Veronika Huf (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Deutschland), Kurt Vollert (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Deutschland), Tobias Schuster (Klinikum Augsburg/Abteilung Kinderchirurgie/Augsburg/Deutschland)  

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6 Months  

Male  

Neck-Other and unknown  

congenital  

Swelling in the right mandibular angle, movable, indolent,stable size for over 2 months.  

Normal development: Cells of the ventral bud of the 3rd pharyngeal pouch detach and migrate in the 8th gestational week caudally and medially towards the thyroid. They migrate further retrosternally into the superior mediastinum.

Development of ectopic thymus tissue:
1. Cells detach along the descensus path and proliferate -> development of accessory thymus tissue.
2. The entire gland or a lobe does not descend and stays at loco -> ectopic thymus tissue.  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.



 

Surgery / Histo  

Hemangioma, Metastasis, Teratoma, Sarcoma, Thyroid tumor  

Ectopic thymus tissue is more frequently prevalent than traditionally suggested. With improved diagnostic modalities (e.g. ultrasound) the diagnosis is more frequently made. 61 % of 18 children who were examined in the neck area had ectopic thymus tissue in the neck according to the literature (see reference). Since we were sensitized for this diagnosis, we diagnosed at least 4 children with ectopic thymus tissue as an incidental finding.
Rarely, a malignant transformation of ectopic thymus tissue has been described in the literature. Thus, in our opinion is a conservative/awaiting position with follow up imaging studies justified.  

N/A  

N/A  

1. Medline:
Chu WXW, Metreweli C
Ectopic thymic tissue in the paediatric age group
Acta Radiologica 2002;43:144-6  

ectopic thymus,neck swelling,accessory thymus  

Veronika Huf, Kurt Vollert, Tobias Schuster. Ectopic Thymus. PedRad [serial online] vol 7, no. 7.
URL: www.PedRad.info/?search=20070724201543  

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 Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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, P. Göbel (Kinderchirurgie St. Barbara-Krankenhaus Halle/S.)  

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14 Years  

Female  

N/A  

N/A  

The first presentation of the then 9 year-old girl was based upon unspecific lower abdominal pain. Chance findings in the routine sonographic examination. Initially, the findings were just watched, with follow-ups every quarter year. As the findings were found to increase in size at the age of 13, ultrasound aspiration was done and a short-term drainage was performed. An instillation of a locally acting substance was performed. In the follow-up examination, the structures decreased in size. After 6 months, however, a renewed increase in size was noted and a renewed aspiration was performed. Since the pathological findings remained, a surgical treatment was performed.  

N/A  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings

 

N/A  

Posttraumatic splenic cyst, dermoid cyst, cystic hemangioma, parasitic cyst  

After the initially performed aspiration without success, the surgical treatment and resection of the splenic lymphangioma was opted. A sufficiently large splenic rest could be saved.
All in all, a splenic lymphangioma is a very seldom illness. Aside from the casuistics in children, isolated splenic lymphangiomas are described mostly in adults. A lymphangiomatosis, which is described often in literature, could not be found in our patient.  

In the experience we gathered in this case, the multicystic changes of the spleen could no longer be treated with aspiration-instillation. This is usually shown to be helpful in solitary splenic cysts.
In childhood, we feel that the resection with saving the spleen was the method of choice.  

N/A  

3. Medline:
Morgenstern L, Bello JM, Fisher BL, Verham RP
The clinical spectrum of lymphangiomas and lymphangiomatosis of the spleen.
Am Surg. 1992 Oct;58(10):599-604

4. Medline:
Wolters U, Keller HW, Lorenz R, Pichlmaier H.
Splenic cysts: indications for surgery and surgical procedures
Langenbecks Arch Chir. 1990;375(4):231-4.  

