Acupuncture needle fragments identified on X-ray and computed tomography studies of chest

1. Med Imagem – Radiologia, Teresina PI, Brazil. 2. UDI 24 horas, Teresina, PI, Brazil. 3. Hospital de Urgência de Teresina Prof. Zenon Rocha, Teresina, PI, Brazil. Mailing address: Dra. Camila Soares Moreira de Sousa. Med Imagem – Radiologia. Rua Paissandu, 1862, Centro. Teresina, PI, Brazil, 64001-120. E-mail: [email protected]. Although the embryogenesis of the anomaly remains under discussion, there is evidence that a primary defect in the initial division of the notochord, neurenteric canal, and paraxial mesoderm—with a persistent connection between the endoderm and ectoderm, causing division or deviation of the notochord—is associated with variety of malformations. Recent hypotheses are based on vascular impairment of the inferior neural structure, which would prevent the closure of the neural tube. Double spines and spinal cords can be observed in SNS and in caudal duplication syndrome, covering a wide spectrum of malformations, ranging from simple fibrous bands dividing the medulla to complete duplication of the caudal structures. A diagnosis of caudal duplication syndrome should be considered only when there is also duplication of vascular structures or organs, the genitourinary tract, the gastrointestinal tract, and the distal neural tube. Among individuals with SNS, the reported survival and prognosis are poor. Including the case reported here, there have been only five reports in which the patient survived. However, with the advances in surgical techniques and neonatal intensive care, there is a trend toward better outcomes. The aim of this case report was to discuss the diagnosis of SNS, a rare condition, associated with congenital anomalies and high mortality. Therefore, we propose that, when spinal defects are detected, a detailed investigation of the associated findings be carried out, thus avoiding diagnostic errors and delays. REFERENCES 1. Srivastava P, Gangopadhyay AN, Gupta DK, et al. Split notochord syndrome associated with dorsal neuroenteric fistula: a rare entity. J Pediatr Neurosci. 2010;5:135–7. 2. Jesus LE, França CG. Síndrome do notocórdio fendido, variante rara do cisto neuroentérico. J Pediatr (Rio J). 2004;80:77–80. 3. Asghar A, Ashraf J, Tareen F, et al. An experience with four cases of split notochord syndrome and review of literature. Pakistan Journal of Medical Sciences. 2002;18:257–61. 4. Mahapatra AK. Split cord malformation – a study of 300 cases at AIIMS 1990-2006. J Pediatr Neurosci. 2011;6(Suppl 1):S41–5. 5. Ersahin Y. Split cord malformation types I and II: a personal series of 131 patients. Childs Nerv Syst. 2013;29:1515–26. 6. Mirza B, Sheikh A. Split notochord syndrome with neuroenteric fistula, a rare malformation. WebmedCentral Paediatric Surgery. 2010; 1(9):WMC00571. 7. Hoffman CH, Dietrich RB, Pais MJ, et al. The split notochord syndrome with dorsal enteric fistula. AJNR Am J Neuroradiol. 1993;14:622–7. 8. Sur A, Sardar SK, Paria A. Caudal duplication syndrome. J Clin Neonatol. 2013;2:101–2.