 Good afternoon everyone. I am Dr. Iktarasthogi from Maharshi Markandeshwar Institute of Medical Sciences, Mulana, Ambala. Today I am going to present an unusual cause of cystic pelvic mass in a young female, curarynotriode. So we come to introduction part. Curarynotriode is a rare autosomal dominant congenital anomaly which consists of three components, sacral bony defect, anorectal malformation and pre-sacral mass. So the leading symptom of this triode is intractable constipation since birth. And the aim of our study is to describe the imaging findings of the syndrome on the various imaging modalities we have, then describing associated congenital anomalies. And to know the pitfalls in the diagnosis and cautious assessment to differentiate it from other pelvic cystic lesions. We come to material and methods. So a case study was conducted at our department of radio diagnosis. Unmarried female of age 23 years presented with a long-standing pelvic pain, heaviness and lower abdomen features of bowel obstruction and chronic constipation. The patient was given a cystic pelvic mass, probably an adnexal cystic lesion in the abdominal ultrasonography, which was done in a private hospital. Then the patient was referred from the department of obstetrics and gynecology for abdominal ultrasonography to our department of radio diagnosis to confirm the above findings. There we found the cyst in the pre-sacral space in close relation to sacrum. Subsequently an MRI imaging of the lower abdomen and CT for the exact localization of its origin was done. So on ultrasonography, abdomen, there was a large well-defined anechoic cystic lesion, which is shown by the red arrow in the adjacent image, which gave posterior acoustic enhancement and few thin internal separations in the pre-sacral space. The lesion appeared to displace the uterus and rectal gas shadows, which is indicated by the yellow arrows anteriorly. Now MRI spine and pelvis T2 weighted sagittal and axial sections, they showed a large T2 weighted hyperintensistic lesion with few thin internal separations in the pre-sacral region and having communication with the spinal canal through a partial sacral defect. On retrospective examination, sacral defect shown by the arrow was noted on ultrasonography. CT pelvis was done, the axial section showed partial sacral defect, which is shown by the arrow with a pre-sacral cystic lesion. Now CT abdomen was done and the coronal section shows associated other congenital anomalies such as bionic uterus shown by the red arrow. We can also notice that the bowel loops are dilated secondary to the compression by the cystic lesion and also due to associated low-grade anal stenosis. To relieve the urinary tract obstruction, Foley's bulb was inserted. We come to discussion. Curorino syndrome is an autosomal dominant hereditary disorder, which is due to mutation in the coding sequence of HLXB9 in chromosome 7Q36. It can be due to sporadic mutation. Spectrum of anomalies within incidents of 1 in 1 lakh people. We have female predilection over here with female to male ratio of 2 is to 1 in pediatric cases and 6 is to 1 in the adult cases. Now curorino syndrome, we already read it's a triad of anorectal malformation, sacral bony defect and pre-sacral mass. Anorectal malformation can vary in range of its severity from anal stenosis or impoverished illness to complex deformities such as cloical x-trophy. Our case had chronic constipation history secondary to low-grade anal canal processes. So the most frequent findings include sacrocoxidial defect which can range from complete agenesis to partial hemisacrum with sickle shape. Anterior sacral meninges are the most common pre-sacral mass lesions accounting for 60% of patients with this syndrome. Now other potential pre-sacral masses include pre-sacral teratoma, dermoid epidermoid cysts, lipoma, hamartomas or rectal duplication cysts. Now the other frequent associations, they can be urologic, gynecological and nervous system anomalies. In our case, they was associated by conoid uterus. Now all the first degree relatives should be assessed with a pelvic radiograph as 20% of the cases can be asymptomatic and they can be unrecognized until the adulthood. The imaging approach includes radiography of the sacrum to detect sacral defects. Now pelvic and spinal MRI are mandatory for the evaluation of pre-sacral mass and any associated intraspinal anomaly. Ultrasonography is also required to explore associated gynecological anomalies. CT scan is rarely performed to assess the sacral defect. Now we come to the treatment part. The treatment is mostly surgical to prevent any further complications and the procedure, it depends upon the severity of the components involved. Now it is important to differentiate the adnexal mass lesions from the pre-sacral mass lesions of the syndrome for the appropriate management and multimodality imaging will help us in clenching the diagnosis. Now early diagnosis is necessary. With adequate surgical treatment, it will prevent eventually serious complications. The complications can include meningitis, sepsis, urinary tract infections and really malignant transmissions of a pre-sacral mass. This is my bibliography. Thank you so much.