Lance Dorsey (University of Missouri/Columbia/USA), Adam Patterson (University of Missouri/Columbia/USA)  

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15 Years  

Female  

Syndromes  

congenital  

15 year old female presents to the ER with nausea and mid-epigastric pain with some radiation to the back which began this morning. Patient also reports headache. No other complaints and complete ROS is otherwise negative. There is an uncertain reported past medical history of "colonic malrotation." Physical exam demonstrates some mild generalized tenderness in the mid upper abdomen, but otherwise unremarkable. Labs were sent and were within normal limits, including wbc count and amylase/lipase. An abdominal CT was then performed with oral and IV contrast.  

Polysplenia syndrome is a rare congenital anomaly which which may be sporadic or familial. Polysplenia syndrome is often associated with multiple cardiopulmonary and abdominal anomalies. This disorder is commonly seen/categoried in association with the spectrum of heterotaxy or cardiospenic syndromes.

The most common cardiac malformations seen with polysplenia are acyanotic L-R shunt lesions including ASD, PAPVC, and AV canal defects. The cardiac defects associated with asplenia are usually more complex with greater morbidity. Abscence of the suprarenal/intrahepatic IVC is also typical with azygous or hemiazygous continuation. Common abdominal anomalies include intestinal malrotation, abdominal heterotaxy, central location of the liver, pre-duodenal portal vein, short pancreas and agenesis of the gallbladder.  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.

 

Laboratory diagnostics  

N/A  

Polysplenia syndrome is more common in females compared with males. Patients without severe cardiac defects often don't present until adolescence or early adulthood and sometimes are only incidentally discovered. These individuals have a better prognosis. However, polysplenia patients that do have significant cardiopulmonary anomalies can present early and often do not survive. Typically patients with asplenia present as neonates/infants due to very severe cardiac malformations. They have a poor prognosis with very high mortality rate in the first few years of life.  

This was an incidental finding discovered on the abdominal CT scan and no findings to explain the patient's acute symptoms were found. The patient's pain subsided and she was discharged from the emergency room in good condition. Follow-up evaluation for possible cardiac anomalies was recommended, however the patient has not returned to our institution for any further workup/evaluation.  

N/A  

1. Medline:
Joseph C Turbyville, MD
Pediatric Asplenia
Emedicine.com

2. Medline:
Michael P. Federle, MD, FACR
Asplenia and Polysplenia
statdx.com  

polysplenia, asplenia, malrotation, azygous continuation, heterotaxy  

Lance Dorsey, Adam Patterson. Polysplenia Syndrome with azygous continuation of IVC, intestinal malrotation, short pancreas, and pre-duodenal portal vein. PedRad [serial online] vol 11, no. 4.
URL: www.PedRad.info/?search=20110407230957  

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

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N/A  

Male  

N/A  

N/A  

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.  

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.  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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



 

N/A  

N/A  

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.  

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.  

Neonate presenting with respiratory distress.  

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

4. 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

 

Pneumomediastinum, Pneumothorax, continuous diaphragm sign, spinnaker sign  

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

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

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10 Years  

Male  

N/A  

N/A  

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

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.  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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



 

N/A  

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

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

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

N/A  

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

Choledochal, choledochocele, IHBD, EHBD, CBD.  

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

Achint K Singh  

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13 Years  

Female  

N/A  

N/A  

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

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

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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



 

N/A  

N/A  

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.  

N/A  

First reported by Klob in 1859.  

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

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

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

Sarma Sanjeeb Kumar (Down Town Hospital/Guwahati/India), Prakritish Bora (International Hospital/Guwahati/India)  

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19 Days  

Female  

N/A  

N/A  

A 29 days old female infant presented with history of drooling of saliva, excessive crying and mild respiratory distress for two days.  

A 29 days old female infant was brought to pediatric outpatient department with history of excessive drooling of salvia, crying and respiratory distress for 2 days. On examination the infant was having tachycardia and was tachypnaec also. Clinically chest, CVS, CNS and per abdominal examinations were normal. Chest x ray (antero-posterior view) revealed a metallic foreign body (a key) in the cervical region and superior mediastinum area confirmed the diagnosis of foreign body ingestion [Fig1]. General anesthesia was given. Direct laryngoscope revealed the tip (broad end) of the foreign body as silver color projection at the level of cricopharynx. Surrounding mucosa shows edema and oozing of blood. On touching the tip of the foreign body by the Mc Gill forcep, a metallic click feeling was observed by the pediatrician and by holding the tip the foreign body was removed. It measured approximately 3.4 cm x 0.9 cm and weighs 5 grams [Fig2].  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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




<- view X-Ray 1

X-Ray 1: Chest x ray (AP view) showing metallic foreign body (a key) in lower cervical and superior mediastinum area.





<- view OP-Situs 1

OP-Situs 1: Showing the foreign body (key) after removal.

 

N/A  

N/A  

No complication followed after removal of the foreign body.  

