her pelvic pain and bowel symptoms resolved and the bladder symptoms improved. The three‐month‐follow‐up CT of abdomen/pelvis demonstrated resolution of the cyst.

Discussion:

Marfan syndrome (MS), an autosomal dominant heritance with Fribrillin‐1 (FBN‐1) gene mutations, represents one of the most common inherited connective tissue disorders. It is well known for its manifestations in cardiovascular, skeletal, ocular, respiratory, and meningeal systems. MS patients used to succumb early in life to cardiovascular complications, such as acute aortic dissection. With the current rapid advance in medical and surgical care, MS patients now start to enjoy near‐normal longevities. Consequently, rare late‐life complications from MS patients are emerging and represent clinical challenges for their diagnoses and treatments.

Conclusions:

We report a rare case of pelvic pain and genital prolapse from a giant Tarlov cyst in a 67‐year‐old MS patient. Our case illustrates that clinicians caring for elderly MS patients need to increasingly recognize such unusual late‐life complications and exercise much heightened clinical astuteness.

To cite this abstract:

Wang B, Chandra K, Olivero D, Wang H. Pelvic Pain and Genital Prolapse from a Giant Tarlov Cyst in a Patient with Marfan Syndrome. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 670. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/pelvic-pain-and-genital-prolapse-from-a-giant-tarlov-cyst-in-a-patient-with-marfan-syndrome/. Accessed December 7, 2019.

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