An infant with a lumbosacral spinal subcutaneous and intraspinal lipoma involving the conus medullaris was studied with computed tomography and high resolution real time ultrasonography to determine the extent and location of the disease before operation. The high resolution ultrasonogram demonstrated the abnormality with good detail and the added advantage of real time display of the lack of pulsatile mobility of the neural elements, confirming spinal cord tethering. Spinal high resolution ultrasonography is a noninvasive diagnostic tool in infants with spinal abnormalities and should be an important part of a neurosurgeon's diagnostic support system.