Though children from 5 months to 6 years of age group present commonly in ENT department with foreign body ingestion, however neonatal foreign body ingestion is rare. It can be accidental like from the hands of parents, relatives or elder sibling. In this case the parents doubted the role of relatives for homicidal attempt. No police case was registered till discharge  

N/A  

1. Panda N. Management of sharp esophageal foreign bodies in young children: a cause for worry. International Journal of Pediatric Otorhinolaryngology, 2002, 64(3):243-246.

2. Tasneem Z, Khan M.A. M., Uddin N. Esophageal foreign body in Neonates. J Pak Med Assoc 2004 Mar; 54(3):159-61.

3. Poorey V. K., Dixit S. and Shakya R. Foreign body oesophagus in neonate with unusual presentation. 2008 June (60)2.

4. Medatwal A., Gupta P. P., Gulati R. K. Multiple Foreign Bodies in a Neonate. Indian pediatrics. 2008 Nov; (45) 17.  

Foreign body, neonate, esophageal, key  

Sarma Sanjeeb, Prakritish Bora. Key as unusual esophageal foreign body in neonate. PedRad [serial online] vol 9, no. 4.
URL: www.PedRad.info/?search=20090420160623  

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

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0 Newborn  

Female  

N/A  

N/A  

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

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).  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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




<- view X-Ray 1

X-Ray 1: Chest x ray (AP view) showing metallic foreign body (a key) in lower cervical and superior mediastinum area.





<- view OP-Situs 1

OP-Situs 1: Showing the foreign body (key) after removal.


<- 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).



<- 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.



<- view MRI 3

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



<- view MRI 4

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


 

N/A  

N/A  

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.  

N/A  

Miller 1963  

11. 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

12. 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

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

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

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

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

K. Gerlach, P. Göbel  

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5 Years  

Male  

N/A  

N/A  

A 5 year old boy presented in the emergency room because of persistent abdominal pain for 5 days with one episode of vomiting.
Initially, the clinical picture was that of a nonspecific mesenteric lymphadenitis. Labs demonstrated leukocytosis of 24.00 Gpt/l with deviation to the left. Platelet count was 434.00 Gpt/l and CRP was 34 mg/l. ESR was increased (10 mm/h) with mild hypoproteinemia. Urinalysis was normal except for a few epithelial cells and bacteria.
Ultrasound demonstrated an inflammatory thickened small bowel wall with a cockade like structure in the right mid abdomen. This bowel wall thickening was also visible in the left mid and lower abdomen with increasing amount of free intraabdominal fluid during the hospital stay.
A CT of the abdomen was performed with the indication of an inflammatory pseudotumor, DD Burkitt lymphoma and a subileus. The boy underwent a diagnostic laparotomy and resection of a purple and thickened jejunal loop with end to end anastomosis.  

Histologically a hemorrhagic small bowel infarction with purulent lymphangitis was found. A second Pathology report described the picture of a submucosal leukocytoclastic vasculitis of the small vessels.

Henoch-Schoenlein Purpura is a generalized immune complex vasculitis of the small vessels of unknown etiology.After simple infections, an increased production of IgA, which if possibly due to hypersensitivity to bacterial antigenes (e.g. Streptococci), leads to deposition of immune complexes and to aseptic inflammation in different organ systems. These include skin (affected up to 100%) with palpable purpura, gastrointestinal tract (30-75%), joints, kidneys (6-60%), testis and CNS.  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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




<- view X-Ray 1

X-Ray 1: Chest x ray (AP view) showing metallic foreign body (a key) in lower cervical and superior mediastinum area.





<- view OP-Situs 1

OP-Situs 1: Showing the foreign body (key) after removal.


<- 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).



<- 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.



<- view MRI 3

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



<- view MRI 4

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



<- view Ultrasound 1

Ultrasound 1: Wall thickened, hypervascular small bowel loop in the axial plane.





<- view CT 1

CT 1: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view CT 2

CT 2: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view OP-Situs 1

OP-Situs 1: Inflammatory changes and purple coloration of a small bowel loop, presenting as pseudotumor.





<- view Histology 1

Histology 1: Hemorrhagic necrotising enteritis with leukocytoclastic vasculitis.

 

N/A  

Invagination, mesenteric lymphadenitis, inflammatory pseudotumor, Burkitt lymphoma  

Henoch-Schoenlein Purpura presents preferably in the cold seasons in the the jung childhood (5-7 years of age), with a slight predominance for boys. The diagnosis is made based on clinical symptoms. Henoch-Schoenlein Purpura is diagnosed if two of four of the following criteria (ACR) are present: palpable purpura, age of manifestation < 20 years, angina abdominalis (abdominal pain and blood in stool), presence of granulocytes in the vessel wall. The treatment is targeted to the symptoms, the prognosis is good.

After initial improvement, the boy developed recurrent swelling in feet and lower legs, testicular pain, massive thrombocytosis as well as position dependent petechia. During the further course a micro hematuria has developed. After administration of Prednisolone a complete cure could be accomplished.  

