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    There are 30 cases available...

    Go to the top of the page   ID: 20110329123519 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Kraig J. Lage (University of Missouri Hospital and Clinics / Columbia / MO / United States)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    N/A  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Thorax-Lung  

     
     Pediatric Radiology CasesMost likely etiology:

    physical  

     
     Pediatric Radiology CasesHistory:

    Newborn male (39 weeks gestation) who had a forceps assisted delivery secondary to nonreassuring fetal heart tones. At delivery, infant was cyanotic, had poor tone, and no cry. Infant was dried, warmed, suctioned, and stimulated without response. Bag/mask ventillation was administered with response of heart rate rising to greater than 100. Bag/mask ventillation was continued for one minute until spontaneous respirations. Infant continued to have increased work of breathing with flaring, retractions, and tachypnea. CPAP was continued with decreased work of breathing.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Alveolar rupture is caused by a pressure gradient between the alveolus and the surrounding interstitium. The pressure gradient is a product of either hyperinflation of the alveolus or a decrease in the surrounding interstitial pressure.

    The air forced into the interstitial tissues tracts centrally toward the peribronchial and perivascular tissue, and may continue into the mediastinum, neck and subcutaneous tissues.

    Because not all alveoli are ruptured, adjacent normal alveoli cause an equalisation of pressure between the affected and damaged alveoli with the result that the interalveolar walls remain intact and the lungs inflated.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Pneumomediastinum occurs in approximately 0.1% of neonates and carries a good prognosis, typically without complications or long term sequella.

    Factors predisposing to pneumomediastinum include pneumonia or meconium aspiration syndrome.

    Neonatal pneumomediastinum can be attributable to pulmonary infection, immature lungs and ventilatory support. However, a significant portion of cases of spontaneous pneumomediastinum occur without identifiable risk factors.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Diagnosis of pneumomediastinum is confirmed by frontal CXR.

    Typical radiologic signs are:

    1. In infants, the “spinnaker sign” which is upwards and outwards displacement of thymic lobes raised above the heart by pneumomediastinal air that separates it from the underlying cardiac silhouette.

    2. "continuous diaphragm sign", visible as lucency interposed between the pericardium and the diaphragm.

    3. Linear bands of mediastinal air parallelling the left side of the heart and the descending aorta with the pleura seen as a thin line separated from the mediastinum by the air lucency. The air may extend superiorly along the great vessels into the neck.  

     
     Pediatric Radiology CasesFirst description / History:

    Neonate presenting with respiratory distress.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Doug Hacking, M.D., and Michael Stewart, M.D.
    Neonatal Pneumomediastinum
    N Engl J Med 2001 June 14; 344:1839

    2. Medline: Medline
    Annik Hauri-Hohl, Oskar Baenziger, and Bernhard Frey
    Pneumomediastinum in the neonatal and paediatric intensive care unit
    Eur J Pediatr. 2008 April; 167(4): 415–418

     

     
     Pediatric Radiology CasesKeywords:

    Pneumomediastinum, Pneumothorax, continuous diaphragm sign, spinnaker sign  

     
     Pediatric Radiology Cases Cite this article:

    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519  

     
     Pediatric Radiology Cases Read similar articles: spinnaker sign&type=1-17">corresponding keywords
    in the same field: Thorax-Lung
    or in the region: Thorax
    or in the tissue/organ: Lung
    or with the etiology: physical
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Search similar cases in:
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    Pneumomediastinum/pneumothorax - iatrogenic
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   

    Pneumomediastinum/pneumothorax - iatrogenic  
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)



        Total answers: 35

     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     


    Go to the top of the page   ID: 20100128133421 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Rickets
    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Sanjeeb Kumar Sarma (Down Town Hospital/Guwahati/India)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    3 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    3 years old emaciated male patient brought to our hospital with inability to stand or walk properly.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The skeletal effects of rickets are due to lack of calcification of osteoid. As a result most obvious changes are seen at metaphysis where the most rapid growth occurs. The earliest changes are loss of normal “zone of provisional calcification” adjacent to metaphysis featuring as indistinctness of metaphyseal margin. This progressed to a “frayed” appearance with widening of the growth plate due to lack of calcification of metaphyseal bone. Weight bearing and stress on the uncalcified bone give rise to “splaying” and “cupping” of the metaphysis. A similar but less marked effect occurs in the sub-periosteal layer causing loss of distinctness of cortical margin. Generalized osteopenia occurs, however, looser’s zones are distinctly uncommon.
    In severe cases additional deformities like bowing of long bones particularly of lower bones, thoracic kyphosis with a pigeon chest, enlargement of anterior ribs causing ricketic rosary and bossing of the skull. In low birth weight premature babies features of rickets may be very severe with spontaneous fractures and respiratory difficulty. Affected infants are usually bellow 1000 g in weight or less than 28 weeks of gestation.
    Treatment is dietary supplement of vitamin D.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Hypophosphatasia, NAI etc  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Prognosis is good with timely intervention.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Patient is undergoing treatment.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Rickets, vitamin D, splaying, fraying, cupping  

     
     Pediatric Radiology Cases Cite this article:

    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421  

     
     Pediatric Radiology Cases Read similar articles: cupping&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Rickets
    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Rickets
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   

    Rickets  
     
    Rickets
    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Rickets
    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Rickets
    Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
    URL: www.PedRad.info/?search=20100128133421


     


    Go to the top of the page   ID: 20091226123802 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Choledochal cyst
    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Sanjeeb Kumar Sarma (Down Town Hospital / Guwahati / India)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    10 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    10 years old male patient complains of on and off right upper abdominal pain since last 3-4 months.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Congenital dilatation of the biliary tract, so called choledochal cyst, is classified based on spectrum of morphologic changes in the bile ducts. The most common classification scheme of Alonso-Lej includes type I, which is dilatation of the CBD; type II, which is diverticulum of the CBD; and type III, which is a rare choledochocele. Todani and his colleagues further added to this classification type IV-A, representing multiple cysts of the IHBDs and EHBDs; type IV-B, representing multiple cysts of EHBDs; and type V, representing multiple cysts of the IHBDs , or Caroli disease.
    The choledochal cyst is not a true cyst of the biliary tract but rather some variation of duct dilatation. Etiology is unknown but supposedly multifactorial.
    On CT choledochal cyst can have varying appearance depending on the extent of ductal involvement and the degree of dilatation. There may only be mild EHBD dilatation or a large water density mass in porta hepatis or adjacent to the head of the pancreas.Reportedly, 60% of choledochal cyst will have associated congenital IHBD dilatation..Congenitally dilated IHBD often have a lobulated cystic appearance with an abrupt transition zone at the junction with the normal ducts.Acquired biliary dilatation usually doesn't have the lobulated cystic appearance and the dilated ducts usually taper gradually towards the periphery of the liver.Direct communication of the cystic duct to the dilated EHBDs will aid making the diagnosis of choledochal cyst.Ultrasonography aids to differentiate with other pathology.However, sometimes DISIDA scan may be required. CT and MR cholangiography are diagnostic.
    Here, is a case of type I disease with tiny calculi both within gall bladder and choledochal cyst.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Gastro-intestinal tract duplication cyst, mesenteric cyst, hepatic cysts, pseudocysts, ovarian cysts, and renal cysts.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    If untreated bile stasis, stone formation,infection , pancreatitis,biliary cirrhosis, and portal hypertension may occur.Reported increased incidence of hepatobiliary malignancy.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Surgical treatment was done with improvement and follow up is done on regular basis.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    3. Medline: Medline
    1.Computed tomography and magnetic resonence imaging of the whole body by John R Haaga, Charles F Lanzeri--4th Ed.Mosby 3003.  

     
     Pediatric Radiology CasesKeywords:

    Choledochal, choledochocele, IHBD, EHBD, CBD.  

