Peds abd cysts

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  • These patients also have a normal pancreaticobiliary junction.
  • Pancreatic pseudocyst
  • Peds abd cysts

    1. 1. Asha Sheth, MD June 25,2014
    2. 2. What is a cyst? Types of cysts Differentials Imaging appearances
    3. 3.  Closed pocket or pouch of tissue  It can be filled with air, fluid, pus, or other material
    4. 4.  Thin /Thick walled  With / Without wall calcifications  Regular/ Irregular in shape  Small / Large in size  With / Without internal septa • Thin / Thick • Single / Multiple  With /Without Solid component
    5. 5.  HEPATOBILIARY • Choledochal Cyst • Gallbladder Hydrops  GASTROINTESTINAL • Duplication Cyst • Omental/Mesenteric Cyst  URINARY TRACT • Renal /parapelvic Cyst • Severe Hydronephrosis/Pelviureteric junction Obstuction. • Cystic Wilm’s Tumour (rare) • Urachal Cyst
    6. 6.  ADRENALS • Resolving adrenal heamorrhage • Cystic neuroblastoma/Ganglioneuroma(rare)  PANCREATIC • Pancreatic pseudocyst  PELVIC • Ovarian Cyst • Teratoma/Dermoid Cyst • Anterior Meningocele • Abscess
    7. 7.  CHOLEDOCHAL CYST  GALLBLADDER HYDROPS
    8. 8.  Congenital dilatations of the biliary tree  Most cause symptoms in childhood and adult life  Todani’s classification • Type I- Fusiform • TypeII- Diverticulum • Type IlI- Choledochocele of intraduodenal common bile duct • Type IV- Extra- and intrahepatic cysts • Type V- Intrahepatic dilatations (Caroli’s Disease)
    9. 9.  Complications include cholangitis, biliary calculi, pancreatitis and biliary cirrhosis  Biliary tree dilatation or cyst can be seen on Ultrasound or CT  99mTc-HIDA scinitraphy will show accumulation of tracer within the cyst  Percutanous or endoscopic cholangiography and MRCP are helpful in preoperative planning
    10. 10. Fusiform choledochal cyst with a long common channel and associated stricture at the pancreaticobiliary junction.
    11. 11. Ultrasound study shows a cystic mass between pancreatic head and the gallbladder. Smooth wall and homogeneous anechoic contents, tortuous cystic duct that joins the gall bladder to the cystic mass
    12. 12.  Duplication Cyst  Omental/Mesenteric Cyst
    13. 13.  May occur anywhere along the gastrointestinal tract  The most frequent sites of duplication are the ileum, followed by esophagus, stomach, duodenum and jejunum • 1/3rd of cases involve the distal small bowel  Colonic and rectal duplications are rare  Etiology is incomplete recanalization around 8 weeks gestation  Cysts lined with GI epithelium
    14. 14. Can be spherical or tubular Most duplications do not communicate with the adjacent bowel, although there is a higher incidence of persistent communication in tubular anomalies Presentation depends on the site of duplication and its size Incidental ultrasound finding in the first few years of life
    15. 15.  Large cysts, especially those associated with the stomach or duodenum, may present with • Abdominal pain • Obstruction • Vomiting  Can serve as lead point for intussusception  Be a source of gastrointestinal bleeding from ectopic gastric mucosa
    16. 16.  Abdominal radiographs may show mass effect with displacement of adjacent bowel loops  Ultrasound demonstrates a simple anechoic or hypoechoic cyst • characteristic 'gut-wall signature'  TREATMENT: Surgical resection
    17. 17. Abdominal x-ray of a patient with a duplication cyst. Note the mass effect of the cyst pressing against the areas of colon (arrows).
    18. 18. Simple cystic mass with characteristic gut wall signature
    19. 19. Gastric duplication cyst causing gastric outlet obstruction in a pediatric patient
    20. 20. Contrast-enhanced computed tomography image of the abdomen showing a well- circumscribed, low-attenuation fluid collection seen in relation to the greater curvature of the stomach with rim enhancement, suggestive of an intestinal duplication cyst
    21. 21.  Developmental anomalies of the lymphatic system arising within the mesentery or omentum  Presentation is similar to duplication cysts  Ultrasound is more likely to show a multiloculated cyst with thin septations  Require surgical resection
