Differential diagnostics of pilonidal cysts

Abstract

Pilonidal cyst (pilonidal disease, epithelial-coccygeal course, epithelial-coccygeal cyst) is a disease common among adolescents, usually asymptomatic and detected during a preventive examination. As a rule, diagnosis does not cause difficulties and is based on examination and ultrasound imaging of the cyst.

During examination, fistulous passages are visualized — primary fistulous openings along the median line in the intervertebral fold. Complaints, as a rule, appear after the addition of inflammatory changes, the severity of which can vary from acute abscess formation to a sluggish process. However, under the guise of this pathology, diseases may occur that require a completely different diagnostic and therapeutic approach.

The differential diagnostic range includes diseases that can manifest themselves as fistula openings, bulky formations, pain and inflammation in the sacrococcygeal region. These include acute and chronic paraproctitis, rectal fistulas, osteomyelitis of the sacrum and coccyx, presacral (caudal) volumetric formations (teratomas, epidermal cysts, dermoid), diseases from the group of latent spinal dysraphism. Errors in diagnosis and, as a result, incorrect patient management tactics lead to serious consequences, therefore, if there are doubts about the diagnosis, the examination should be supplemented by magnetic resonance imaging of the lumbosacral spine.

Keywords

pilonidal cyst / diagnosis / differential diagnosis / epithelial-coccygeal passage / epithelial-coccygeal cyst

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Zvonkov D.A., Stepanova N.M., Novozhilov V.A., Sharapov I.S., Stupina M.I., Naryshkina J.A., Ludwig M.N.