N/A  

N/A  

15. Medline:
Chan JC,Li PK; Lai FM, Lai KN.
Fatal adult Henoch-Schönlein purpura due to small intestinal infarction.
J Intern Med 232(1992)181-4

16. Medline:
Prenzel F, Pfäffle R, Thiele F, Schuster.
Decreased factor XIII activity during severe Henoch-Schoenlein purpura - Does it play a role?
V. Klin Padiatr 2006;218:174-76

17. Medline:
Lawes D, Wood J.
Acute abdomen in Henoch-Schönlein purpura.
J R Soc Med. 2002 Oct;95(10):505- 6

18. Medline:
C.Rieger.
Vaskulitiden, In: Pädiatrie Grundlagen und Praxis. Hrsg. Lentze, Schaub, Schulte, Spanger, S.662ff. 2. Auflage 2003, Springer Verlag, Berlin, Heidelberg, New York,
 

Henoch-Schoenlein Purpura, small bowel infarct, thrombocytosis, petechia  

K Gerlach, P Göbel. Henoch-Schoenlein Purpura. PedRad [serial online] vol 8, no. 3.
URL: www.PedRad.info/?search=20080327175230  

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

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5 Years  

Female  

N/A  

N/A  

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.  

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)  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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




<- view X-Ray 1

X-Ray 1: Chest x ray (AP view) showing metallic foreign body (a key) in lower cervical and superior mediastinum area.





<- view OP-Situs 1

OP-Situs 1: Showing the foreign body (key) after removal.


<- 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).



<- 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.



<- view MRI 3

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



<- view MRI 4

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



<- view Ultrasound 1

Ultrasound 1: Wall thickened, hypervascular small bowel loop in the axial plane.





<- view CT 1

CT 1: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view CT 2

CT 2: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view OP-Situs 1

OP-Situs 1: Inflammatory changes and purple coloration of a small bowel loop, presenting as pseudotumor.





<- view Histology 1

Histology 1: Hemorrhagic necrotising enteritis with leukocytoclastic vasculitis.


<- 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)




<- view CT 1

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






<- view CT 2

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






<- 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.





<- view MRI 2

MRI 2: MRI of the head - T2 axial






<- view MRI 3

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






<- view MRI 4

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



 

N/A  

Lymphoma, solitary bone metastasis of a Neuroblastoma  

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)  

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.  

N/A  

(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.
 

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

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  

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 )  

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14 Years  

Female  

N/A  

N/A  

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.  

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.  

<- view CT 1

CT 1: Axial CT of the upper abdomen demonstrates multiple spleens of different sizes in the posterior LUQ.



<- view CT 2

CT 2: Axial CT shows enlarged azygous vein adjacent to the aorta in the lower chest, representing azygous continuation of the abdominal IVC.



<- view CT 3

CT 3: Coronal CT shows the multiple spleens in the LUQ and azygous continuation of the IVC paralleling the aorta along the right.





<- view CT 4

CT 4: Axial CT of the mid-abdomen demonstrates short pancreas with no visualized distal body or tail of the pancreas. The contrast opacified vessel seen anterior to the shorted pancreas represents a pre-duodenal portal vein. Also, again noted are several spleens in the left abdomen anterior and lateral to the left kidney.




<- view CT 5

CT 5: Axial CT of the abdomen shows the small bowel entirely within the right abdomen and the colon located only with the left abdomen. There is also abnormal orientation of the the mesenteric vessels visualized with the superior mesenteric vein seen to the left of the superior mesenteric artery.



<- view CT 6

CT 6: Axial CT of the lower abdomen demonstrates small bowel within the right lower quadrant with abdnormal location of the cecum and appendix identified within the left lower quadrant.


<- 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.





<- view X-Ray 2

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




<- view MRI 1

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





<- view MRI 2

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





<- view MRI 3

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





<- view MRI 4

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





<- view MRI 5

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




<- view MRI 6

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





<- view MRI 7

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





<- view MRI 8

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




<- view MRI 1

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




<- view MRI 2

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




<- view MRI 3

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




<- view X-Ray 1

X-Ray 1: Chest x ray (AP view) showing metallic foreign body (a key) in lower cervical and superior mediastinum area.





<- view OP-Situs 1

OP-Situs 1: Showing the foreign body (key) after removal.


<- 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).



<- 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.



<- view MRI 3

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



<- view MRI 4

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



<- view Ultrasound 1

Ultrasound 1: Wall thickened, hypervascular small bowel loop in the axial plane.





<- view CT 1

CT 1: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view CT 2

CT 2: Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





<- view OP-Situs 1

OP-Situs 1: Inflammatory changes and purple coloration of a small bowel loop, presenting as pseudotumor.





<- view Histology 1

Histology 1: Hemorrhagic necrotising enteritis with leukocytoclastic vasculitis.


<- 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)




<- view CT 1

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






<- view CT 2

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






<- 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.





<- view MRI 2

MRI 2: MRI of the head - T2 axial






<- view MRI 3

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






<- view MRI 4

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




<- 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.






<- 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.






<- 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.




<- 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.




<- 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.




<- view OP-Situs 1

OP-Situs 1: Specimen





<- view Pathology 1

Pathology 1: Specimen