Subcutaneous fat necrosis of the newborn (SCFN) is an infrequent, self-limiting panniculitis observed in neonates. We report an unusual presentation of SCFN in a premature infant who developed a progressively enlarging mass in the supraclavicular region. Lesions commonly develop on the shoulders, back, buttocks, thighs, and cheeks. The patient was a male infant born via emergency cesarean delivery at 30 weeks and 6 days gestation due to fetal distress. Maternal history was significant for diabetes. His postnatal course was complicated by hypoglycemia, episodes of apnea associated with hypoxia, and hypotension. Physical examination revealed a firm, non-tender, subcutaneous mass without overlying skin changes in the left supraclavicular area. Ultrasonography demonstrated ill-defined thickening of the subcutaneous fat with heterogeneous echogenicity and internal blood flow. MRI showed reduced T1 signal intensity lower than that of normal fat and increased signal on T2 and fat-suppressed T2 sequences, indicating abnormal subcutaneous fat. The differential diagnosis included SCFN, infantile myofibromatosis, embryonal rhabdomyosarcoma, hemangioma, and neurofibroma. Embryonal rhabdomyosarcoma is the most prevalent tumor affecting young children. Unlike subcutaneous fat necrosis, however, rhabdomyosarcoma typically arises after the first few months of life. It usually presents as a solitary, rapidly growing, firm mass involving striated muscle. Infantile myofibromatosis commonly involves multiple sites, including the bone, lungs, heart, and gastrointestinal tract. Given the infant’s prematurity and clinical history of perinatal hypoxia, metabolic derangements, and maternal diabetes, SCFN was considered the most likely diagnosis. While SCFN resolves spontaneously, the most significant potential complication is hypercalcemia, which occurs in approximately 28% of cases. Additionally, renal ultrasound should be performed to assess nephrocalcinosis and nephrolithiasis. In summary, subcutaneous fat necrosis may be present in premature infants with relevant perinatal risk factors. Its clinical and radiologic features can mimic neoplastic or infectious conditions. It is essential for radiologists to recognize the clinical and imaging characteristics of this rare condition to enable timely diagnosis and avoid unwarranted surgical intervention. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Zawin Joan, Buyukkaya Ayla

Keywords: Soft Tissue Mass, MR, Ultrasound

Menetrier’s Disease is a rare form of hypertrophic gastropathy characterized by excessive mucous secretion, protein loss, and enlarged gastric folds. It poses a diagnostic challenge due to its nonspecific clinical presentation and is often misdiagnosed as more common gastric disorders. Although more prevalent in adults, pediatric cases—frequently associated with cytomegalovirus (CMV) infection—can present acutely and typically resolve spontaneously. We present a case that underscores the importance of recognizing this rare condition in children to ensure timely diagnosis and appropriate management. A previously healthy 3-year-old boy presented with vomiting, anorexia, wet cough, and prominent periorbital and peripheral edema. Laboratory tests revealed hypoproteinemia, hypoalbuminemia, and elevated stool α1-antitrypsin levels, suggestive of protein-losing enteropathy. CMV viremia was detected, with no leukocytosis or peripheral eosinophilia. Imaging studies, including abdominal ultrasound and computed tomography, revealed thickened and hyperemic gastric walls, moderate abdominopelvic ascites, and pleural effusion. CT demonstrated markedly enlarged and tortuous gastric folds in the fundus and body, particularly along the greater curvature, with sparing of the antrum and preserved gastric wall thickness between folds. The presence of tiny cystic structures within the thickened folds, likely representing hypertrophied glands, helped differentiate the condition from solid gastric tumors. The differential diagnosis included eosinophilic gastritis, infectious gastritis (e.g., Helicobacter pylori), Crohn’s disease, Zollinger-Ellison syndrome, gastric lymphoma, gastrointestinal stromal tumors (GISTs), and familial protein-losing enteropathy. Upper gastrointestinal endoscopy confirmed the presence of enlarged polypoid folds in the fundus and body with mucosal hyperemia—findings consistent with Menetrier’s Disease. This case highlights a classic presentation of pediatric Menetrier’s Disease associated with CMV infection. Recognition of its characteristic features and self-limiting nature in children is crucial to avoid unnecessary diagnostic procedures and interventions. Supportive care remains the cornerstone of treatment. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Buyukkaya Ayla, Zawin Joan

Keywords: Stomach, Abdomen CT, Ultrasound

Case Report Duodenum inversum is an uncommon congenital anomaly, in which the duodenum ascends to the level of the duodenal bulb, then passes posteriorly before crossing the midline above the pancreas. This condition is thought to result from the persistence of the dorsal mesentery, leading to increased mobility of the duodenum. It is frequently associated with fixation or positional anomalies of the right kidney, pancreas, and transverse mesocolon. Diagnosis is typically made via upper gastrointestinal (GI) series or laparoscopy, but may be delayed or overlooked if the configuration of the proximal duodenum is not carefully evaluated. Although often asymptomatic, when symptoms such as vomiting, abdominal pain, or signs of obstruction are present, accurate diagnosis through imaging is essential for appropriate management. Awareness of this condition can help differentiate it from disorders such as malrotation, duodenal obstruction, or superior mesenteric artery (SMA) syndrome, and prevent potential complications associated with misinterpretation of imaging findings. Associated conditions can include pancreatitis, gallbladder disease, duodenal ulcer, and, more rarely, gastric ulcer. Many of these symptoms are believed to result from stasis within the duodenal loop. We present the case of a 1-year-old child with a history of hypoxic ischemic encephalopathy, who underwent upper GI imaging for evaluation of vomiting that had worsened over the past two weeks. On imaging, the first and second portions of the duodenum appeared normal. However, the third portion of the duodenum did not cross the midline, as would be expected. Instead, it ascended on the right side of the spine, posterior and parallel to the descending duodenum, reaching the level of the duodenal bulb. It then completed a transverse course to the left upper abdomen, where the duodenojejunal junction was appropriately located on the left side of the spine, at the level of the duodenal bulb findings consistent with duodenum inversum. Treatment is primarily medical in the absence of obstruction. In cases where obstruction is attributed to SMA syndrome, transpyloric feeding is considered. Surgical intervention is reserved for cases of obstruction caused by fibrotic bands, in which a partial Ladd’s procedure may be performed. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Zawin Joan, Buyukkaya Ayla

Keywords: Abdominal Imaging, Duodenum, Upper GI Study