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| CLINICAL IMAGES |
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| Year : 2015 | Volume
: 8
| Issue : 2 | Page : 276-277 |
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Transillumination test: A bedside aid for differentiating meningocele from myelomeningocele: Point of care testing
Aakash Pandita1, Deepak Sharma2, Sweta Shastri3
1 Department of Paediatrics, Government Medical College, Jammu, Jammu and Kashmir, India
2 Department of Paediatrics, PGIMS, Rohtak, Haryana, India
3 Department of Pediatrics, ACPM Medical College, Dhule, Maharashtra, India
| Date of Web Publication | 13-Mar-2015 |
Correspondence Address:
Deepak Sharma
Department of Paediatrics, PGIMS, Rohtak, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-2870.153189
Transillumination test is a bedside and simple technique to illuminate the body cavity by transmission of light through the cavity. Transillumination test is used in a variety of conditions like hydrocele, Hydrocephalus, pneumoperitonium and pneumothorax in neonatology. We describe use of transillumination for differentiating meningocele and myelomeningocele. Keywords: Meningocele, myelomeningocele, point of care testing, transillumination test
How to cite this article:
Pandita A, Sharma D, Shastri S. Transillumination test: A bedside aid for differentiating meningocele from myelomeningocele: Point of care testing. Med J DY Patil Univ 2015;8:276-7 |
| Introduction | |  |
Transillumination test is done by shining high intensity light through a body area or organ to check for any abnormalities like collection of fluid or air. It is bed side test that can be done by getting room lights dimmed or getting room dark so that the glow of light can be seen easily. A bright light is then pointed at that area. Areas where this test is used include the head (Hydrocephalus), scrotum (Hyderocele), chest of a premature or newborn infant (pnumothorax), or abdomen in neonate (pneumoperitoneum). We describe the use of transillumination test to differentiate meningocele and myelomeningocele.
| Case Report | | |
A term male infant with a birth weight of 3.2 kg was born to primigravida mother with an Apgar score of 8/8/9. The infant was diagnosed antenatally to have myelomeningocele in the lumbosacral region. There was no history of drug intake in the mother. At parturition, the infant was diagnosed to have swelling of size 8 cm × 8 cm in the lumbosacral area. The swelling was tense and was with intact covering. On neurological examination, infant had a fragile tone of both lower limbs. Head ultrasound was not suggestive of any hydrocephalus. Transillumination test was executed as an infant was diagnosed antenatally with myelomeningocele. The transillumination test showed fluid-filled sac with meningeal sac with no nervousness as the sum of the sac [Figure 1] and [Figure 2] which showed the malformation as meaningless. The diagnosis was confirmed with ultrasound of the swelling. The infant was operated, and postoperative course was uneventful and the baby was released successfully. | Figure 1: Infant with swelling in the lumbosacral area. Transillumination showing sac fi lled with cerebrospinal fl uid with no nerve roots within the pouch. Notice the red light glowing within the pocket cavity
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 | Figure 2: Infant with swelling in the lumbosacral area. Transillumination showing sac filled with cerebrospinal fluid with no nerve roots within the pouch. Notice the red light glowing within the pocket cavity
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| Discussion | | |
Meningocele and meningomyelocele are usually commonly seen condition in neonatology. They are often misdiagnosed with each other. If the swelling on the infant back is covered by skin with no neurological deficit of legs and anus with normal micturition, we can suspect it as an example of a simple meningocele. Otherwise, it is really difficult to differentiate a meningocele from a myelomeningocele from its site or its covering. Transillumination test can be done bedside that can easily distinguish them both. [1] During transillumination in meningocele sac there will be no nerves and the dismissal will be filled with fluid whereas in myelomeningocele we can easily see the nerves floating in a hammock. This test can be done by simply turning the way dark and using a helpful source of clarification. The light is pressed against the swelling and illumination is noted in the sac. This cheap bedside test can be done easily even in far off spots where there is no radiologist to perform the scans and help in the forecasting of the newborns as meningomyelocele has a poorer prognosis than meningocele and can be used as point of care in the nursery. [2] The gold standard for diagnosis of meningocele and meningomyelocele is magnetic resonance imaging (MRI) which exactly delineates the anatomy of spinal cord and brain. The other uses of transillumination include: [3]
- Hydrocele.
- Pneumothorax.
- Hydrocephalus in newborns or infants.
- Breast lesions or cysts in females.
Learning points
- Transillumination test should be done at bedside to differentiate between meningocele and meningomyelocele.
- The test is cheap, easily achievable and can be executed in the periphery by health care people, who doesn't have access to modern ultrasound machines.
- This bedside test can be used as a point of care for the neonates.
- MRI is the gold standard for diagnosing meningocele and meningomyelocele and to find out associated bony defects.
| References | | |
| 1. | Gupta ML. The spine and spinal cord. In: Gupta RL, editor. Textbook of Surgery. 2 nd ed. New Delhi: Jaypee; 2003. p. 410-23.  |
| 2. | Saha ML. Blood vessels and nerves. In: Saha ML, editor. Bedside Clinics in Surgery. 2 nd ed. New Delhi: Jaypee; 2013. p. 374-416. |
| 3. | Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000;342:868-74. |
[Figure 1], [Figure 2]
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