José Vilar and Friends Case 3 (Update: Solution!)

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

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    Feb 2019
    DISCUSSION 17 Comments

    17 Responses to : José Vilar and Friends Case 3 (Update: Solution!)

    1. moha mad says:

      hiatal hernia

    2. Rafat says:

      I think there is some thing in the stomach look its good contoring like calsification around wall

    3. Thomas Savage says:

      Rim like calcification in left upper quadrant. Differential adrenal mass ( neuroblastoma, adrenocortical carcinoma), renal (Wilms), congenital cyst, lymphatic malformation.

    4. Trinity says:

      Good morning sir.
      Chest radiograph PA view shows

      • Trinity says:

        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


        • Jose Vilar says:

          Excellent! You did see the main finding but the retrocardiac region is ok. Any other ideas?

    5. Fingers crossed says:

      Hydatid cyst?

    6. jose vilar says:

      Good guess! Hydatid cyst was in our differential but….

    7. Yul says:

      Neumotorax anterior izquierdo

    8. jose vilar says:

      frio frio Yul…

    9. Mauro says:

      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?).

    10. Jose vilar says:

      Not vascular but yes Mauro its cystic partly . Keep looking

      • Mauro says:

        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.

    11. husam vehbi says:

      Left adrenal cystic mass with peripheral calcification They are often the sequellae of prior adrenal trauma or hemorrhage.

    12. husam vehbi says:

      Left adrenal cystic mass with peripheral calcification They are often the sequellae of prior adrenal trauma infection or hemorrhage.

    13. Sanvyd says:

      Left adrenal haemorrhage associated with Streptococcal pneumonia-Waterhouse-Friderichsen syndrome .Subsequent adrenal necrosis and then dystrophic calcification.