Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

RADIOLOGICAL QUIZ
Year
: 2000  |  Volume : 10  |  Issue : 2  |  Page : 105--106

Radiological quiz - abdomen


Pratibha Issar1, Sanjeev K Issar2, R Radhakrishnan3,  
1 Dept of Radiology, LJN Hospital & Research Centre, Bhilai, India
2 Dept of Gastroentrology, LJN Hospital & Research Centre, Bhilai, India
3 Dept of Pediatric Surgery, LJN Hospital & Research Centre, Bhilai, India

Correspondence Address:
Pratibha Issar
Mohini Kunji, PO SAF Lines, Saket Colony, Katul BOD, Bhilai-22, Dist Durg, Madhya Pradesh
India




How to cite this article:
Issar P, Issar SK, Radhakrishnan R. Radiological quiz - abdomen.Indian J Radiol Imaging 2000;10:105-106


How to cite this URL:
Issar P, Issar SK, Radhakrishnan R. Radiological quiz - abdomen. Indian J Radiol Imaging [serial online] 2000 [cited 2020 Jul 6 ];10:105-106
Available from: http://www.ijri.org/text.asp?2000/10/2/105/30613


Full Text

A four-year old boy presented to the hospital with complaints of pain in the abdomen for four days with vomiting on and off and constipation for three days. On abdominal examination tenderness and guarding were present all over the abdomen with absent bowel sounds.

A plain abdominal radiograph [Figure 1] and ultrasound [Figure 2] were obtained.

The plain radiograph shows peripheral displacement of bowel gases by the soft tissue mass [Figure 1]. Ultrasound examination reveals a multiloculated anechoic cystic mass measuring 18.5 x 9 cm extending from the epigastrium to the pelvis. The walls are thin with thin septae dividing the mass into multiple irregular spaces of varying sizes [Figure 2].

 View Answer

 Radiological Diagnosis



MESENTERIC LYMPHANGIOMA

On the basis of these findings, a diagnosis of mesenteric lymphangioma was made. At surgery, a large mesenteric cyst 20x10 cm was seen in the mesentery of the jejunum 12cm from the duodenal-jejunal junction stretching the jejunal loops. Torsion and hemorrhage of the cyst was not noticed.

Gross examination of specimen showed large, thin-walled, multiloculated cystic masses along with serous and chylous fluid [Figure 3]. Histopathology revealed multiple, thin-walled loculi, lined with endothelial cells containing lymph, suggestive of lymphangioma.

Lymphangioma is commonest in infancy and early childhood. Many cases are asymptomatic and are detected as a palpable, doughy abdominal mass, but pain may occur, as a result of infection, bowel obstruction, hemorrhage or ascites [2]. Plain radiographs and barium studies may demonstrate bowel displacement by the soft tissue mass. Rarely, calcification or even lympholiths may occur [2],[4].

On US, lymphangiomas appear as cystic, multiseptated masses with locules that may be anechoic or contain internal echoes and / or sedimentation with fluid-fluid levels due to debris. On CT, they appear as cystic masses with Hounsfield values ranging from water density (if contents are serous) to fat density (if contents are chylous). Uncommonly the cyst contents may be hemorrhagic and show high-density features on CT [1],[2]. MR helps to determine both the mesenteric origin of a lymphangioma (specifically with the use of multiple planes) and the nature of the contents of the cyst. Serous contents will appear hypointense on T1W weighted images and hyperintense on T2W weighted images. Cysts with fatty content will appear hyperintense on TIW and hypointense on T2W images [4],[5].

US, CT and MR imaging can suggest in many cases a mesenteric or omental location of a cystic abdominal mass when the viscera appear intact. If a mesenteric / omental mass is cystic in nature, the differential diagnosis includes lymphangioma, enteric duplication cyst, enteric cyst, mesothelial cyst and non-pancreatic pseudocyst. Enteric duplication cysts are usually seen as unilocular masses with thin walls, on US and CT. Enteric cysts may appear as hypoechoic masses with few, thin septae and without a visible wall on US. Mesothelial cysts appear as unilocular, anechoic thin-walled masses with acoustic enhancement. Non-pancreatic pseudocysts on US appear as hypoechoic masses, unilocular or multilocular, thin or thick-walled with varying amounts of echogenic debris corresponding grossly to hemorrhage, purulent or serous contents [1],[4],[5]. A histologic diagnosis is required to establish the definitive diagnosis. However, in a case of a multiloculated cystic mass with thin walls and thin septae, a diagnosis of cystic lymphangioma should be suspected.

References

1Ros PR, Olmsted WW etal. Mesentric and omental cysts: Histologic classification with imaging correlation. Radiology 1987; 164: 327-332.
2Felson B. A modern approach to the abdominal masses in children. Seminars in Roentgenology. July 1988; 23: 228.
3Sivit CJ. CT scan of Mesentry-Omentum Peritoneum. The Radiologic Clinics of North America 1996; 34: 875-879.
4Grainger RG, Allison DJ. Mesentric/Omental cysts. Diagnostic Radiology. A Text book of Medical imaging. 1997; Vol 2, 3rd Edition. 1069-1071.
5Grainger RG, Allison DJ. Mesentric/Omental cysts. Diagnostic Radiology. A Text book of Medical imaging. 1997; Vol 2, 3rd Edition. 1069-1071.