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Case 1
Two-day-old girl with bilious
.emesis
There is abnormal position of the •
duodenum; and there is a corkscrew
configuration of contrast as it passes
.through the proximal small bowel
Malrotation /midgut volvulus
Normally, a long, fixed small bowel mesenteric root attachment runs from the duodenojejunal junction in
the left upper quadrant to the cecum in the right lower quadrant
With malrotation, duodenojejunal and ileocecal junctions are malpositioned, with resulting short small
bowel mesentery base prone to volvulus
Malrotation also predisposes to duodenal obstruction due to paraduodenal hernias or Ladd bands
(peritoneal reflections crossing duodenum and extending to the inferior liver or posterior wall of the
)abdomen
Compromise of superior mesenteric vessels may occur with volvulus, which can result in small bowel
.ischemia and necrosis
Midgut volvulus results in death in at least 15% of cases
High incidence of morbidity in survivors from short gut syndrome and dependence on TPN leading to
cirrhosis
May present at any age, but 60% present by one month of age
Present with bilious vomiting
:Diagnose with upper GI
:Malrotation
Abnormally positioned duodenojejunal junction
Right of spine
Inferior to the duodenal bulb
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Jejunum in the right abdomen
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:Midgut Volvulus
Proximal small bowel obstruction or corkscrew pattern as contrast traverses the proximal jejunum in right or mid upper
abdomen
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Treatment is surgical
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Case 2
Routine prenatal ultrasound in healthy •
.thirty-year-old
There is a large occipital :Findings
encephalocele, containing mixed solid and cystic
areas. The calvarial defect is between 1-2 cm,
through which brain tissue is seen to herniate
:Differential Diagnosis
Occipital encephalocele
Cystic hygroma
Teratoma
Branchial cleft cyst
Scalp edema
Epidermal scalp cyst
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:Occipital encephalocele
An encephalocele results from failure of the surface
ectoderm to separate from the neuroectoderm.
The final result is a bony defect in the skull table,
which allows herniation of the meninges (cranial
.meningocele) or herniation of brain tissue
Encephaloceles represent 10-15% of all neural tube
.defects
Of encephaloceles, occipital encephaloceles are
.most common (75-80%). 90% are midline
The absence of brain tissue within the herniated sac
is the single most favorable prognostic feature for
.survival
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Case 3
.Woman with breast cancer •
Initial MRI of the brain shows numerous enhancing lesions :Findings
scattered throughout the calvarium, consistent with metastatic bony
involvement. There is also diffuse enhancement of the pachymeninges.
There are no enhancing parenchymal lesions. Newer MRI of the brain
shows confluent periventricular deep white matter FLAIR and T2 hyper
intensities. There are no abnormal parenchymal lesions or enhancement.
There is mild volume loss. There was no restricted diffusion (images not
shown) to suggest infarct. Again seen are heterogeneous and enhancing
.calvarial lesions
:Differential Diagnosis
Post radiation white matter disease
Microvascular disease
Age related white matter changes
Tumor edema from metastatic or primary neoplasm
Diffuse infectious process
Diffuse inflammatory process
Post radiation white matter injury. Metastatic disease to the :Diagnosis
.calvarium
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Case 4
Salient findings include :Findings •
overgrowth of the soft tissues and bones
of the fourth and fifth digits with tuft
expansion, periarticular osseous
projections and degenerative changes of
.the interphalangeal joints
Macrodystrophia lipomatosa :Diagnosis
:Differential diagnosis •
Neurofibromatosis –
Klippel – Trenaunay – Weber syndrome –
Lymphangiomatosis –
Hemangiomatosis –
Macrodystrophia lipomatosa –
Fibrolipomatous hamartoma of the nerve –
Case 5
Plain films show an aggressive appearing :Findings •
permative destructive mass involving the proximal fibula.
On the MRI, there is a lobulated, heterogeneous mass
that extends superiorly to the growth plate, but not into
the growth plate. There is mixed signal throughout the
lesion. There is periosteal reaction and abnormal
enhancement within bone marrow of the fibula distal to
the tumor. Blood-fluid levels are evident, consistent with
.telangiectatic osteosarcoma
Telangiectatic osteosarcoma :Diagnosis
:Differential diagnosis •
:Sarcomatous tumors –
Osteosarcoma
Ewings Sarcoma
Angiosarcoma
Fibrosarcoma
Malignant fibrous histiocytoma
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Lymphoma –
)Giant cell tumor (GCT –
Metastasis –
Case 6
Case 6
IVP demonstrates a dilated :Findings •
distal left ureter with mild tortuosity and a
filling defect in the left bladde
Transitional cell carcinoma of :Diagnosis •
bladder