     
     Pediatric Radiology Cases Cite this article:

    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802  

     
     Pediatric Radiology Cases Read similar articles: CBD.&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Choledochal cyst
    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Choledochal cyst
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   

    Choledochal cyst  
     
    Choledochal cyst
    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Choledochal cyst
    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Choledochal cyst
    Sanjeeb Kumar. Choledochal cyst. PedRad [serial online] vol 9, no. 12.
    URL: www.PedRad.info/?search=20091226123802


     


    Go to the top of the page   ID: 20090514012315 Original case in german  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Cerebellopontine Angle Lipoma
    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Achint K Singh  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    13 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory: *

    13 year old female with history of hearing loss in right ear. Audiogram revealed moderate sensorineural hearing loss on right side.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease : *

    Lipoma in the CPA are maldevelopmental masses arising from abnormal differentiation of the meningeal precursor tissue.  

     
     Pediatric Radiology CasesRadiological findings: *


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings: *

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other : *

    It usually does not grow over time and malignant transformation has not been reported.

    CPA Lipoma is a rare tumor with an incidence of 10% of all intracranial lipomas and less than 0.14% of all CPA tumors. It has a tendency to infiltrate with splaying of 7th and 8th cranial nerves. Surgical excision is usually avoided due to intermingled nerve fibers and adherence to neural structures via fibrous elements.

    The most common site for intracranial lipoma is interhemispheric fissure. Other sites are quadrigeminal cistern, pineal region, CPA, suprasellar cistern and sylvian fissure.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History: *

    First reported by Klob in 1859.  

     
     Pediatric Radiology CasesLiterature:

    4. Medline: Medline
    Saunders JE, Kwartler JA, Wolf HK, et al.
    Lipomas of the internal auditory canal.
    Laryngoscope 1991;101:1031-7.  

     
     Pediatric Radiology CasesKeywords: *

    CPA Tumors, Lipoma, Cerebellopontine angle, IAC, Internal auditory canal  

     
     Pediatric Radiology Cases Cite this article:

    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315  

     
     Pediatric Radiology Cases Read similar articles: Internal auditory canal&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   

    Thanks to Martina Paetzel, M.D. for translating this case!

     
    Cerebellopontine Angle Lipoma
    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315


     

    Search similar cases in:
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    Cerebellopontine Angle Lipoma
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   

    Cerebellopontine Angle Lipoma  
     
    Cerebellopontine Angle Lipoma
    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Cerebellopontine Angle Lipoma
    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Cerebellopontine Angle Lipoma
    Achint K. Cerebellopontine Angle Lipoma. PedRad [serial online] vol 9, no. 5.
    URL: www.PedRad.info/?search=20090514012315


     


    Go to the top of the page   ID: 20090427151244 Original case in german  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Agenesis Of The Corpus Callosum
    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Sanjeeb Kumar Sarma (Down Town Hospital/Guwahati/India), GS Ahmed (Down Town Hospital/Guwahati/India)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    1 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory: *

    A one year old male child was brought with history of grossly delayed milestones and repeated bouts of seizure. History of premature delivery was given by parents.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease : *

    The corpus callosum is a white matter structure located in the midline and composed of fibers that connect both cerebral hemispheres. The development of the corpus callosum begins during the fifth week of fetal life with the formation of the primitive lamina terminalis, which thickens to form the commissural plate. Glial cells coalesce to form a bridge like structure that serves as a guide for the callosal fibers crossing the longitudinal cerebral fissure to their targets on the contra lateral side of the brain. The mature corpus callosum is formed by the seventeenth week of gestation
    Complete agenesis of the corpus callosum may occur after inflammatory or vascular lesions before its complete development. Later insults result in partial agenesis of a previously normal corpus callosum; therefore, generally only the posterior portion is affected.
    Agenesis of corpus callosum (ACC) may be an isolated finding; however, it is frequently associated with other malformations and genetic syndromes including chromosomal aberrations and inborn errors of metabolism. Associated central nervous system abnormalities include Chiari malformations, anomalies of neuronal migration including lissencephaly, schizencephaly, pachygyria and polymicrogyria, encephalocele, Dandy-Walker malformations, holoprosencephaly, and olivopontocerebellar degeneration. Extra cranial malformations include abnormalities of the face and of the cardiovascular, genitourinary, gastrointestinal, respiratory, and musculoskeletal systems.
    Here, in this case it is associated with bilateral fronto-parietal gross encephalomalacea mainly involving the white matter, possibly suggesting hypoxic ischemic encephalopathy.  

     
     Pediatric Radiology CasesRadiological findings: *


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings: *

    Developmental anomaly , Infective lesion etc.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other : *

    Prognosis is dependent upon the cause of the malformation. In approximately 90% of the cases of isolated ACC, development is normal. ACC can even be an occasional finding in the investigation of children with mental retardation or microcephaly. There is no treatment for this condition
     

     
     Pediatric Radiology CasesComments of the author about the case: *

    In this case the parents were very poor to carry out any investigation as a result this was the first scan, in fact any investigation done after birth.The milestones were so much delayed that even the head lifting was not proper till one year. We did this MR scan on academic interest in our hospital and found this condition. Only palliative treatments were given. No definite improvement till date.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    5. Medline: Medline
    Parrish ML, Roessmann U, Levinshon MW
    Agenesis of the corpus callosum: a study of the frequency of associated malformations
    Ann Neurol 1979;6:349-354

    6. Medline: Medline
    Jeret JS, Serur D, Wisniewski K, et al.
    Clinicopathological findings associated with agenesis of the corpus callosum
    Brain Dev 1987;9:255-60

    7. Medline: Medline
    Barkovitch AJ, Norman D
    Anomalies of the corpus callosum: correlation with further anomalies of the brain
    AJR AM J Roentgenol 1988;151:171-179
     

     
     Pediatric Radiology CasesKeywords: *

    Corpus callosum, Agenesis, Encephalomalacea, Colpocephaly  

     
     Pediatric Radiology Cases Cite this article:

    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244  

     
     Pediatric Radiology Cases Read similar articles: Colpocephaly&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   

    Thanks to Martina Paetzel, M.D. for translating this case!

     
    Agenesis Of The Corpus Callosum
    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244


     

    Search similar cases in:
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    Agenesis Of The Corpus Callosum
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   

    Agenesis Of The Corpus Callosum  
     
    Agenesis Of The Corpus Callosum
    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Agenesis Of The Corpus Callosum
    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Agenesis Of The Corpus Callosum
    Sanjeeb Kumar, GS Ahmed. Agenesis Of The Corpus Callosum. PedRad [serial online] vol 9, no. 4.
    URL: www.PedRad.info/?search=20090427151244


     


    Go to the top of the page   ID: 20081216172615 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

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    Discussion
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Fritz Schneble (KUNO/Kinder-Universitätskinderklinik-Ostbayern/Regensburg)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    15 Months  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    Clinical finings:
    Klinische Befunde:
    15 months old girl (Down syndrome, s/p acute myeloic leucemia) underwent oncologic follow up where a 3 cm solid and oval shaped liver mass in segment VIII was detected..
    Clinically, the girl is unremarkable and labs, including AFP were normal.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The focal nodular hyperplasia (FNH) is a benign lesion of the liver of unknown etiology. In adults it has has been reported to have an incidence of 10/100 000. Therefore, FNH represents after hemangioma the second most common benign liver lesion (WANLESS et al. 1985; ZOLLER und LIESS 1994).  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Hepatoblastoma
    Metastasis
    Abscess  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After regular follow up ultrasound exams, the finding stayed unchanged. FNH is usually clinically asymptomatic. Because of its good prognosis, generally no therapy is necassary.  

