Dear friends,
Warming up after the last case, here we are presented with a case of a 6-year-old boy with suspected pneumonia (cough and fever).
This case was shown to me by Dr. José Vizuete and Gregorio Martin; two former residents and now excellent radiologists at Dr. Peset Hospital.
What do you see from the image? Where is the pathology?
Just a little help in this case from my friend and colleague Dr José Vizuete
Two images of an abdominal MRI study in this young patient.
Any ideas?
The solution will come soon…
Click here for the answer
There are no signs of pulmonary infection, but if you look closely at the left sub phrenic region there is a curvilinear calcification (white arrows).
An abnormal calcification in the abdomen in a child should alert and move you to discard abdominal pathology.
MRI showed a left adrenal mass partially cystic but with nodules that enhanced with contrast.
MRI: Coronal T2, axial STIR, axial diffusion and axial T1 with contrast. The lesion shows peripheral areas of hypointensity due to the calcified capsule (a), restricted diffusion (b) and peripheral hyperintense nodules (c) that enhance in the T1 sequence (d): (red arrows).
DIagnosis: Ganglioneuroblastoma.
Teaching point: Upper abdominal pathology can be seen in chest radiographs,
especially when the lesion contains calcium.
Comment: Hydatid cyst was initially included in the differential diagnosis, but the presence of enhancing nodules discarded this choice.
Suprarenal Hydatid cyst ( Left subphrenic curvilinear calcification). MR: Peripheral rim of enhancement but no enhancing nodules).
hiatal hernia
I think there is some thing in the stomach look its good contoring like calsification around wall
Rim like calcification in left upper quadrant. Differential adrenal mass ( neuroblastoma, adrenocortical carcinoma), renal (Wilms), congenital cyst, lymphatic malformation.
Good morning sir.
Chest radiograph PA view shows
A well defined opacity in left paraspinal region with peripheral curvilinear rim of calcification. The left retrocardiac region also shows a non homogeneous opacity with left hilar lymphadenopathy as it is increased in size and density.No erosion of underlying ribs seen.
D/d 1. Extralobar pulmonary sequestration.
2. Subsegmental pneumonia LLL
Regards.
Excellent! You did see the main finding but the retrocardiac region is ok. Any other ideas?
Hydatid cyst?
Good guess! Hydatid cyst was in our differential but….
Neumotorax anterior izquierdo
frio frio Yul…
Hello.
The lesion projected on the left upper quadrant of the abdomen could be vascular in origin (splenic artery aneurysm?), or a cyst with calcified walls (hydatid? Secondary to previous adrenal hematoma?).
Not vascular but yes Mauro its cystic partly . Keep looking
The MR demonstrates this complex solid cystic mass and there seems to be signal loss in the T2 fat sat sequence. I favour this to be neoplastic, likely a primary adrenal teratoma.
Very good Mauro, you are almost there! Remember this is a child.
Left adrenal cystic mass with peripheral calcification They are often the sequellae of prior adrenal trauma or hemorrhage.
Left adrenal cystic mass with peripheral calcification They are often the sequellae of prior adrenal trauma infection or hemorrhage.
Left adrenal haemorrhage associated with Streptococcal pneumonia-Waterhouse-Friderichsen syndrome .Subsequent adrenal necrosis and then dystrophic calcification.