Splenic, lymphangioma, spleen, treatment, splenic lymphangioma  

Dirk Schaper, P Göbel. Splenic Lymphangioma. PedRad [serial online] vol 4, no. 4.
URL: www.PedRad.info/?search=20040414134304  

M. Paetzel (Cleveland/USA)  

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11 Years  

Male  

N/A  

N/A  

11 year old boy, fall from a tree, abdominal pain, therefore admission under presumption of a blunt abdominal trauma.  

Parynchmal hemorrhage of the liver without affection of the capsule appears often near the teres hepatis ligament, due to a natural fixation, where the gravitational effects are appearant.

The lesion is scaled as a Grade I of the Organ Injury Scale (OIS).

The free intraperitoneal fluid shows that the rupture is not solely intraparenchymal. (A hemorrhage that was within the liver capsule (subcapsular hemorrhage) was not seen, so through this proof of free fluids, a lesion in the liver capsule must be assumed.)

On the whole, only about a half of the organ's lesions were detected with ultrasound. Only through the use of CT or MRI (without contrast!) could the hemorrhages be correctly found.

Ultrasound could thus be seen as the main modality of detecting intraperitoneal fluid.  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings


<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.


 

N/A  

none  

In slight parenchymal hemorrhages, there is often no other findings. Posttraumatic cysts or bilomas are rare.  

N/A  

N/A  

N/A  

Traumatic, liver hemorrhage, grade I, bleeding, bleed, hemorrhage, liver, fluid, trauma, traumatic grade I liver hemorrhage  

M Paetzel. Traumatic liver hemorrhage grade I. PedRad [serial online] vol 3, no. 11.
URL: www.PedRad.info/?search=20031110211430  

H. Eberhardt (Marburg), S. Kallsen (Landshut)  

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Preterm  

N/A  

N/A  

N/A  

Premature infant in the 36. week of gestation. On the 5th day of life, recurrent spitting and loss of weight of 15% since birth.
Only meconium passage, no transitional stools.

Abdomen was somewhat distended, otherwise unnoticeable examination.  

Inherent disorder  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings


<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.



<- view X-Ray 1

X-Ray 1: "Double bullbe" phenomenon in the abdominal overview (Stomach and proximal duodenum is filled with air).


 

N/A  

Duodenal atresia, annular pancreas  

Pediatric-surgical correction: Duodeno-duodenostomy, Duodeno-jeunostomy. In some cases a duodenal membrane can form.

Finding other malformations before an surgical procedure is important.  

N/A  

N/A  

5. Medline:
Saxena A, Willital GH, Lehmann RR
Chirurgie im Kindesalter; S.243-251 und 259ff in Willital GH, Lehmann RR, 1. Auflage
Spitta Verlag, 2000
 

Duodenal stenosis, small intestinal atresia, duodenal atresia, recurrent spitting, recurrent vomiting, distended, no stool passage  

H Eberhardt, S Kallsen. Duodenal atresia. PedRad [serial online] vol 3, no. 6.
URL: www.PedRad.info/?search=20030602162043  

W. Weiwad, A. Jassoy (Halle)  

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N/A  

N/A  

N/A  

N/A  

Nanosomia, therefore a tumor in the hypophysial region or a maldevelopment of the pituitary gland must be ruled out.

In addition, absence epilepsy and mental retardeation - therefore diagnostic imaging to rule out an intracerebral tumor or an intracranial anomaly.  

N/A  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings


<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.



<- view X-Ray 1

X-Ray 1: "Double bullbe" phenomenon in the abdominal overview (Stomach and proximal duodenum is filled with air).



<- view MRI

MRI 1: T1-SE saggital before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 2: T1-SE saggital after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary shows a normal position and contrast media absorption.





<- view MRI

MRI 3: T1-SE coronal before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 3: T1-SE coronal after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary gland (adenohypophysis) shows a normal position and contrast media absorption.


 

N/A  

N/A  

The diagnoses of a pituitary infantilism was made based on the STH deficiency shown in laboratory findings.
For other symptoms (epilepsy, mental retardation), there were no imaging correlations as to the cause of such.  