     
     Pediatric Radiology CasesComments of the author about the case:

    There are only a few publications about the incidence of FNH in children.
    Contrast enhanced ultrasonography (CEUS) of the liver has been established for over 10 years, especially for diagnosis of liver lesions. The contrast media (Levovist and esp. Sonovue) are currently not approved for usage in children. Contrast enhanced ultrasonography can be still performed in special cases, after comprehensive explanation and consent from parents. In this case, the confirmation of the benign nature of this lesion was possible and a biopsy of this difficult to access lesion and an MR exam under anesthesia could be avoided.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    Wanless IR, Mawdsley C, Adams R. "On the pathogenesis of focal nodular hyperplasia of the liver." Hepatology 1985 ; 5(6): 1194-2000 ,
    Zoller WG, Liess H. "Fokalnoduläre Hyperplasie" . 1994 ; 119(15): 570

    9. Medline: Medline
    von Herbay A, Vogt C, Willers R, Häussinger D.
    Real-time imaging with the sonographic contrast agent SonoVue: differentiation
    between benign and malignant hepatic lesions.
    J Ultrasound Med. 2004 Dec;23(12):1557-68.

     

     
     Pediatric Radiology CasesKeywords:

    Liver mass, FNH, focal nodular hyperplasia, CEUS in children  

     
     Pediatric Radiology Cases Cite this article:

    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615  

     
     Pediatric Radiology Cases Read similar articles: CEUS in children&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Liver mass - focal nudular hyperplasia (FNH)
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   

    Liver mass - focal nudular hyperplasia (FNH)  
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     


    Go to the top of the page   ID: 20081204115159 Original case in german  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    Discussion
     
    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Galea Janabel (Aberdeen Royal Infirmary/Aberdeen/Scotland), Samuel Stafrace (Royal Aberdeen Children`s Hospital/Aberdeen/Scotland), Karen Duncan (Royal Aberdeen Childrenss Hospital/Aberdeen/Scotland), Lena Crichton (Aberdeen Maternity Hospital/Aberdeen/Scotland)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    0 Preterm  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory: *

    22 week pregnant. Ultrasound shows possible abnormality involving both lung bases. MRI performed for further evaluation.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease : *

    CCAM are pulmonary lesions with abnormal proliferation of bronchiolar structures that connect to the bronchial tree. They may contain micro or macro cysts - when the later are identified, they are rather typical of the lesion.  

     
     Pediatric Radiology CasesRadiological findings: *


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.




     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings: *

    Sequestration is also part of the same spectrum and lesions can be of mixed CCAM-sequestration pathology. Sequestrations have a systemic arterial blood supply.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other : *

    Variable prognosis - mainly dependant on size. May involute during pregnancy. The larger lesions result in mediastinal shift and pulmonary hypoplasia. These can result in vascular compromise, oesophageal compression, polyhydramnios and hydrops.  

     
     Pediatric Radiology CasesComments of the author about the case: *

    Good case showing macrocysts typically identified in CCAM  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    10. Medline: Medline
    Hubbard AM, Scott Adzick N, Crombleholme TM et al.
    Congenital Chest Lesions:Diagnosis and Charecterization with Prenatal MR Imaging.
    Radiology 1999;212:43-48.

    11. Medline: Medline
    12. Medline: Medline
    Levine D. Barnewolt CE, Mehta TS et al.
    Fetal Thoracic Abnormalities:MR Imaging.
    Radiology 2003;228:379.

    12. Medline: Medline
    Levine D.
    Atlas of Fetal MRI.
    Taylor and Francis Editors - 2005 pg 96-98.  

     
     Pediatric Radiology CasesKeywords: *

    CCAM, Congenital Cystic Adenomatoid Malfromation, Fetal MRI  

     
     Pediatric Radiology Cases Cite this article:

    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159  

     
     Pediatric Radiology Cases Read similar articles: Fetal MRI&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   

    Thanks to Martina Paetzel, M.D. for translating this case!

     
    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159


     

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    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
    Search Karen Duncan in Medline Karen Duncan (1)   
    Search Lena Crichton in Medline Lena Crichton (1)   

    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI  
     
    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI
    Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081204115159


     


    Go to the top of the page   ID: 20080522125523 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Lissencephaly Type 1
    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Johannes Gossner (Institut für Radiologie/ Klinkum Braunschweig), J. Larsen (Institut für Radiologie/ Klinikum Braunschweig)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    0 Newborn  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    Postpartum hypotrophic and respiratory distressed newborn (intubation required) with rapidly evolving seizures.
    Sonographically decreased sulcal pattern.
    Sibling with known lissencephaly type 1.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Most severe form of neuronal migration disorders (probably in 12th-16th gestational week). Current classification dpendent on when the cortical development was affected. The type 1 lissencephaly belongs to group A. In the setting of a Miller-Diecke syndrome, a monosomy 17p13 can be found, which is mostly a "de Novo" deletion or translocation.
    Without visualized chromosomal abnormality it can be found as an isolated lissencephaly or in the setting of a Norman-Roberts syndrome.
    However, even without visualized chromosomal abnormalities, in up to 40% of cases.a defect of the LIS 1 gene can be found, which regulates the neural migration by forming PAF (platelet activating factor).  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Overall poor prognosis with marked mental retardation and early, partially therpy refractary seizures. Usually the children die before they reach the second year of life. Associated malformations are frequent.
    Lissencephaly is a rare malformation. A study from the Netherlands reports 11.7 cases in 1 million newborns. Girls are slightly more frequently affected.
    The cortical surface is smooth up to the 2nd trimester. First sulci and fissures can be detected by ultrasound in the 20th gestational week. Widening of the ventricles is described to be an indirect sign of a neuronal migration disorder. If this is evident, a follow up exam and/or MRI is recommended. Image findings by MRI is indicatory.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    Miller 1963  

     
     Pediatric Radiology CasesLiterature:

    13. Medline: Medline
    Barkovich AJ, Kuzniecky RI, Jackson GD, Guerrinen R, Dobyns WB
    Classification system for malformations of cortical development: update 2001
    Neurology 2001; 57:2168- 2178

    14. Medline: Medline
    Ghai S, Fong KW, Toi A, Chitayat A, Pantazi S, Blaser S
    Prenatal US and MR imaging findings of Lissencephaly: review of fetal cerebral sulcal development
    Radiographics 2006; 26: 389- 405

    15. Medline: Medline
    Gressens P
    Mechanisms and Disturbances of Neuronal Migration
    Pediatric Research 2000; 48: 725-730

    16. Medline: Medline
    de Rijk-van Andel JF, Arts WFM, Hofman A, Staal A, Niermeijer MF
    Epidemiology of Lissencephaly Type I.
    Neuroepidemiology 1991;10:200-204
     

     
     Pediatric Radiology CasesKeywords:

    Lissencephaly, neuronal migration disorder, Pachygyria, Agyria, Lissencephaly type I, Miller-Dieker syndrome, Chromosome 17p13 syndrome, Chromosomal deletion 17p13, Norman-Roberts syndrome  

     
     Pediatric Radiology Cases Cite this article:

    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523  

     
     Pediatric Radiology Cases Read similar articles: Norman-Roberts syndrome&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Lissencephaly Type 1
    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Lissencephaly Type 1
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
    Search Karen Duncan in Medline Karen Duncan (1)   
    Search Lena Crichton in Medline Lena Crichton (1)   
    Search Johannes Gossner in Medline Johannes Gossner (18)   
    Search J. Larsen in Medline J. Larsen (1)   

    Lissencephaly Type 1  
     
    Lissencephaly Type 1
    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Lissencephaly Type 1
    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Lissencephaly Type 1
    Johannes Gossner, J Larsen. Lissencephaly Type 1. PedRad [serial online] vol 8, no. 5.
    URL: www.PedRad.info/?search=20080522125523


     


    Go to the top of the page   ID: 20070611231443 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Susanne Oechsle (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany), Kurt Vollert (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    5 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    History: Fall on the back of the head 11 days ago. According to mother she developed increased swelling in the left occipital area. There are no neurological deficits.
    Physical examination: Painful palpable left occipital swelling.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Eosinophilic granuloma is the most common and the least severe varient of the Langerhans Cell histiocytosis. Most commonly found in the skull, femur pelvis, ribs and vertebral column. Most monostotic - in 20% of the cases there are multiple masses. Included in the Langerhans Cell Histiocytosis spectrum are the multisystemic forms - Abt-Letterer-Siwe and the Hand-Schüller-Christian illnesses. (I)

