0:00

Let's do one more case.

0:03

I'm really happy that we're doing this case because

0:07

I'll just be honest with you. I mucked up this case and I needed my smarter

0:10

colleagues to help me with this one. So hopefully we can we will

0:13

muck it up again 27 year old female got a

0:16

that was a non contrast CT had an indeterminate Mass

0:19

on the left of a quadrant. They got an ultrasound. We

0:22

distilled a nose going on got the Mr. I happen to

0:25

look at it. I still don't know what's going on, but I needed some people

0:28

to bail me out.

0:29

And now that I've seen this case my hope is that

0:34

I will always get this correct, but

0:37

We're all human so I never say always right so let's

0:40

go through this. So here we go young female. I think I forget

0:43

the age of young female. Otherwise, no past medical history and

0:46

determine a mass scene.

0:48

And the group needs to tell me.

0:52

what they think this mass is

0:59

t2aded image. Let me show you two fats that.

1:08

It's going to pre contrast.

1:16

and post

1:29

maybe a coronal help.

1:38

Alright pseudocyst we're looking where's left

1:41

real implication system. Okay minded cystic lymphatic

1:44

cyst, which we don't mind your light bulb sign here.

1:47

Eventually duplication system. Okay. Yeah people are

1:50

gastro duplications

1:52

Are people are on the right track angling? Neuroma? Good good.

1:55

Okay, and so let me show you the left adrenal gland. I

1:58

think somebody was asking about that. I think it's a very very good thought

2:01

to let's find it. Let's see where it is it.

2:10

Here it is.

2:15

one limb

2:17

one limb

2:20

Suppose, it's tough. You know, I mean I

2:23

Looking for a claw sign. I don't know if I quite see it. Maybe

2:26

the Chronos will help.

2:33

Yeah, see adrenal gland right there.

2:36

So I suppose if it's a rising from the adrenal client.

2:39

It's quite a synthetic. But to be honest, I'm not quite seeing a call. I have

2:42

a nice claw sign here.

2:45

Which particularly see if I did? Yeah, that's a

2:48

really good thought I gotta tell you. I love these answers because I went

2:51

through every single one of these and and you

2:54

know, so that was my sales. So I would

2:57

say that first, excuse me. My approach to

3:00

this case is sort of describing the location right? It's it's it's located between

3:04

a bunch of organs right but I don't really thought I didn't really

3:07

think there's a rising for many of the organs. Somebody talked

3:10

about pseudosis. I thought that's a good thought.

3:12

Patient knows your power pancreatitis and you know, let's assume that

3:15

they know their history well and so be kind of unusual just have a Serial

3:18

assist that's arising like that. Some people have talked about neurogenic tumors.

3:21

Listen. I thought that was a very reasonable possibility a

3:26

neurogenic tumor. In fact, that's what I favored. That's what

3:29

this was going to be.

3:31

I thought of things like ganglia neuroma, you know, some people

3:34

have talked about that stuff and well levangioma

3:37

is a possibility. I find those

3:40

tend to not like this almost looks like it has some sort

3:43

of Mass Effect and pushing things away. We're so sort

3:46

of insinuated a little bit. So I don't know if I liked it

3:49

for lymphangioma, you know in terms of just a way and had more

3:52

of like a mass effect to it. But but I

3:55

think it's a good thought of you know, you have

3:58

this what amounts to a cystic mass and you know this location what

4:01

it could be

4:03

And I thought there may be some low level enhancement. You

4:06

know, when I showed it to my group they weren't entirely convinced maybe some

4:09

of the slow level enhancement. But the problem was that you look

4:12

at the gallbladder. We should have no enhancement. There's also a little bit of supposed low

4:15

level enhancement here. So maybe it's just some motion and

4:18

and and and misregistration that

4:21

is accounting for that. But really this is a cystic lesion

4:24

and diaphragmatic system.

4:27

I think a lot of people are getting many people have gone to the

4:30

right diagnosis. And and so I

4:33

won't I won't torture the group anymore, by the way, if anyone I

4:36

think during which it's been a favorite diagnosis that we've talked about today,

4:39

but I'm sure and not in this case, but this didn't have any fat in

4:42

it so

4:44

This turns out is a very specific. It's

4:47

quite a

4:50

specific look for a bronchogenic retroperitoneal

4:53

bronchogenic cyst. And

4:57

I remember seeing one case of this

5:00

at some point.

5:02

And then this is a second case. And so this case I'd seen a while

5:05

ago. I forgot about and so when I saw this, I mean this is what they look like.

5:08

They're there are four good duplications as many people mentioned in the talk.

5:11

So I'm sure you guys are all over it oftentimes. You'll

5:14

see the more in the chest really they

5:17

mean the Retro parents name and if you look at the reports out there in the literature,

5:20

they all kind of look like this. There's someone you know allocular, they're

5:23

solitary. They may have a little bit of debris which this one didn't but

5:26

it's just like weird location. That's to Jason to

5:29

the left adrenal gland and then the next common. It's like just post here

5:32

to the pancreas and this sort of followed both and it's often asymptomatic

5:35

incidental if it's large you can compress things and

5:38

cost symptoms. But for the most part the importance of

5:41

just knowing if you see a simple appearing cystic mass

5:44

in this location

5:46

that don't go wild and

5:49

start to just sting potentially these crazy diagnoses where

5:52

they have to go in and do something aggressive about

5:55

It may end up being that depending on the Imaging. I

5:58

don't know what it looks like. But if it looks simple like this, there is

6:01

an entity that can live here.

6:04

And that's what this is what this turns out to be.

6:09

Okay, and so with that?

6:12

In ultrasound image showing. Yeah. Bronchogenic Oh,

6:15

I thought

6:18

those maybe the enteric this maybe a little bit more classic. I'm not

6:21

sure I forget the bronchogenics as well have the same bowel gut signature. I don't

6:24

I got feelings that they won't but if you know better

6:27

than all over I'll defer to you. So what

6:30

are the take points of some of the case that we saw today? Let me just

6:34

close up here.

6:36

Oops here. So we saw a case of tumor and

6:39

undescended testicles. So look at the somatic course look at the vesicles. Remember

6:42

CF has uncommon GI manifestations try

6:45

to remember one or two of them from the talk. We all were all over

6:48

the fmd or all over the maritzi so I don't need to go there.

6:51

Remember naturally carcinoma young patient infiltrative Mass. Maintaining

6:54

the shape of the kidney with lots of Mets everywhere.

6:58

Remember to scrutinize bowel for sites of the primary carsto tumor the

7:01

group knows how to see the mesenteric mass. But taking a

7:04

step further to see if we can identify the mass and the bowel that makes cases a lot

7:07

more interesting challenging and of course, it's most importantly

7:10

good for our patient in our providers and the

7:13

group seem to know this but this is

7:16

certainly learn lesson for me cystic mass that

7:19

Jason left you're gonna look simple consider the structure parent, you know

7:22

broncogenexist.

7:24

so

7:25

I truly thank the Cooper engagement. This would

7:28

not be possible without the engagement of this group. And I hope

7:31

you learned something. I certainly learned a lot from from chatting with

7:34

you. And I really appreciate you attending

7:37

today. I'll stick around for a little bit if anyone wants to

7:40

chat.