Presacral cysts are rare lesions not typically evaluated with sonography, due to their location between the rectum and sacrum. This case study reviews the imaging and biopsy of a presacral lesion, in a patient presenting with gastrointestinal symptoms, back, and leg pain. The patient underwent numerous diagnostic imaging examinations, with multiple identified differential pathologies. After biopsy, the pathology report identified features of an epithelial squamous cyst, with the main differential of an epidermoid cyst. Presacral lesions have a wide variety of differential diagnoses and should be evaluated with diagnostic imaging and possibly tissue sampling. This anatomical site is often diagnostically evaluated with magnetic resonance imaging or computed tomography. Transvaginal sonography has rarely been reported as imaging technique that can be used in the presacral space but proved valuable in this patient case. Utilizing transvaginal sonography may be a diagnostic option considered, to evaluate lesions in this location.
Angela Storto (2026) studied this question.