    The eitology of the Langerhans Cell Histiocytosis is still unclear. There is a reactice proliferation and/or accumulation of dendritic cells. Assumingly, there is an intercellular communication defect with cytokine-disregulation. As of now, there is no proof of malignancy. (II)

    X-ray morphology is mainly dependent on the stage of the eosinophilic granuloma. Morphology is very diverse, including aggressive as well as latent and active growth patterns possible.
    In the calvarium, there are usually round or oval osteolyses with diameters up to 3 cm. Most are sharply demarcated, as if "punched" through, but in the acute phase there are also unsharp borders possible. In the healing phase, one may find border sclerosis (50%). Bony leftovers in the mid-section of the lesion are seen as button sequesters. In a severe case, there may be a "map-like" picture. (I)  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Lymphoma, solitary bone metastasis of a Neuroblastoma  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Treatment options in Langerhans Cell Histiocytosis: Surgical excision in a solitary skeletal mass (II). Intralesional steroid injection have been tried with questionable results (I). In multisystemic masses and multiple bony lesions, a systemic treatment with corticosteroids, cytostatics and immunosuppressives. Radiation only as a last resort (II).

    The course and prognosis of Langerhans Cell Histiocytosis:
    Monosystemic lesions independent of the treatment have a good prognosis. Multisystemic lesions with organ dysfunction in particularly small children is seen as having a poor prognosis, with possible lethal course. (II)

    Eosinophilic granulomas are mostly seen between the ages of 5 and 10 years. Male gender predominates (makes up of about 60-80% of all Langerhans Cell Histiocytoses). (II)  

     
     Pediatric Radiology CasesComments of the author about the case:

    In this case, there was an unnoticed development of a eosinophilic granuloma in the skull. After trauma, there was hemorrhaging and pain, then the noticed swelling on the left, occipital side.
    Final diagnosis and treatment was accomplished through resection of the mass.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    (I) Bohndorf, Imhof, Fischer:
    Radiologische Diagnostik der Knochen und Gelenke.
    Thieme Verlag 2006. S. 208-209.
    (II) Staatz, Honnef, Piroth, Radkow:
    Kinderradiologie. In: Pareto-Reihe Radiologie.
    Thieme Verlag 2007. S. 257-262.
     

     
     Pediatric Radiology CasesKeywords:

    solitary osteolysis of the skull, langerhans cell histiocytosis, LCH, eosinophilic granuloma, lymphoma, neuroblastoma, swelling of head  

     
     Pediatric Radiology Cases Cite this article:

    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443  

     
     Pediatric Radiology Cases Read similar articles: swelling of head&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     

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    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
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    Search Lena Crichton in Medline Lena Crichton (1)   
    Search Johannes Gossner in Medline Johannes Gossner (18)   
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    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)  
     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)



        Total answers: 74

     
    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     

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    Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH)
    Susanne Oechsle, Kurt Vollert. Eosinophilic granuloma / monostotic bone lesion of a langerhans cell histiocytosis (LCH). PedRad [serial online] vol 7, no. 6.
    URL: www.PedRad.info/?search=20070611231443


     


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    Discussion
     
    Noncommunicating small bowel duplication
    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Martin Stenzel (Institut für Radiologie/Unfallkrankenhaus Berlin-Marzahn/Deutschland)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    5 Months  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    5 month old male infant. Acute vomiting several times a day since the second month of life. Physical examination is unremarkable.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    A duplication can occur from the mouth to the anal canal, always in relation to the gastrointestinal tract. Mucosa with secretory glands lead to cystic and tubular appearance.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: B mode [Toshiba Aplio 50]:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color coded ultrasound:
    In the color coded US there is evidence of vessels.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: B mode:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




    Pathology 1 <- view Pathology 1

    Pathology 1: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




    Pathology 2 <- view Pathology 2

    Pathology 2: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample, opened: a mucocele is marked with an arrow.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Mesenterial cyst, Omental cyst, Meckel's diverticulum  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    According to IYER 2/3 of the cases become clinical within the first year of life. The symptoms are dependent on the location of the duplication. Duplications may represent origins for intussusceptions. Further complications: hemorrhage, perforation, ileus.
    Multiple isolated duplications have been also described in one child (MENON).
    According to IYER duplications are associated with cardiac anomalie, myelomeningoceles and microcephalus.
    Etiology: vascular insufficiency which leads to separation of small bowel segments in the fetal period?
    Noncommunicating duplications are extremely rare (so far only 4 case reports). As in the case of STEINER there seems to be a resorption of the secreted fluids in the noncommunicating variant.  

     
     Pediatric Radiology CasesComments of the author about the case:

    The duplication was shown on a prior study (not shown) as a cystic structure with a luminal width of 30 mm.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    18. Medline: Medline
    Iyer CP, Mahour GH.
    Duplications of the Alimentary Tract in Infants and Children.
    J Pediatr Surg 1995; 30:1267-70.

    19. Medline: Medline
    Steiner Z, Mogilner J.
    A Rare Case of Completely Isolated Duplication Cyst of the Alimentary Tract.
    J Pediatr Surg 1999; 34:1284-6.

    20. Medline: Medline
    Menon P, Rao KLN, Vaiphei K.
    Isolated Enteric Duplication Cysts.
    J Pediatr Surg 2004;39:E27.  

     
     Pediatric Radiology CasesKeywords:

    infant, acute vomiting, acute emesis, intestinal duplication, cyst, surgery, noncommunicating duplication, small bowel duplication, duplication, noncommunicating  

     
     Pediatric Radiology Cases Cite this article:

    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053  

     
     Pediatric Radiology Cases Read similar articles: noncommunicating&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     
    Noncommunicating small bowel duplication
    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Noncommunicating small bowel duplication
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
    Search Karen Duncan in Medline Karen Duncan (1)   
    Search Lena Crichton in Medline Lena Crichton (1)   
    Search Johannes Gossner in Medline Johannes Gossner (18)   
    Search J. Larsen in Medline J. Larsen (1)   
    Search Susanne Oechsle in Medline Susanne Oechsle (17)   
    Search Kurt Vollert in Medline Kurt Vollert (2)   
    Search Martin Stenzel in Medline Martin Stenzel (17)   

    Noncommunicating small bowel duplication  
     
    Noncommunicating small bowel duplication
    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)


    • Mesenterial cyst
      Votes: 2 (2 %)


    • Omental cyst
      Votes: 0 (0 %)


    • Meckel's diverticulum
      Votes: 1 (1 %)


    • Small bowel duplication
      Votes: 8 (9 %)


    • GIST tumor
      Votes: 1 (1 %)



        Total answers: 86

     
    Noncommunicating small bowel duplication
    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Noncommunicating small bowel duplication
    Martin Stenzel. Noncommunicating small bowel duplication. PedRad [serial online] vol 7, no. 1.
    URL: www.PedRad.info/?search=20070112213053


     


    Go to the top of the page   ID: 20061112110821 Original case in german  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Posterior fossa subdural hematoma and Cephalhematoma
    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821


     
     Pediatric Radiology CasesImages to this case: There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Samuel Stafrace (Raigmore Hospital/Inverness/Scotland), J. Miller (Raigmore Hospital/Inverness/Scotland), H. Shannon (Raigmore Hospital/Inverness/Scotland)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    2 Weeks  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory: *

    Normal term baby.
    Difficult ventouse delivery.
    Low Apgar scores.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease : *

    Subdural haematoma- collection of blood in potential space between pia-arachnoid and dura.Crosses suture lines. Limited by dural reflections. It is argued in the literatiure that neonatal subdural is not always indicative of birth trauma.

    Cephalhaematoma - Incidence: 2.5%. Increased incidence with vacuum extraction - up to 23%. Represents a subperiosteal collection of blood. Rarely complicated by infection in relation with aspiration, scalp electrode or general sepsis.  

