0:01

So this was an infant who, uh, came for ultrasound imaging

0:05

to follow up an abnormality on prenatal ultrasound.

0:08

So a cystic mass was noted in the abdomen of the fetus,

0:12

and we were asked to get a better assessment of

0:14

what the lesion was postnatally.

0:16

So she came to abdominal ultrasound

0:18

and you can almost immediately see this abnormal cystic

0:22

lesion in the right upper abdominal quadrant.

0:25

It looks separate from the liver parenchyma.

0:28

And when we look at the wall of this structure,

0:30

it has this sort of Big Mac

0:33

or Oreo cookie look to the wall of this structure

0:36

with multiple layers.

0:38

Um, so this is pretty classic.

0:40

We call it gut signature at ultrasound.

0:42

Um, and the, this cystic structure does contain a little bit

0:46

of heterogeneous, uh, genic debris internally,

0:50

but that gut signature helps us to be really confident

0:52

that this is just a gastrointestinal duplication cyst.

0:56

Um, uh, so you know, no, uh,

1:00

no other like mass effect on other structures.

1:03

Um, other things to put in our differential are,

1:05

could this be, um, in utero, ovarian torsion, um, that will

1:10

be located more in the pelvis rather than in, uh,

1:13

in the peritoneal cavity in the abdomen.

1:17

Um, and you should be able to find, um, ovaries

1:21

or a lack thereof in the, in the setting

1:23

of neonatal ovarian torsion.

1:25

Um, here you can see this is a pretty large

1:27

duplication cyst.

1:29

Up to five centimeters in this tiny little baby is,

1:31

is nearly half of the abdomen.

1:34

Other things that you wanna rule out, a duplication, uh,

1:37

a chodo cyst could give this appearance,

1:39

but you would expect that cystic structure

1:41

to be at the Port of Haus.

1:43

Um, 'cause chodo cysts are involving, uh, the, uh,

1:46

common bile duct if they are extra hepatic location.

1:50

Um, this is located within the,

1:52

like peritoneal cavity itself within the right mid abdomen.

1:55

So really not much of a differential after imaging.

1:58

This is a, a pretty classic

1:59

gastrointestinal duplication cyst.

2:02

This patient did go on to MRI imaging

2:05

because there were a couple of other questions that the,

2:07

the team and, um, the,

2:09

the parents were pretty nervous about

2:10

this, about this lesion.

2:12

And so she, she did go to MRI prior to surgical removal

2:17

and uh, you can see, uh, a nice correlate on this MRI

2:21

of this duplication cyst.

2:22

It's just kind of chilling here in the

2:25

center of the abdomen.

2:26

There's normal looking bowel loops surrounding it.

2:28

We do have some fluid filled colon here in the right upper

2:31

abdomen, but you can definitely tell it's not a co double

2:34

cyst 'cause it's not anywhere near the Porta Haus.

2:36

We have a collapsed gallbladder here

2:38

as we continue inferiorly just to show you

2:40

that this is completely also separate from the ovaries.

2:43

So we have, uh, normal uterus here, um, in the pelvis,

2:47

normal urinary bladder.

2:49

And then we have, uh, uh, right ovary over here, um,

2:53

with se several physiologic follicles.

2:56

We don't have a great look at the

2:57

left ovary, but we did see,

2:59

Um, left ovary on, on a different ultrasound.

3:02

So a classic duplication cyst.

3:05

This patient did get contrast, um,

3:07

which wasn't necessarily needed,

3:10

but uh, again, no enhancement

3:12

of this large duplication cyst,

3:14

but all other, uh,

3:16

structures in the abdomen have normal enhancement

3:18

including the kidneys.

3:20

Um, one other thing just to point out on this, um,

3:25

newborn MRI is

3:27

that there is some cirrhosis of this liver.

3:31

So if you look at this liver, it is

3:33

lower in signal than we would expect.

3:36

Um, and that is a normal finding in a newborn over the first

3:40

several months of life.

3:41

If you look at a liver of, uh, of a newborn,

3:44

there is normal cirrhosis.

3:46

So there is increased iron content of a newborn liver.

3:50

So just be careful. Don't over call that as being a

3:53

concerning for gestational alloimmune Liver disease

3:57

formally called, uh, neonatal hemochromatosis is normal

4:00

to have iron, uh, increased iron content in the liver.

4:03

So if the concern is neonatal hemochromatosis, you have

4:07

to look at other organs, namely the pancreas,

4:09

or they'll do a buccal biopsy actually clinically.

4:12

Um, we don't have a role of, of, uh,

4:15

sampling the buccal content at imaging.

4:17

But just important to note

4:18

that low signal liver is normal in a newborn.