Diagnosis of intrathoracic meningocele.

Intrathoracic meningocele is looked upon by many as a rare tumor of the thoracic cavity. Its diagnosis is usually not made preoperatively. Among the twenty-odd certain cases reported in the literature there are no more than 4 diagnosed with certainty without thoracotomy (SchUller and Uiberall 1938, Head 1949, Cross and co-workers 1949, Cmyral 1952, and Scars, Clayton and Siebel 1953) ; to these is to be added the case now reported. Intrathoracic meningocele is very often accompanied by von Recklinghausen’s cutaneous neurofibromatosis and characteristic skeletal changes. If, in addition, radiographic examination reveals an intrathoracic tumor, there is every reason to suspect the presence of a meningocele. On the other hand, when there is reason for such suspicion, it is not too difficult to find out, by means of myelography or puncture, whether the cyst communicates with the subarachnoid space or not. The diagnostic difficulties are mainly due to the fact that intrathoracic meningocele is seldom encountered even in large hospitals and doctors consequently have little experience with it. In the past two years, two cases of intrathoracic meningocele have been treated at First Surgical University Clinic, Helsinki. In one of these cases, published previously by one of us (M.T. 1952), the diagnosis was not established until operation. In the other case, the diagnosis was confirmed preoperatively by air myelography. Since this case exhibited all the typical features of intrathoracic meningocele, the following report of it will be found justified.