     
     Pediatric Radiology CasesRadiological findings: *


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: B mode [Toshiba Aplio 50]:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color coded ultrasound:
    In the color coded US there is evidence of vessels.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: B mode:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




    Pathology 1 <- view Pathology 1

    Pathology 1: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




    Pathology 2 <- view Pathology 2

    Pathology 2: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample, opened: a mucocele is marked with an arrow.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]


    CT 1 <- view CT 1

    CT 1: demonstrates a crescentic extracranial hyperattenuated collection to the right of the skull vault which does not cross sutures.






    CT 2 <- view CT 2

    CT 2: demonstrates a crescentic hyperattenuated collection in the posterior fossa.






    CT 3 <- view CT 3

    CT 3: shows extention of the infratentorial collection above the tentorium adjacent to the posterior falx.






    MRI 1 <- view MRI 1

    MRI 1: - Sagittal T1 image showing a crescentic high signal collection in the posterior fossa and mixed signal in the extracranial collection.






    MRI 2 <- view MRI 2

    MRI 2: - Axial T1 (GRE) image showing a crescentic high signal collection in the posterior fossa.





     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings: *

    Extracranial collection - Caput succedaneum; oedema not blood and crosses suture lines.

    Posterior fossa collection-
    Extradural which would have an elliptical configuration and does not cross sutures.
    Subarachnoid blood - would be seen between the sulci. Both unlikely in this case.
     

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other : *

    Subdural haematoma - Majority treated with expectant therapy. Depends on size and clinical condition.

    Cephalhaematoma - Conservative treatment. Surgical if ossified and causing skull deformities.  

     
     Pediatric Radiology CasesComments of the author about the case: *

    Good example of two different pathologies related to birth.

    Shows different signal in both haematomas on MRI.  

     
     Pediatric Radiology CasesFirst description / History: *

    N/A  

     
     Pediatric Radiology CasesLiterature:

    21. Medline: Medline
    Dahnert Wolfgang
    Radiology Review Manual 5th edition
    Lippincott Williams and Wilkins.

    22. Medline: Medline
    Chamnanvanakij S, Rollins N, Perlman JM
    Subdural hematoma in term infants.
    Pediatr Neurol. 2002 Apr;26(4):301-4

    23. Medline: Medline
    Chen MH, Yang JC, Huang JS, Chen MH
    MRI features of an infected cephalhaematoma in a neonate.
    J Clin Neurosci. 2006 Oct;13(8):849-52. Epub 2006 Aug 22

    24. Medline: Medline
    Johanson RB, Menon BK
    Vacuum extraction versus forceps for assisted vaginal delivery.
    Cochrane Database Syst Rev. 2000;(2):CD000224

    25. Medline: Medline
    Thacker KE, Lim T, Drew JH
    Cephalhaematoma: a 10-year review
    Aust N Z J Obstet Gynaecol. 1987 Aug;27(3):
    210-2

    26. Medline: Medline
    Chung HY, Chung JY, Lee DG, Yang JD, Baik BS, Hwang SG, Cho BC.
    Surgical treatment of ossified cephalhematoma.
    J Craniofac Surg. 2004 Sep;15(5):774-9  

     
     Pediatric Radiology CasesKeywords: *

    birth related subdural hematoma, posterior fossa bleed, cephalhaematoma, cephalhematoma, extracranial bleed  

     
     Pediatric Radiology Cases Cite this article:

    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821  

     
     Pediatric Radiology Cases Read similar articles: extracranial bleed&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are CT-images available for this case. [ CT ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   

    Thanks to Martina Paetzel, M.D. for translating this case!

     
    Posterior fossa subdural hematoma and Cephalhematoma
    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821


     

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    Posterior fossa subdural hematoma and Cephalhematoma
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    Posterior fossa subdural hematoma and Cephalhematoma  
     
    Posterior fossa subdural hematoma and Cephalhematoma
    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)


    • Mesenterial cyst
      Votes: 2 (2 %)


    • Omental cyst
      Votes: 0 (0 %)


    • Meckel's diverticulum
      Votes: 1 (1 %)


    • Small bowel duplication
      Votes: 8 (9 %)


    • GIST tumor
      Votes: 1 (1 %)


    • Caput succedaneum and subdural hematoma
      Votes: 5 (4 %)


    • Extradural hematoma and subarachnoid hemorrhage
      Votes: 2 (1 %)


    • Subdural hematoma and cephalhematoma
      Votes: 8 (7 %)


    • Subarachnoid hemorrhage and caput succedaneum
      Votes: 3 (2 %)



        Total answers: 104

     
    Posterior fossa subdural hematoma and Cephalhematoma
    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Posterior fossa subdural hematoma and Cephalhematoma
    Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
    URL: www.PedRad.info/?search=20061112110821


     


    Go to the top of the page   ID: 20060104123424 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] There are OP-Situs-images available for this case. [ OP-Situs ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, A. Jassoy, W. Lässig (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle und Institut für Radiologie und Klinik für Kinder- und Jugendmedizin Städtisches Krankenhaus Martha-Maria Halle-Dölau gGmbH )  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    14 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    In-patient admittance because of reoccuring nausea, vomiting and stomach aches for 6 months. In the pediatrician's office, an epigastric tumor was palpated which was 15 cm in size. The 14 year-old girl was never seriously ill before this, and shows no signs of distress in schoolwork. She has been referred to a dermatologist due to loss of hair.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Bezoars are conglomerates of undigestable materials like hair (i.e. Hairballs), and are usually located in the stomach. Physiologically, one usually observes this in birds (wool) or in cats. The undigestable left-overs are usually vomited. Bezoars in humans are differentiated due to their make-up. Most common are phytobezoars, which consist of undigestable plant material (cellulose, lignine), the second most common form are trichobezoars, which are usually due to trichophagia (eating of hair) combined with a psychological illness (trichotillomania). Also to the classifications of bezoars are the following: Lactobezoars of premature newborns, the pharmakobezoars due to the clumping of medicinal tablets/capsules. Aside from these four main groups, observations of mixed-types have been made.
    The Rapunzel-Syndrome is when the the bezoar has a "pig-tail" which continues though the gut. This may be observed throughout the entire small intestines and can have an increasingly obstructive effect. Furthermore, gastrointestinal symptoms occur and the bezoar itself.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: B mode [Toshiba Aplio 50]:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color coded ultrasound:
    In the color coded US there is evidence of vessels.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: B mode:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




    Pathology 1 <- view Pathology 1

    Pathology 1: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




    Pathology 2 <- view Pathology 2

    Pathology 2: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample, opened: a mucocele is marked with an arrow.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]


    CT 1 <- view CT 1

    CT 1: demonstrates a crescentic extracranial hyperattenuated collection to the right of the skull vault which does not cross sutures.






    CT 2 <- view CT 2

    CT 2: demonstrates a crescentic hyperattenuated collection in the posterior fossa.






    CT 3 <- view CT 3

    CT 3: shows extention of the infratentorial collection above the tentorium adjacent to the posterior falx.






    MRI 1 <- view MRI 1

    MRI 1: - Sagittal T1 image showing a crescentic high signal collection in the posterior fossa and mixed signal in the extracranial collection.






    MRI 2 <- view MRI 2

    MRI 2: - Axial T1 (GRE) image showing a crescentic high signal collection in the posterior fossa.






    MRI 1 <- view MRI 1

    MRI 1: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the entire stomach, and continues to the duodenum.






    MRI 2 <- view MRI 2

    MRI 2: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the whole stomach, and continues to the duodenum.






    MRI 3 <- view MRI 3

    MRI 3: T2-weighted HASTE sequence, transversal: Here, a large, inhomogeneous, hypointense mass (which has sharp margins), which almost completely fills the stomach. There is distal extension through the pylorus into the duodenum.
    There is a small fluid level to the right and lateral to the mass and air ventral to the mass inside the stomach.




