Widened presacral space

Widening of the presacral space is one of the diagnostic indicators of the diseases involving pelvic pathology and rectal involvement. It is ideally measured on barium studies at the level of S3/4 disc level on lateral radiographs and the normal value of the presacral space is <15 mm in adults.​

There are a large number of potential causes of widening of the presacral space, including:

• presacral masses
  • metastases
  • chordomas
  • rectal carcinoma
  • giant cell tumors of bone
  • neurofibromas 
  • schwannomas 
  • osteosarcomas 
  • sacral chondrosarcomas 
  • presacral paragangliomas 
  • presacral hemangiomas 
  • solitary fibrous tumors
  • myelolipomas
• ulcerative colitis
• osteomyelitis of the sacrum
• presacral perineural cysts
• anterior presacral perineural cysts
• dermoid cyst
• rectal duplication anomalies
• gonococcal proctitis