N/A  

N/A  

N/A  

Neurohypophysis, STH-Deficiency, Ectopia, cctopic neurohypophysis, nanosomia, absence epilepsy, mental retardeation,posterior pituitary gland, posterior pituitary  

W Weiwad, A Jassoy. Ectopic Posterior Pituitary Gland (Ectopic Neurohypophysis). PedRad [serial online] vol 3, no. 5.
URL: www.PedRad.info/?search=20030501212143  

H. Frimmel (Halle/S.)  

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21 Months  

Male  

N/A  

N/A  

1 9/12 year-old boy. Reoccurring respiratory infections. In the X-ray (sent to us from another clinic), segmental, basal opacities on the left side.  

Pulmonary sequester = "Rokitansky-lobe"
Congenital malformation of the lung.
A mass of non-aerated pulmonary tissue that is not connected to the normal bronchial tree. It receives its own blood supply from a systemic artery.
In 65% of the cases in the left lobe, otherwise in the right, posterior lower lobular segment.
Two forms:
Intralobular (75-85%) - without own pleura, drainage into the pulmonary veins.
Extralobular (15-25%) - with own pleura, drainage into the vena cava/azygos vein.
 

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings


<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.



<- view X-Ray 1

X-Ray 1: "Double bullbe" phenomenon in the abdominal overview (Stomach and proximal duodenum is filled with air).



<- view MRI

MRI 1: T1-SE saggital before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 2: T1-SE saggital after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary shows a normal position and contrast media absorption.





<- view MRI

MRI 3: T1-SE coronal before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 3: T1-SE coronal after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary gland (adenohypophysis) shows a normal position and contrast media absorption.



<- view MRI 1

MRI 1: T2-HASTE coronal: conically configurated, ca. 4x2cm large structure in the left dorsobasal lung, In the T2-weighted image, an obvious signal intensity increase is seen.







<- view MRI 2

MRI 2: T1-FLASH coronal with contrast: strong, homogenic, aortic synchronized enhancement of the sequestration after application of contrast. No aerated areas within this structure.







<- view MRI 3

MRI 3: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.













<- view MRI 4

MRI 4: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.









<- view MRI 5

MRI 5: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.










 

N/A  

In obvious sequester-vascular supply: none.  

Congenital deformity.
Often secondary hematogenic infection with delayed healing and sustained inflammatory symptoms due to missing aeration (no self-cleaning).
Mostly, surgical resection. Sometimes also prophylactically due to the danger of infection.  

The presented case is the classical example of a lung sequester. Here, probably an extralobular sequester.  

N/A  

6. Medline:
M. Galanski, M. Prokop
Ganzkörper-CT
Georg-Thieme-Verlag 1998

7. Medline:
Psychrembel
Klinisches Wörterbuch, 256. Auflage
de Gruyter-Verlag 1990  

Lung sequester, extralobular, Rokitansky lobe, Rokitansky, lung sequestration, recurrent respiratory infections  

H Frimmel. Lung sequestration, extralobar. PedRad [serial online] vol 2, no. 8.
URL: www.PedRad.info/?search=20020815182432  

A. Meyer-Bahlburg (Halle), Carsten Bock (Halle)  

Viewable for logged on visitors (Log on)  

1 Years  

Female  

N/A  

N/A  

2.5 year-old girl with acute, incomplete hemiparalysis of the right side. Up until now, the child developed normally. Sensitivity lost in the right arm and leg region.  

This deals with fluid filled cavities within the arachnoid. Most frequently, this occurs in the middle cranial fossa (about 2/3 of the cases, left more frequent than right), furthermore, in the sella region and in the posterior cranial fossa.

Arachnoid cysts are more commonly associated with cerebral anomalies (hypoplasia of the temporal lobe), where it is unclear if these are primarily or secondarily formed.  