    MRI 4 <- view MRI 4

    MRI 4: T1 weighted 3D-GE-Sequence with fat-saturation and before constrast application. Conspicuous fat saturation in the T1-weighted image, which shows inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass.




    MRI 5 <- view MRI 5

    MRI 5: T1 weighted 3D-GE-Sequence with fat-saturation after contrast application, transversal. Conspicuous fat saturation in the T1-weighted image, which shows an inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass. There is intense contrast uptake in the stomach wall.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Specimen





    Pathology 1 <- view Pathology 1

    Pathology 1: Specimen

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Phytobezoar, Diosphyrobezoar, Pharmacobezoar  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After diagnostic imaging, initial attempt to reduce the size and removal of the bezoar endoscopically. Because of the size and consistency of the bezoar, it was not possible, and a gastrotomy and removal of the bezoar followed. In this case, this was a trichobezoar with a "pigtail" that reached into the duodenum - about 15 cm in size. The bezoar weighed 1700 grams. After wound healing, the patient was transferred to the clinic for child- and adolescent psychiatry.  

     
     Pediatric Radiology CasesComments of the author about the case:

    In our case, the endoscopic treatment was not possible, so that we decided upon a surgical intervention. In accordance to Alik et al., this was a Rapunzel Syndrome grade I°.  

     
     Pediatric Radiology CasesFirst description / History:

    Bezoars are known since the 12th century, where they were described initially in India. Because of their rarity and the uncertain pathogenesis, bezoars were given magical properties. Even the name, bezoar, comes from the arabic word "Bedzehr" - the persian "Padzahr" - or the hebrew "Beluzaar" - all meaning "opposite material." This, of course, increased the mystical meaning. In the mideval times, bezoars were seen as being valuable, and were even plated in gold. Today, bezoars are more or less a potential medical problem, whose complication rates should not be underestimated.
    Next to the displacement related gastrointestinal symptoms, ileus situations may occur. Furthermore, ulcerations, strangulations and hemorrhages may result and have been described. The name, "Rapunzel Syndrome" was coined by Vaughan et al. in 1968, who referred to the Brothers Grimm fairytale.  

     
     Pediatric Radiology CasesLiterature:

    27. Medline: Medline
    Gockel,I., C.Gaedertz,H.-J.Hain,U.Winckelmann,M.Albani,D.Lorenz
    Das Rapunzel-Syndrom
    Chirurg 2003 74:753-756

    28. Medline: Medline
    M.K.Sanders
    Bezoars: From mystical charms to medical and nutritional management
    Practical Gastroenterology 13 2004

    29. Medline: Medline
    Balik,E.,I.Ulman,C.Taneli,M.Demircan
    The Rapunzel syndrome. A case report and review of the literature
    Eur J Pediatr Surg 3 (1993) 171-173

    30. Medline: Medline
    Vaughan,E.D.,J.L.Sawyers,H,W.Scott
    Rapunzel syndrome: An unusual complication of intestinal bezoar
    Surgery 63: 339-343  

     
     Pediatric Radiology CasesKeywords:

    Bezoar, trichobezoar, hairball, foreign object, stomach, trichophagia, trichotillomania, hair eating, Rapunzel syndrome,  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424  

     
     Pediatric Radiology Cases Read similar articles: Rapunzel syndrome&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] There are OP-Situs-images available for this case. [ OP-Situs ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

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    Rapunzel syndrome grade I° due to trichobezoar
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    Rapunzel syndrome grade I° due to trichobezoar  
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)


    • Mesenterial cyst
      Votes: 2 (2 %)


    • Omental cyst
      Votes: 0 (0 %)


    • Meckel's diverticulum
      Votes: 1 (1 %)


    • Small bowel duplication
      Votes: 8 (9 %)


    • GIST tumor
      Votes: 1 (1 %)


    • Caput succedaneum and subdural hematoma
      Votes: 5 (4 %)


    • Extradural hematoma and subarachnoid hemorrhage
      Votes: 2 (1 %)


    • Subdural hematoma and cephalhematoma
      Votes: 8 (7 %)


    • Subarachnoid hemorrhage and caput succedaneum
      Votes: 3 (2 %)


    • Gastric carcinoma
      Votes: 0 (0 %)


    • Phytobezoar
      Votes: 0 (0 %)


    • Ascarides
      Votes: 1 (0 %)


    • Trichobezoar
      Votes: 19 (15 %)



        Total answers: 124

     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

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    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     


    Go to the top of the page   ID: 20051215115942 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, P. Göbel (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle-S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    7 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    One week ago, stomach ache for the first time, partly crampy in nature, 3 times a day. There is an obvious connection to food ingestion. In the sense of primary symptoms, bloodwork was done on the 2nd of November; there, anemia noted. On the 5th of November, initial worsening of the patient's condition with lack of appetite, malaise, increased stomach aches and a repeating vomiting with acute onset.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    N/A  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: B mode [Toshiba Aplio 50]:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color coded ultrasound:
    In the color coded US there is evidence of vessels.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: B mode:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




    Pathology 1 <- view Pathology 1

    Pathology 1: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




    Pathology 2 <- view Pathology 2

    Pathology 2: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample, opened: a mucocele is marked with an arrow.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]


    CT 1 <- view CT 1

    CT 1: demonstrates a crescentic extracranial hyperattenuated collection to the right of the skull vault which does not cross sutures.






    CT 2 <- view CT 2

    CT 2: demonstrates a crescentic hyperattenuated collection in the posterior fossa.






    CT 3 <- view CT 3

    CT 3: shows extention of the infratentorial collection above the tentorium adjacent to the posterior falx.






    MRI 1 <- view MRI 1

    MRI 1: - Sagittal T1 image showing a crescentic high signal collection in the posterior fossa and mixed signal in the extracranial collection.






    MRI 2 <- view MRI 2

    MRI 2: - Axial T1 (GRE) image showing a crescentic high signal collection in the posterior fossa.






    MRI 1 <- view MRI 1

    MRI 1: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the entire stomach, and continues to the duodenum.






    MRI 2 <- view MRI 2

    MRI 2: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the whole stomach, and continues to the duodenum.






    MRI 3 <- view MRI 3

    MRI 3: T2-weighted HASTE sequence, transversal: Here, a large, inhomogeneous, hypointense mass (which has sharp margins), which almost completely fills the stomach. There is distal extension through the pylorus into the duodenum.
    There is a small fluid level to the right and lateral to the mass and air ventral to the mass inside the stomach.




    MRI 4 <- view MRI 4

    MRI 4: T1 weighted 3D-GE-Sequence with fat-saturation and before constrast application. Conspicuous fat saturation in the T1-weighted image, which shows inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass.




    MRI 5 <- view MRI 5

    MRI 5: T1 weighted 3D-GE-Sequence with fat-saturation after contrast application, transversal. Conspicuous fat saturation in the T1-weighted image, which shows an inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass. There is intense contrast uptake in the stomach wall.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Specimen





    Pathology 1 <- view Pathology 1

    Pathology 1: Specimen


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: RUQ transverse: 42x30 mm in size, irregularly marked, non-echo-free mass with incomplete, gechogenic edge. Changes position on breathing in the area of the right colonic flexure.





    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: RUQ longitudinal: Same mass in power-mode. Homogenic vasculature, therefore not a cystic process.





    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: RUQ diagonal: Questionable localization of the mass (in the gut?) which has a stalk-like structure. At the lower edge one got the impression that there was a intussception "bulls-eye," which was not able to be completely visualized.





    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: RUQ diagonal: Visualization of the vessel's stalk and the branching within the mass.





    Ultrasound 5 <- view Ultrasound 5

    Ultrasound 5: RUQ transverse, paramedian: Obvious lymph node swelling medial to the mass.





    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Palpable tumor in the cecum.




    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Ileocecal transition. Lymph node in the foreground, tweezers in the partly intusscepted ileum in the cecum.




    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Intraoperative: Determination of the resection's edges.




