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| Year : 2003 | Volume
: 13
| Issue : 4 | Page : 409-412 |
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| MR findings in trichobezoar |
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A Sharma, Saurabh, Samarjeet, N Sharma, UK Makwane
Department of Radio-diagnosis and Imaging G.B. Pant, Superspeciality Hospital and MAM College, New Delhi, India
Click here for correspondence address and email
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 Abstract | | |
A 21-year-old female presented with gastric outlet obstruction and a palpable mass in epigastrium and clinical diagnosis of HCC was put forward. US findings were suggestive of band like echogenic structure with total posterior acoustic shadowing. CT findings were characteristic of trichobezoar. Single shot heavily T2 weighted image and BFE CORONAL images were comparable with barium meal projection. In present case we performed barium meal examination, as a last investigation. We have described MR findings and in literature we could trace only one case in which MR findings of trichobezoar with gastric ulcer has been described. Keywords: Trichobezoar, US, CT, MR, Barium Meal.
How to cite this article:
Sharma A, Saurabh, Samarjeet, Sharma N, Makwane U K. MR findings in trichobezoar. Indian J Radiol Imaging 2003;13:409-12 |
| Introduction | |  |
The majority of gastric trichobezoars occur in young girls who chronically chew and swallow their own hair or other fiber material from rugs, blankets or clothing[1]. Over a prolonged period an intragastric mass forms consisting of meshwork of matted hair containing trapped food debris that is molded to the shape of the stomach and may extend into small bowel[2]. The signs and symptoms of this lesion are similar to those of other abdominal tumors and include the presence of a firm, sometimes tender epigastric mass, vomiting and weight loss[2].
| A case report | | |
A 21-year-old female presented with history of swelling in right upper quadrant of abdomen and extending to umbilical region. There was history suggestive of gastric outlet obstruction for last six months. There was no history of weight loss or loss of appetite or H/O previous surgery. Physical examination revealed an evidence of engorged veins in the lower limbs. Routine blood investigation were normal. SGOT, PT, ALKALINE PHOSPHATASE and alfa feto proteins were normal. Clinical diagnosis of liver massHCC with IVC thrombosis was kept. Patient was referred to the radiology department for further investigation. US showed an evidence of hyper echoic lesion with densi hyperreflective shadowing in the epigastium suggestive of foreign body [Figure - 1]. Lesion became more conspicuous when stomach was distended with water. Patient was subjected to plain CT and CECT which showed an evidence of intraluminal whorled streaky filling defects with an evidence of air and food particles. There was an evidence of mucosal wall thickening uniformly suggestive of chronic disease. Digital scanogram and MPR images also show an evidence of trichobezoar [Figure - 1],[Figure - 2],[Figure - 3],[Figure - 4] and [Figure - 5]. MR was performed on 1.5 T Phillips unit. On B-TFE corona) lesion was hypointense with streaking and intermingled air and food particles [Figure - 6]. T1 W/1 P/FAT SAT axial sequence showed hypointense lesion scattered in the stomach lumen [Figure - 7]. T 2/SSH/ 60 axial showed hypo-intense distended stomach with hyper-intense areas intraluminally [Figure - 8]. SSH MRCPheavily T2 weighted fat suppressed sequence showed a normal GB, CBD, biliary channels. Stomach was well distended and showed evidence of a mass filling the stomach and extending till pylorus [Figure - 9]. The mass was characterized by very low signals intensity similar to air. There was gastric wall thickening interpreted as chronic gastritis. At last barium meal examination was performed showing trichobezoar [Figure - 10].
This finding on barium meal examination was comparable to heavily T2 weighted image. GI endoscopy showed trichobezoar occupying the fundus, body and extremity of the antrum. Scope could not be entered into duodenum. Interesting part in this patient is that psychiatric history was taken after diagnosis. Patient had a history of compulsive hair pulling till the age of 10 years (Trichotillomania). But there was no H/O of trichotillomania for the last 11 years. Trichobezoar was confirmed art surgery.
| Discussion | | |
Gastric trichobezoars are most commonly diagnosed preoperatively with upper GIT Contrast study. On plain abdominal radiograph the bezoars may be visualized as mottled mass similar in appearance to food filled stomach. Similar findings are seen in present case retrospectively. Barium contrast study confirms it as a mobile irregular, coherent Intraluminal mass and is best demonstrated on delayed films as delayed double contrast effect. In present case barium study was performed last. Sometimes large ingested food such as dry cereal or pista can give falsepositive results[1].
In present case, the investigation carried was US which showed band like echogenic structure with total posterior acoustic shadowing originating from mass in epigastrium. Similar findings have been described by Tomas et al (2001) and B. Newman (1990). In our case, we showed characteristic findings of trichobezoar as has been described By Gabriela G et al (1999). B. Newman (1990) and Tomas et al (2001). Only one case has been reported so far on MR findings. Maria Sinzig et al (1998) have reported a case in 10 year old female child. On US, it revealed a band like echogenic structure of the mass with total posterior acoustic shadowing. They documented MR findings of highly distended stomach filled with mass extending from cardia to the Pyloric region. The mass was characterized by very low signal intensity similar to air on T 1 and T2 - weighted and T2 - weighted sequences with fat suppression. There was thickening of gastric wall. In present case, we have obtained T1, T2 axial, coronal, and Sagittal sequences. In addition to these sequences, we used heavily T2 weighted fat suppressed single shot sequence of 8 sec, the one we use for MRCP. This sequence has demonstrated the stomach fluid with trichobezoar till pyloric canal and the image is as on barium meal X-Ray. Gastric wall thickening was also demonstrated on all sequences. We could not demonstrate any associated complication as has been demonstrated by Maria e al. The uniqueness in our case is that the clinical diagnosis was of HCC and psychiatric history of compulsive hair pulling was taken after radiological diagnosis. To conclude, we still feel that it may be difficult to diagnose trichobezoar on MR. We have tried to compare heavily T-2 weighted images with that of barium film and suggest that this sequence should be recommended.[3],[4],[5]
| References | | |
| 1. | Tomas R, Javier GA, Maria J, et al. Gastrointestinal Bezoars : Sonographic and CT Characteristics. AJR 2001, 177: 65-69.  |
| 2. | B. Newman and B. R. Girdany. Gastric trichobezoarsonographic and computed tomographic appearances. Pediatric Radiology 1990, 20:526-527. |
| 3. | Gabriela G, Talijonas, et al. Bezoar in stomach and small bowel-CT appearance. Clinical Radiology, 1999, 54, 228-232. |
| 4. | Maria Sinzig, Heinz W, et al. Gastric Trichobezoar with gastric ulcer: MR findings. Pediatric Radiol, 1998, 28, 296. |
| 5. | Lee JM, Jung SE. Small bowel obstruction caused by Phytobezoar MR Findings. AJR 2002, 179: 538-39. |
Correspondence Address:
A Sharma
C 10 Kendriya Vihar Sector 51 Noida 201307
India
 Source of Support: None, Conflict of Interest: None  | Check |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10] |
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