Purpose or Case Report: Duodenal atresia (DA) results from failure of recanalization of the solid core of the duodenum, usually diagnosed as the classic “double bubble”. It may come in solitary or associated with other congenital abnormalities. The aim of this educational exhibit is to describe and demonstrate common and uncommon presentations of prenatal DA and associated anomalies with emphasis on fetal MR findings.
Methods & Materials: 57 fetal MRI exams with findings of DA were identified. Prenatal and postnatal imaging findings were evaluated, and chart review was performed. When available, pathology results are included.
Results: Fetal MRI accurately diagnosed most cases of DA. Mimickers will be discussed in the exhibit, including a gastric duplication cyst posing as a “double bubble” and a preduodenal portal vein resulting in duodenal obstruction. Unusual presentations of DA will also be demonstrated, including a case with complete decompression of the stomach and duodenum and an erroneously diagnosed choledochal cyst, likely representing the abnormal duodenum. Concomitant esophageal atresia cases are presented, one of them prenatally interpreted as gastric hernia. Other associated anomalies include biliary atresia, MCDK (multicystic dysplastic kidney), and cloacal malformation with meconium and urine intermixing and presence of enterocoliths at fetal MRI. Neurological anomalies seen prenatally include agenesis of the corpus callosum, microcephaly and lissencephaly. The most common associated syndromes include Trisomy 21, Turner and VACTERL.
Conclusions: Fetal MRI provides accurate diagnosis of DA and helps delineate coexisting anomalies. Identification of associated abnormalities helps facilitate prenatal parental counseling, as well as pre- and postnatal surgical planning.