    OP-Situs 4 <- view OP-Situs 4

    OP-Situs 4: Specimen luxated out of the cecum.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Gastrointestinal inflammatory myofibroblastic tumor, intussusception, duplication, lymphoma.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After extensive diagnostics (including CT, MRI), the ileocecal resection with end-to-end anastomosis is performed. After receiving histology, the child was transferred to the department of pediatric hematology and oncology.  

     
     Pediatric Radiology CasesComments of the author about the case:

    The sonographic categorization of the process in the lumen of the gut was difficult. Because of the connection to the gut and its partial intussusception, the categorization of which organ this belonged could be assumed. Intraoperatively, the sonographic findings of a partial intussusception were confirmed. A remarkable mobile cecum explains the localization of the tumor in a supine patient in the RUQ.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    31. Medline: Medline
    Mendelson, R.M., S.Fermoyle: Primary gastrointestinal Lymphomas: A radiological-pathological review. Part1: Stomach, oesophagus and colon
    Australasian Radiology (2005) 49, 353-364

    32. Medline: Medline
    Zuti,S.,G.A.Rouse,M.de Lange:
    Burkitt´s Lymphoma: A spectrum of sonographic findings
    J Diag Med Sonograph (1993) 9(1) 19-23  

     
     Pediatric Radiology CasesKeywords:

    Burkitt Lymphoma, Gut, tumor, partial intussusception  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942  

     
     Pediatric Radiology Cases Read similar articles: partial intussusception&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     
    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942


     

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    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
    Search Karen Duncan in Medline Karen Duncan (1)   
    Search Lena Crichton in Medline Lena Crichton (1)   
    Search Johannes Gossner in Medline Johannes Gossner (18)   
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    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search A. Jassoy in Medline A. Jassoy (6)   
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    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)  
     
    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Non-accidental trauma
      Votes: 0 (0 %)


    • Lead poisening
      Votes: 0 (0 %)


    • Metaphyseal chondrodysplasia
      Votes: 2 (2 %)


    • Rickets
      Votes: 32 (43 %)


    • Hypophosphatasia
      Votes: 5 (6 %)


    • Mesenterial cyst
      Votes: 2 (2 %)


    • Omental cyst
      Votes: 0 (0 %)


    • Meckel's diverticulum
      Votes: 1 (1 %)


    • Small bowel duplication
      Votes: 8 (9 %)


    • GIST tumor
      Votes: 1 (1 %)


    • Caput succedaneum and subdural hematoma
      Votes: 5 (4 %)


    • Extradural hematoma and subarachnoid hemorrhage
      Votes: 2 (1 %)


    • Subdural hematoma and cephalhematoma
      Votes: 8 (7 %)


    • Subarachnoid hemorrhage and caput succedaneum
      Votes: 3 (2 %)


    • Gastric carcinoma
      Votes: 0 (0 %)


    • Phytobezoar
      Votes: 0 (0 %)


    • Ascarides
      Votes: 1 (0 %)


    • Trichobezoar
      Votes: 19 (15 %)


    • Lymphangioleiomyoma with Intussusception
      Votes: 5 (3 %)


    • Burkitt-Lymphoma
      Votes: 6 (4 %)


    • Simple Intussusception
      Votes: 0 (0 %)


    • Ganglioneuroma of the Intestines with Intussusception
      Votes: 2 (1 %)


    • Gut Duplication
      Votes: 0 (0 %)


    • Crohn's Disease
      Votes: 0 (0 %)



        Total answers: 137

     
    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma)
    Dirk Schaper, P Göbel. B-cell NHL of the Ileum (Type: Sporadic Burkitt Lymphoma). PedRad [serial online] vol 5, no. 12.
    URL: www.PedRad.info/?search=20051215115942


     


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    Discussion
     
    Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis
    Dirk Schaper. Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis. PedRad [serial online] vol 5, no. 11.
    URL: www.PedRad.info/?search=20051128163422


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    15 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    15 year old boy presented with known history of hereditary spherocytosis. Initially nephrologic workup for hematuria. During sonography, the pathology was found. Patient was otherwise without complaints.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Hereditary spherocytosis is the most frequent hereditary hemolytic anemia in central europe. Due to the spheric form of the erythrocytes, hemolysis and increased break down of erythrocytes in the spleen occurs. The increased accumulation of bilirubin leads to development of bilirubin gallstones.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.





    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


    MRI 1 <- view MRI 1

    MRI 1: Axial T2 sections showing dilated CBD with intraluminal sludge and calculi.





    MRI 2 <- view MRI 2

    MRI 2: Axial T2 sections showing multiple small calculi in gall bladder neck (arrow).





    MRI 3 <- view MRI 3

    MRI 3: Axial T2 sections showing gall bladder ( short arrow) and a cystic structure (long arrow)





    MRI 4 <- view MRI 4

    MRI 4: Axial T2 sections showing a cystic structure with luminal sludge and the gall bladder.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2 sections showing dilated CBD anterior to IVC.




    MRI 6 <- view MRI 6

    MRI 6: MRCP showing gall bladder with calculi (short arrow) and a cystic structure (long arrow).





    MRI 7 <- view MRI 7

    MRI 7: MRCP showing both gall bladder and a cystic structure.





    MRI 8 <- view MRI 8

    MRI 8: MRCP showing small calculi in a cystic structure (arrow)




    MRI 1 <- view MRI 1

    MRI 1: T1W MRI showing hyperintense mass in right CP angle cistern extending into the internal auditory canal.




    MRI 2 <- view MRI 2

    MRI 2: T2W MRI showing hyperintense mass with splaying of 7th and 8th cranial nerves.




    MRI 3 <- view MRI 3

    MRI 3: T1W post gadolinium fat suppressed image showing nonenhancing mass with fat suppression.




    MRI 1 <- view MRI 1

    MRI 1: Axial T1WI showing dilated and separated ventricles with bilateral fronto-parietal encephalomalacic changes.





    MRI 2 <- view MRI 2

    MRI 2: Coronal T1WI showing absent corpus callosum with dilated ventricles and bilateral fronto-parietal encephalomalacea.





    MRI 3 <- view MRI 3

    MRI 3: Coronal T1WI showing colpocephaly.





    MRI 4 <- view MRI 4

    MRI 4: Sagittal T1WI showing complete absence of corpus callosum with encephalomalacic changes involving fronto-parietal white matter.





    MRI 5 <- view MRI 5

    MRI 5: Axial T2WI showing dilated ventricles with bilateral encephalomalacic changes.





    MRI 6 <- view MRI 6

    MRI 6: Axial T2WI showing absence corpus callosum more clearly.





    MRI 7 <- view MRI 7

    MRI 7: Coronal FLAIR image showing similar findings to coronal T1WI.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.




    MRI 1 <- view MRI 1

    MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





    MRI 2 <- view MRI 2

    MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





    MRI 3 <- view MRI 3

    MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.





    MRI 1 <- view MRI 1

    MRI 1: T2 weighted axial image with markedly decreased sulcal pattern (= pachygyria) and thin cortex. Furthermore seen is a hemorrhage into the right lateral ventricle (hypointense).



    MRI 2 <- view MRI 2

    MRI 2: T1 weighted axial image demonstrates also significant pachygyria and prominent external CSF spaces. The fluid-fluid level containing hemorrhage in the posterior horns of the right lateral ventricle is better deliniated on the T1 weighted sequence.



    MRI 3 <- view MRI 3

    MRI 3: T2 weighted axial image at the level of the basal ganglia, which appear normal.



    MRI 4 <- view MRI 4

    MRI 4: Coronal CSF suppressed T2 weighted sequence (FLAIR) also demonstrates a markedly decreased sulcal pattern.



