Murphy Ryan,  Murati Michael,  Holm Tara,  Dietz Kelly

Final Pr. ID: Poster #: EDU-012

The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist.

Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More

Authors:  Murphy Ryan , Murati Michael , Holm Tara , Dietz Kelly

Keywords:  anterior meningocele, low flow vascular malformation, enteric cyst

Ng Evonne,  Dawani Anuradha

Final Pr. ID: Poster #: CR-022

Enteric Duplication cysts (EDCs) are uncommon congenital anomalies of the alimentary tract. These can arise from anywhere along the gut including the foregut, midgut and hindgut duplications with most common location being ileum. Majority of the EDCs are symptomatic within the first 2 years of life and early surgery is the treatment of choice for symptomatic EDCs. Radiologically, gut signature sign is pathognomonic on the ultrasound for the more common (80%) cystic/spherical EDCs. However, the less common (20%) tubular subtype can be difficult to interpret on imaging and mimics other pathologies. We present an atypical case of a long tubular duplication cyst in an infant that posed imaging diagnostic challenge.
An 8 week old female child presented with fresh red blood in stools, intermittent drawing up of legs and tachycardia with low dropping haemoglobin levels. Intussusception was suspected clinically and ultrasound was initially performed which showed a grossly dilated (up to 4 cm diameter) small bowel loop in left abdomen with mild wall thickening and hyperemia. Rest of the bowel was normal. Incidentally, gall bladder duplication was noted. Subsequently, CT was also performed to delineate the full extent of the abnormality which demonstrated similar findings of a very long segment of dilated jejunal loop with features of enteritis and possibility of congenital segmental intestinal dilatation was considered. Surgery revealed that the dilated bowel loop was in fact a tubular EDC intimately associated with a long segment of jejunum approx. 45 cm in length and complete resection with end to end anastomosis was done.
Our case highlights that the tubular subtype of enteric duplications cysts is a rare entity that poses a diagnostic challenge and must be included as plausible differential diagnosis in the appropriate clinical setting and supporting imaging features. Read More

Authors:  Ng Evonne , Dawani Anuradha

Keywords:  Abdominal Imaging, Bowel, Enteric Cyst