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

QUIZ
Year
: 2004  |  Volume : 14  |  Issue : 1  |  Page : 87--88

Radiological quiz - abdominal imaging


U Hemal, R Anand, MK Narula, AZ Siddiqui 
 Dept of Radio-diagnosis, Lady Hardinge Medical College and SK Hospital, New Delhi, India

Correspondence Address:
U Hemal
E-90, Ansari Nagar, AIIMS Campus, New Delhi-110 029
India




How to cite this article:
Hemal U, Anand R, Narula M K, Siddiqui A Z. Radiological quiz - abdominal imaging.Indian J Radiol Imaging 2004;14:87-88


How to cite this URL:
Hemal U, Anand R, Narula M K, Siddiqui A Z. Radiological quiz - abdominal imaging. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Oct 14 ];14:87-88
Available from: http://www.ijri.org/text.asp?2004/14/1/87/30306


Full Text

A 45 day old male child presented with distension of abdomen since birth without any history of bladder or bowel complaints. On examination, abdomen was tense and distended.

 View Answer

 Radiological Diagnosis



 Thoracoabdominal Duplication Cyst



 Discussion



X-Ray abdomen revealed soft tissue haze and bowel loops displaced toward left side. USG abdomen showed multiple, variable size, round to tubular sonolucent lesions smooth in outline, adjacent to bowel loops. CT scan revealed multiple varying size cysts, few of them multiloculated, smooth walled with enhancement, Coronal reconstructed image of CT abdomen showed tubular cystic lesions with extension to posterior mediastinum. Vertebral bodies and their appendages and other solid organs in abdomen, lung fields and heart were seen normal.

Based on these findings possibility of thoraco-abdominal duplication cuyst or lymphangioma was considered. Surgery was performed. Thoraco-abdominal duplication cyst was the per operative diagnosis.

Enteric duplication cysts are uncommon congenital abnormalities hypothesized to be due to abnormal canalization of gastro intestinal tract during embryological development when solid gastrointenstinal tract at this stage becomes hollow tube of 8 weeks embryo Abnormal canalization leads to formation of 2 channels, which persists as duplication cyst. Enteric duplication is a true duplication, which has well-developed muscle wall with my-entric plexus and is lined by oesophageal, gastric or intestinal mucosa [2]. Such duplication with vertebral anomalies is neuroentric and results from in-complete separation of fore gut from notochord. This contains both neural and gastrointestinal element and is connected by a stalk to the meninges. It may be limited to the cyst as a blind sac or may extend below time diaphragm and either end blindly or communicate with the intestinal tract[3]. Extra-intestinal anomalies associated with duplication cyst are uncommon though vertebral defect may exist[2].

The various types of enteric duplication cyst are double barrel, tubular and spherical and site can be stomach, oesophagus or colon 20% of cyst communicate with bowel lumen, 85% cases reported are of single cyst, 35% showed lining of gastric mucosa [1].

Barium studies generally reveal mass effect on bowel caused by duplication cysts. Computed tomography can be used to know the extent of the disease as in our case it revealed posterior mediastinal extension of duplication cyst, which was not confirmed on ultrasound. Sonographically duplication cysts of the stomach and ileum rarely have been reported prevailing as cystic intrabdominal masses [4]. The differential diagnosis for such a finding include mesenteric or omental cyst.

Ultrasound may provide more specific information as wall of anechoic cyst may demonstrate echogenic line representing gastric mucosa [3]. Echogenic material within the cyst probably represents haemorrhage or inspissated secretion [2]. Computed tomography and magnetic resonance imaging demonstrate cystic and non vascular nature of the lesion and clearly demonstrate precise size, location in relation to adjacent organs and tans-diaphragmatic extension. Technetium 99m pertechnetate scintigraphy demonstrates gastric mucosa in cyst thereby confirming pre-operative diagnosis[3].

About 85% of patient with enteric duplication cysts eventually become symptomatic and may present with pain, bleeding and as an intussusceptions[4].

References

1Egelhoff JC, Bisset GS, Strife JL: Multiple enteric duplications in a infant, Pediatr. Radiol 1986; 16: 160-161.
2Nyberg DA. Intraabdominal abnormalities In: Nyberg DA, Mahony BS, Pretorius DH, eds. Diagnostic ultrasound of Fetal anamalies: Text and Atlas, St. Louis: Mosby-Year book Inc; 1990; Chapt 10:374-375.
3Parker BR, Congenital Malformations. In: Silverman FN, Kuhn JP, editors, Caffey's Pediatric X-Ray diagnosis: St. Louis, Mosby-Year book, Inc, 1993; Section 3: 1008-1009.
4Walker AR, Putnam TC: Omental, meseuric and retroperitoneal cysts. Area Surg 1984; 119:838-842.