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Ultrasound of the back of the head
    Left occipital identified is a 2 cm, subcutaneous, inhomogeneous and hypoechoic mass lesion. In this area, there is about 12 mm cortical discontinuity. Dura appears deviated inferiorly.
    Color coded Duplex sonography: Increased vascularization in the periphery of the lesion. (Images not shown)
    Ultrasound of the abdomen is unremarkable. (Images not shown)




    CT 1 <- view CT 1

    CT 1: CCT Brain window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    CT 2 <- view CT 2

    CT 2: CCT Bone window
    Left occipital osteolytic lesion with soft tissue components, no further osteodestructive findings.






    MRI 1 <- view MRI 1

    MRI 1: MRI of the head - T1 axial
    Left occipital soft tissue mass with marked marginal contrast enhancement, size ca. 1,8 x 2,8 x 1,5 cm. It causes the known defect in the posterior skull and mild dural displacement to the inside.
    There is surrounding leptomeningeal contrast enhancement. There is increased T2 signal and fluid level in the center of the lesion, which represents a trauma related secondary hemorrhage.





    MRI 2 <- view MRI 2

    MRI 2: MRI of the head - T2 axial






    MRI 3 <- view MRI 3

    MRI 3: MRI of the head - T1 axial with contrast






    MRI 4 <- view MRI 4

    MRI 4: MRI of the head - T1 spir coronal (oblique coronal with surface coil) with contrast




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: B mode [Toshiba Aplio 50]:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. In addition, a 5 mm hypoechoic structure is noted at the outer border of this structure with a thin wall (arrow with interrupted lines).




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color coded ultrasound:
    In the color coded US there is evidence of vessels.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: B mode:
    5 layered, 35 x 12 mm bowel like structure in the right mid abdomen without evidence of a communication with the small bowel (whole arrows) . There is a small amount of fluid within the lumen. Mesenteric lymph nodes (arrow with interrupted lines). Peristalsis could not be observed.




    Pathology 1 <- view Pathology 1

    Pathology 1: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample: the arrow shows the vessel stalk with ligation suture.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]




    Pathology 2 <- view Pathology 2

    Pathology 2: Intraoperative/macro-/microscopic findings:
    Structure with vessel stalk, evidence of several mucoceles - consistent with the smaller round structure in the picture - adjacent to the wall. The structure is completely covered with serosa, consistent with a noncommunicating form.
    Macroscopic sample, opened: a mucocele is marked with an arrow.
    [With permission of the Institute of Pathology, Sana Hospitals Lichtenberg]


    CT 1 <- view CT 1

    CT 1: demonstrates a crescentic extracranial hyperattenuated collection to the right of the skull vault which does not cross sutures.






    CT 2 <- view CT 2

    CT 2: demonstrates a crescentic hyperattenuated collection in the posterior fossa.






    CT 3 <- view CT 3

    CT 3: shows extention of the infratentorial collection above the tentorium adjacent to the posterior falx.






    MRI 1 <- view MRI 1

    MRI 1: - Sagittal T1 image showing a crescentic high signal collection in the posterior fossa and mixed signal in the extracranial collection.






    MRI 2 <- view MRI 2

    MRI 2: - Axial T1 (GRE) image showing a crescentic high signal collection in the posterior fossa.






    MRI 1 <- view MRI 1

    MRI 1: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the entire stomach, and continues to the duodenum.






    MRI 2 <- view MRI 2

    MRI 2: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the whole stomach, and continues to the duodenum.






    MRI 3 <- view MRI 3

    MRI 3: T2-weighted HASTE sequence, transversal: Here, a large, inhomogeneous, hypointense mass (which has sharp margins), which almost completely fills the stomach. There is distal extension through the pylorus into the duodenum.
    There is a small fluid level to the right and lateral to the mass and air ventral to the mass inside the stomach.




    MRI 4 <- view MRI 4

    MRI 4: T1 weighted 3D-GE-Sequence with fat-saturation and before constrast application. Conspicuous fat saturation in the T1-weighted image, which shows inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass.




    MRI 5 <- view MRI 5

    MRI 5: T1 weighted 3D-GE-Sequence with fat-saturation after contrast application, transversal. Conspicuous fat saturation in the T1-weighted image, which shows an inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass. There is intense contrast uptake in the stomach wall.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Specimen





    Pathology 1 <- view Pathology 1

    Pathology 1: Specimen


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: RUQ transverse: 42x30 mm in size, irregularly marked, non-echo-free mass with incomplete, gechogenic edge. Changes position on breathing in the area of the right colonic flexure.





    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: RUQ longitudinal: Same mass in power-mode. Homogenic vasculature, therefore not a cystic process.





    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: RUQ diagonal: Questionable localization of the mass (in the gut?) which has a stalk-like structure. At the lower edge one got the impression that there was a intussception "bulls-eye," which was not able to be completely visualized.





    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: RUQ diagonal: Visualization of the vessel's stalk and the branching within the mass.





    Ultrasound 5 <- view Ultrasound 5

    Ultrasound 5: RUQ transverse, paramedian: Obvious lymph node swelling medial to the mass.





    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Palpable tumor in the cecum.




    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Ileocecal transition. Lymph node in the foreground, tweezers in the partly intusscepted ileum in the cecum.




    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Intraoperative: Determination of the resection's edges.




    OP-Situs 4 <- view OP-Situs 4

    OP-Situs 4: Specimen luxated out of the cecum.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Right upper quadrant, echogenic, partially echo mixed 18x36mm large structure in an echo-free environment subhepatic, with irregular surface.





    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Dito, longitudinal view with significantly irregular surface.





    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: 8 months later, sharply demarkated structure with clear shadowing 24x37mm.





    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Same structure with good mobility upon changing the patient's position.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Cholelithiasis, Hemobilia  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    So far no treatment, but waiting and observing. A solel splenectomy should prevent the development of gallstones. In the case of coexisting gallstones at time of splenectomy, the simultaneous cholecystectomy is discussed. Continuous clinical and sonographic follow up exams are recommended, especially if the stones are small or the gallbladder wall appears thickened.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    33. Medline: Medline
    Guidlines for the diagnosis and management of hereditary spherocytosis.
    B.Bolton-Maggs,Stevens, R.F., N.J.Dold, G.Lamont,P.Tillensor,P.H., M.J.King
    BJ of Hematology 126 (2004) 455-474  

     
     Pediatric Radiology CasesKeywords:

    gallstone, gallbladder stone, cholelithiasis, hereditary, spherocytosis, hereditary spherocytosis, bilirubin, bilirubin stone, bilirubin gallbladderstone  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper. Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis. PedRad [serial online] vol 5, no. 11.
    URL: www.PedRad.info/?search=20051128163422  

     
     Pediatric Radiology Cases Read similar articles: bilirubin gallbladderstone&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis
    Dirk Schaper. Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis. PedRad [serial online] vol 5, no. 11.
    URL: www.PedRad.info/?search=20051128163422


     

    Search similar cases in:
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    Asymptomatic Solitary Gallbladder Stone in Hereditary Spherocytosis
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search Achint K Singh in Medline Achint K Singh (17)   
    Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (24)   
    Search GS Ahmed in Medline GS Ahmed (1)   
    Search Fritz Schneble in Medline Fritz Schneble (23)   
    Search Galea Janabel in Medline Galea Janabel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (3)   
    Search Karen Duncan in Medline Karen Duncan (1)   
    Search Lena Crichton in Medline Lena Crichton (1)   
    Search Johannes Gossner in Medline Johannes Gossner (18)   
    Search J. Larsen in Medline J. Larsen (1)   
    Search Susanne Oechsle in Medline Susanne Oechsle (17)   
    Search Kurt Vollert in Medline Kurt Vollert (2)   
    Search Martin Stenzel in Medline Martin Stenzel (17)   
    Search Samuel Stafrace in Medline Samuel Stafrace (19)   
    Search J. Miller in Medline J. Miller (1)   
    Search H. Shannon in Medline H. Shannon (2)   
    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search A. Jassoy in Medline A. Jassoy (6)   
    Search W. Lässig in Medline W. Lässig (2)   
    Search Dirk Schaper in Medline Dirk Schaper (59)