An Uncommon Cause of Pediatric Limp: Thoracic

Intramedullary Spinal Cord Lipoma

Background information/purpose:

Radiological evaluation of pediatric limp is a commonly encountered scenario. Transient

synovitis, trauma, and septic hip are common causes of acute onset of limp in infants.
Rarely, spinal cord tumors can also cause gait instability. This should be considered in
the differential when the initial workup is negative.

This is the case of an eleven month old female child with a history of limp in which an
MRI of the spine demonstrated a thoracic, intramedullary spinal cord lipoma without
associated spinal dysraphism.

Approximately one third of spinal cord tumors in children are intramedullary neoplasms.
Less than one percent of these are intramedullary spinal cord lipomas. The two types of
intramedullary spinal cord lipomas are dysraphic and non-dysraphic, of which the non-
dysraphic form is much less common.

Educational goals/teaching points:

Spinal cord tumors must be considered in the differential for a child presenting with limp.

Intramedullary spinal cord lipoma is a benign lesion, which can present in early
childhood or with a delayed presentation in third or fourth decade of life. It can cause
symptoms due to mass effect and compressive myelopathy.

They are considered congenital in origin with “developmental error theory” being the
most frequently accepted hypothesis. This states that the tumor arises from misplaced
adipocytes within the spinal cord during neural tube development. The most common
location is in the cervicothoracic spinal cord.

Intramedullary spinal cord lipomas have diagnostic signal characteristics on MRI

imaging. Proper definition of these tumors is critical for surgical planning, as the lack of
a definite cleavage plane influences the surgical management.

Key anatomic or pathophysiologic issues, imaging findings or imaging technique:

The authors present a case of a child with limp whose imaging workup demonstrated a
thoracic intramedullary lipoma without associated spinal dysraphism. The tumor
demonstrated hyperintense signal on T1 weighted images with signal loss on fat
suppressed images. Adjacent spinal cord demonstrated increased T2 signal, consistent
with edema.

Surgical and pathological evaluation confirmed the diagnosis.

Conclusion:

Spinal cord tumors are a rare cause of pediatric limp. Spinal cord lipomas are rare,
benign, congenital tumors with characteristic appearance on MRI. Surgical management
depends on presence and severity of symptoms.