<- view Ultrasound 1

Ultrasound 1: Ultrasound of the tumor in the right mandibular angle which is hypoechoic and extending deeply into the soft tissue.




<- view Ultrasound 2

Ultrasound 2: The tumor extends between the neck vessels (internal jugular vein and common carotid artery) without signs of invasion.



<- view Ultrasound 3

Ultrasound 3: Good vascularization on Doppler ultrasound



<- view MRI 1

MRI 1: T1w noncontrast axial; the tumor is nearly isointense to muscle. The hyperintense areas represent predominantly protein-rich cysts or fat.





<- view MRI 2

MRI 2: T2w SPIR axial; The known tumor is hyperintense to muscle.





<- view OP-Situs 1

OP-Situs 1: intraoperative findings of the tumor in the right mandibular angle




<- view Histology 1

Histology 1: Hassall's bodies in the central portions of the specimen.




<- view Histology 2

Histology 2: Hassall's bodies in the central portions of the specimen.




<- 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 Ultrasound 1

Ultrasound 1: Presentation of the pathological findings in the left upper abdominal quadrant. Multicystic structure, which moves well with breathing.




<- view Ultrasound 2

Ultrasound 2: Presentation of the spleen as a neighboring organ.




<- view Ultrasound 3

Ultrasound 3: Doppler sonographic vascularization




<- view OP-Situs 1

OP-Situs 1: Surgical findings




<- view OP-Situs 2

OP-Situs 2: Surgical findings




<- view OP-Situs 3

OP-Situs 3: Surgical findings


<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.



<- view X-Ray 1

X-Ray 1: "Double bullbe" phenomenon in the abdominal overview (Stomach and proximal duodenum is filled with air).



<- view MRI

MRI 1: T1-SE saggital before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 2: T1-SE saggital after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary shows a normal position and contrast media absorption.





<- view MRI

MRI 3: T1-SE coronal before contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk.





<- view MRI

MRI 3: T1-SE coronal after contrast media: Depiction of a round hyperintense structure in the course of the pituitary stalk. The anterior pituitary gland (adenohypophysis) shows a normal position and contrast media absorption.



<- view MRI 1

MRI 1: T2-HASTE coronal: conically configurated, ca. 4x2cm large structure in the left dorsobasal lung, In the T2-weighted image, an obvious signal intensity increase is seen.







<- view MRI 2

MRI 2: T1-FLASH coronal with contrast: strong, homogenic, aortic synchronized enhancement of the sequestration after application of contrast. No aerated areas within this structure.







<- view MRI 3

MRI 3: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.













<- view MRI 4

MRI 4: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.









<- view MRI 5

MRI 5: MRA (MIP-Projections): Proof of the systemic arterial vasculature from the aotra and the venous drainage in the hemiazygos vein.











<- view MRI 1

MRI 1: (T2-FLAIR-Sequence, transversal): Large, temporally located cyst on the left side (5.5 x 8 x 8.5 cm), which causes a median shift due to compression of the left lateral ventricle.







<- view MRI 2

MRI 2: T1 SE-coronal after contrast application: Cystic mass in the left temporal lobe, which is seen compressed.







<- view MRI 3

MRI 3: T2-FLAIR transversal following surgery: Expansion of the previously compressed temporal lobe. In this slice, one sees the complete cerebral parenchymal filling of the area where the cyst was previously located.







<- view MRI 4

MRI 4: T2- TSE-FS transversal following surgery: Expansion of the previously compressed temporal lobe. In this slice, one sees the complete cerebral parenchymal filling of the area where the cyst was previously located.
In the area of of the lenticulostratal artery on the left side there is a striped area of infarction - assumed to be a result of the expansion and compression of the cyst (yellow arrow).




<- view MRI 5

MRI 5: T1-SE coronal after contrast application: After surgical windowing, a regression of size of the cyst is seen. There is no median shift. After windowing, a hygroma (left) is seen parietally (often after removal of cysts). Here one sees the area of infarction as well (arrow).