    22. 22. Mesenteric cyst CT demonstrating a large left-sided cystic abdominal mass with compression of the left kidney. Ultrasound showed multiple fine septations within the cyst
    23. 23. Lymphangioma has enhancing septa. Unlike in cystic peritoneal metastases, ascites is not a feature of lymphangioma. When you see a septated cystic lesion without ascites the most likely diagnosis is a lymphangioma.
    24. 24. Notice that CT does not always appreciate the septations, although the specimen clearly shows multiple septations.
    25. 25. Renal /Parapelvic Cyst Severe Hydronephrosis/UPJ obstruction Cystic Wilm’s Tumour (rare) Urachal Cyst
    26. 26. Severe hydronephrosis with proximal hydroureter
    27. 27. Resolving adrenal heamorrhage  Cystic neuroblastoma/ Ganglioneuroma(rare)
    28. 28. commonest cause of an adrenal mass Associated with perinatal stress, hypoxia, septicaemia and hypotension may be unilateral or bilateral Adrenal insufficiency is rare, even in bilateral cases. Ultrasound in the first few days of life usually demonstrates an avascular heterogenous adrenal mass that becomes cystic and smaller over the following weeks as clot retraction
    29. 29. Over half of them arise in the adrenals, but 30% can arise from sympathetic tissue elsewhere in the abdomen Calcification has been noted to occur in over 50% of Cases Ganglioneuroma is a mature form of neurogenic tumour. Calcification helps in suggesting a diagnosis of neurogenic tumour
    30. 30. Adrenal ganglioneuroma with hepatic metastasis
    31. 31. Pancreatic pseudocyst
    32. 32.  well-known complication of pancreatitis  fluid collections may occur within the pancreatic mass, or in the peripancreatic spaces, or elsewhere within the abdomen following either acute / chronic pancreatitis  In acute pancreatitis, the pseudocyst contains enzyme-rich fluid and products of autodegradation of the pancreas  in chronic pancreatitis the cyst is a consequence of duct obstruction.
    33. 33. Patients who have persistent abdominal pain or persistently elevated levels of pancreatic enzymes should be suspected of harbouring a pseudocyst one-third of pancreatic pseudocysts will resolve spontaneously
    34. 34. Pancreatic pseudocyst Large septated cystic mass in the mid abdomen with nodular component. In the absence of history of pancreatitis it would be difficult to differentiate this from a cystic pancreatic tumour.
    35. 35.  Ovarian Cyst  Teratoma/Dermoid Cyst  Anterior Meningocele  Abscess
    36. 36.  Cysts are fluid filled spaces within the ovary.  very common and could be physiological / pathological, benign/ malignant  Functional or physiological cysts are either follicular or of corpus luteum origin.  Follicular cysts form when a follicle fails to rupture at midcycle leading to its continuous enlargement. Usually these cysts are asymptomatic and disappear without any intervention within one or two months  Similarly a persistent corpus luteum might fail to disintegrate before menstruation and enlarge in size
    37. 37. Both follicular and luteal cysts could become haemorrhagic if bleeding occured within them leading to rapid increase in size and severe pain. they might cause severe pain only if they are large in size (>7 cm) and cause pressure symptoms or torsion of the whole ovary compromising blood flow when surgical intervention is indicated
    38. 38. A simple ovarian cyst on the right side of the uterus
    39. 39. Haemorrhagic ovarian cyst
    40. 40. A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of more than one germ layer They therefore contain developmentally mature skin complete with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
    41. 41.  A pus-filled cavity in the pelvis due to infection  A pelvic abscess is the end stage in the progression of a genital tract infection and is frequently an unnecessary complication  Treatment : Surgical drainage of abscess and dead tissue removal/ antibiotics
    42. 42. Abdominal computed tomography showed pelvic abscess (asterisk) and right tubo- ovarian abscess (arrow).
    43. 43. Cysts may have different characteristics and origins Location, appearances, multi modality can help in the diagnosis

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