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Macrocephaly Capillary Malformation
Heather Borders, MD
over 9 years ago
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Case History

Newborn with prenatal history of polyhydramnios and abdominal calcifications.

Case Detail

Anatomy: Gastrointestinal
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: CR US
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Reveal Clinical Notes

Distal small bowel perforation found at laparotomy.

Reveal Findings

CR – Subhepatic mass with faint peripheral clcifications; no dilated loops of bowel.

US – Complex sub-hepatic mass with peripheral calcifications and heterogeneous internal contents.

Reveal Discussion

Meconium is a sterile mixture of desquamated epithelium, bile salts, enzymes, cholesterol and mucopolysaccharides. A chemical inflamatory process occurs when meconium spills into the peritoneal cavity. Bowel perforation may occur before or after birth. Etiology of perforation is largely related to obstruction (e.g., atresia, volvulus, meconium ileus). It is interesting that no obstructing lesion is found at surgery in a significant number of patients.

Peritonitis may be contained, fibroadhesive or generalized and quickly calcifies. Calcification patterns are variable. There may only be a few scattered calcifications, extensive peripheral plaque-like calcifications, scrotal/labial calcifications (patent process vaginalis), and psuedocyst calcification. Contained perforations result in the characteristic pseudocyst which is often right sided. Fibroadhesive inflammation results in intense fibroblastic reaction and adhesion formation.

On radiography calcifications, free air, signs of bowel obstruction, ascites, or pseudocyst may be found. On sonography calcifications, echogenic fluid containing particulate material, free air or pseudocyst may be seen. On MR, meconium is hyperintense on T1 sequences.

Reveal Diagnosis

Meconium Pseudocyst

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