Differential Diagnosis for Presacral Stranding without Osseous Erosion

• Single Most Likely Diagnosis
  • Chronic inflammatory disease (e.g., Crohn's disease): This condition often presents with presacral stranding due to inflammation and fibrosis in the presacral space, without necessarily causing osseous erosion.
• Other Likely Diagnoses
  • Rectal carcinoma: Tumors in the rectum can cause presacral stranding due to tumor infiltration or desmoplastic reaction, and may not always erode adjacent bone.
  • Lymphoma: Involvement of the presacral space by lymphoma can lead to stranding without osseous erosion, especially in the early stages.
  • Infectious processes (e.g., abscess or cellulitis): Infections in the presacral space can cause stranding due to inflammation and may not always result in bone erosion.
• Do Not Miss Diagnoses
  • Chordoma: Although rare, chordomas are malignant tumors that originate from the clivus or sacrum and can present with presacral stranding. They are crucial to identify due to their potential for aggressive behavior and the need for specific treatment.
  • Metastatic disease: Metastases to the presacral space from other primary cancers can cause stranding and may not always erode bone, especially if they are small or located in soft tissues.
• Rare Diagnoses
  • Desmoid tumors: These are rare, benign but locally aggressive tumors that can occur in the presacral space, causing stranding without osseous erosion.
  • Presacral epidermoid cysts: These are congenital or acquired cysts that can cause presacral stranding if they become inflamed or infected, and may not erode adjacent bone.
  • Neurogenic tumors (e.g., schwannoma, neurofibroma): These tumors can arise in the presacral space and cause stranding, typically without osseous erosion unless they are large or undergo malignant transformation.