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Duplicated Renal Collecting System
Joseph Junewick, MD FACR
over 5 years ago
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Case History

Newborn with bulging anterior fontanelle.

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US MR
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Case Images

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Reveal Findings

US – Large hyperechoic and hypervascular right cerebral mass.

MR – Axial and coronal T2 and 3 plane post-gadolinium images of the brain demonstrate an enhancing T2 heterogeneous right cerebral mass with occasional areas of cystic degeneration and several flow voids resulting in significant mass effect.

Reveal Discussion

Desmoplastic infantile astrocytoma (DIT) tends to be large slow growing supratrentorial mass. The frontal and parietal lobes are most often affected but multillobar involvement is common. The lesions are heterogenous with cysts and calcification usually present. Typically, DIT appears as a hypointense cystic mass with an isointense peripheral solid component on T1-weighted MR images. On T2-weighted MR images, the cystic component is hyperintense and the solid portion isointense or heterogeneous. Edema is usually absent or moderate The peripheral solid component enhances with gadolinium administration. Leptomeningeal enhancement and remodeling of the inner table are common. Desmoplastic infantile astrocytomas are frequently adherent to the dura mater.

DIT is rarely symptomatic but is usually found within the first 18 months of life as a result of increased head circumference, paresis or seizure. The male-female ratio is 1.7:1. This tumor is not exclusively seen in pediatric patients; it may be diagnosed in older patients. DIT represents a formidable surgical challenge. Complete surgical excision usually results in a cure with no further treatment being necessary. In case of incomplete resection, favorable development is noted in most and adjuvant treatment is determined individually. Recurrence and death have been noted in some atypical cases.

The radiologic differential diagnoses of DIT include primitive neuroectodermal tumor, ependymoma, ganglioglioma, and dysembryoplastic neuroepithelial tumor, and choroid plexus carcinoma.

Reveal Diagnosis

Desmoplastic Infantile Astrocytoma

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