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E2438. Imaging Approach to Presacral Masses
Authors
  1. Dineshkumar Sontakke; Seth GS Medical College and KEM Hospital
  2. Shehbaz Ansari; Seth GS Medical College and KEM Hospital
  3. Ankur Chand; Tata Memorial Hospital
Background
The presacral region is affected by a myriad of lesions, ranging from a simple cyst to malignant neoplasms. The ever-increasing use of imaging modalities has led to more frequent detection of these masses. Certain imaging characteristic favours a benign cause over an aggressive variety. A simplified approach has been proposed in the presentation using such characteristics in mind. The role of imaging in such cases is predominantly to determine extent and distant metastasis as the diagnosis is predominantly histopathological.

Educational Goals / Teaching Points
1.Characterization of presacral mass 2. Differentiating between various types of presacral masses using a systematic approach 3. List the major categories of space-occupying masses in the presacral space with respect to their origin.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The presacral space is a clinically important space that is important for multiple disciplines. It lies at the junction of the axial skeleton, neural axis, and soft tissues of the pelvis. Anatomically it is bounded by the rectum anteriorly; the presacral fascia, sacrum, and coccyx posteriorly; and the levator ani inferiorly. The presacral space is separated from the supralevator space by presacral fascia. Superiorly the presacral space is bounded by the pelvic peritoneal reflection and laterally by the iliac vessels and ureters. Its contents include osteochondral tissue originating from the sacrum and coccyx, neural tissue arising from the cauda equina and branches of the sacral plexus, and mesenchymal tissue from adjacent organs. It also includes surrounding connective tissue and blood and lymphatic vessels. A large number of benign and malignant conditions may derive from these varied elements. By considering the specific imaging features of a given case, an appropriate differential diagnosis may be formulated from a more comprehensive list.

Conclusion
Imaging in presacral masses can be used for diagnosis or characterisation of a clinically suspected pathology. Clinical history and results of biochemical investigation of the patient is of utmost importance, more than most other branches of radiology. Lastly, presacral masses can present with diverse manifestations. Hence, detection and characterisation of any presacral masses may become the guiding torch for further evaluation.