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Case 45 - Choledochal cyst
- from Section 5 - Gastrointestinal imaging
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- By Gregory Cheeney, University of Washington, Heike E. Daldrup-Link, Lucile Packard Children's Hospital, Stanford University
- Edited by Heike E. Daldrup-Link, Beverley Newman
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- Book:
- Pearls and Pitfalls in Pediatric Imaging
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp 201-204
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- Chapter
- Export citation
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Summary
Imaging description
A seven-year-old boy presented with nausea, right upper abdominal pain, and jaundice. An initial ultrasound (not shown) demonstrated a cystic lesion in the area of the porta hepatis, separate from the gallbladder. Axial and coronal T2-weighted MR images and 3D MRCP demonstrated fusiform dilatation of the central hepatic ducts and the common bile duct, consistent with a type I choledochal cyst (CC) (Fig. 45.1a–k). The intrahepatic bile ducts appeared normal in caliber. There was no evidence for choledocholithiasis or pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) confirmed contrast filling of a fusiform dilated common bile duct without associated dilatation of the intrahepatic bile ducts (Fig. 45.1).
Importance
CCs represent congenital dilatation(s) of the extrahepatic and/or intrahepatic biliary system. The initial diagnostic workup usually entails an abdominal ultrasound, which demonstrates an anechoic cystic structure in the region of the porta hepatis, separate from the gallbladder. Depending on the extent of the cyst, five different types are recognized according to the classification system of Todani (Fig. 45.2). Type I is the most common type, comprising 80–90% of CCs, and representing a fusiform or cystic dilatation of the extrahepatic biliary system. A mild, secondary dilatation of the more proximal intrahepatic biliary system may be visualized; however, the more peripheral intrahepatic bile ducts are typically not dilated.
Case 62 - Nephroblastomatosis
- from Section 6 - Urinary imaging
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- By Gregory Cheeney, Stanford University, Rakhee Gawande, Stanford University, Beverley Newman, Lucile Packard Children's Hospital, Stanford University, Heike E. Daldrup-Link, Lucile Packard Children's Hospital, Stanford University
- Edited by Heike E. Daldrup-Link, Beverley Newman
-
- Book:
- Pearls and Pitfalls in Pediatric Imaging
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp 260-263
-
- Chapter
- Export citation
-
Summary
Imaging description
A four-year-old boy presented with large palpable flank masses bilaterally. An ultrasound (not shown) revealed bilaterally enlarged kidneys with homogeneous low echogenicity, resembling renal cortex. A contrast-enhanced CT was performed which showed a thick rim of non-enhancing, homogeneous soft tissue, surrounding centrally enhancing renal parenchyma (Fig. 62.1). Bilateral homogeneous non-enhancing soft tissue surrounding the renal parenchyma is a typical finding in diffuse bilateral nephroblastomatosis. Another patient with a similar presentation is shown in Figure 62.2. In this case, axial contrast-enhanced CT images demonstrate multiple lenticular, uniform, non-enhancing lesions in the renal cortex (Fig. 62.2), consistent with the more common multifocal type of nephroblastomatosis. On CT, focal nephroblastomatosis appears as low attenuation, subcapsular, or intraparenchymal lesions with poor enhancement relative to that of adjacent normal renal parenchyma. On MRI, focal nephroblastomatosis demonstrates low to intermediate signal intensity foci on both T1- and T2-weighted sequences. Both types of nephroblastomatosis typically resemble the normal renal cortex with regard to their echogenicity on ultrasound, and density and signal intensity on unenhanced CT and MRI. After contrast media injection, however, the lesions typically show no or only minimal enhancement. Contrast administration is helpful in differentiating nephroblastomatosis from Wilms’ tumor. The latter is typically inhomogeneous and enhances after contrast media administration.