Visual Diagnosis: Midline Thoracic Dimple in a 10-month-old Girl

PRESENTATION

A 10-month-old girl presents to the clinic with a dimple at the level of the midthoracic spine that has been present since birth. The parents do not have any other concerns. Developmental milestones are appropriate for age. The mother reports that there is no discharge from the dimple, motor anomalies, or changes in bowel or bladder pattern.

The patient was born at 33 weeks’ gestation by cesarean delivery owing to fetal bradycardia. She had respiratory distress at birth and was treated with nasal continuous positive airway pressure for 1 day. The mother had a history of gestational diabetes, poorly controlled with insulin.

On physical examination, her temperature is 98.8°F (37.1°C), heart rate is 134 beats/min, and respiratory rate is 32 breaths/min. She has a dimple over the T5 spinous process; it is a very small opening without erythema or discharge (Figs 1 and 2). Mental status is appropriate for age, and no facial asymmetry or weakness is noted. She has normal sensory response to touch, normal motor examination findings with normal bulk and tone in arms and legs, and no nystagmus. She is able to crawl and has normal reflexes with absent clonus.