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Sonographic Pitfalls in the Diagnosis of Enteric Duplication Cysts

¹ Department of Diagnostic Radiology, Queen's University, Kingston General Hospital, 76 Stuart St., Kingston, ON K7L 2V7, Canada.
² Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
³ Department of Surgery, Queen's University, Kingston General Hospital, Kingston, ON, Canada.
⁴ Department of Pathology and Molecular Medicine, Queen's University, Kingston General Hospital, Kingston, ON, Canada.

View larger version (155K): [in a new window]   Fig. 1A. —Case 1: 6-week-old girl with mesenteric cyst. Physical examination revealed small mass palpable under umbilicus. Sonogram depicts echogenic granulation layer (arrowheads) with surrounding thin hypoechoic fibrous band (arrows). Note hyperechoic debris (asterisk) in cyst lumen.

View larger version (104K): [in a new window]   Fig. 1B. —Case 1: 6-week-old girl with mesenteric cyst. Physical examination revealed small mass palpable under umbilicus. Intraoperative photograph illustrates cyst is separate from small bowel (SB).

View larger version (110K): [in a new window]   Fig. 1C. —Case 1: 6-week-old girl with mesenteric cyst. Physical examination revealed small mass palpable under umbilicus. Histologic photomicrograph depicts layer of granulation tissue with focal microcalcification (arrowheads) overlying outer wall of fibrous connective tissue (arrows).

View larger version (118K): [in a new window]   Fig. 2A. —Case 2: 15-year-old nulligravida girl with cystic teratoma. Patient presented with severe right lower quadrant pain and associated nausea and vomiting. Sonogram depicts cyst (C) with hyperechoic inner rim (arrowheads) and outer hypoechoic wall (arrows). B = bladder.

View larger version (113K): [in a new window]   Fig. 2B. —Case 2: 15-year-old nulligravida girl with cystic teratoma. Patient presented with severe right lower quadrant pain and associated nausea and vomiting. CT scan depicts cyst (C) with low-attenuating (fat) inner ring (arrowhead) and higher-attenuating outer wall (white arrow). Note focus of calcification (black arrow).

View larger version (123K): [in a new window]   Fig. 2C. —Case 2: 15-year-old nulligravida girl with cystic teratoma. Patient presented with severe right lower quadrant pain and associated nausea and vomiting. Histologic photomicrograph shows cyst mucosa with squamous epithelial lining (arrowheads) and outer fibromuscular wall (arrows).

View larger version (112K): [in a new window]   Fig. 3A. —Case 3: 3-year-old girl with infected duplication cyst. Patient presented with 3-week history of nausea and diarrhea and palpable left upper quadrant abdominal mass. Sonogram depicts cyst (C) with thick, ill-marginated hypoechoic wall (white arrows). Note small bright echoes (black arrow) related to air in cyst. B = bowel.

View larger version (112K): [in a new window]   Fig. 3B. —Case 3: 3-year-old girl with infected duplication cyst. Patient presented with 3-week history of nausea and diarrhea and palpable left upper quadrant abdominal mass. CT scan depicts complex cyst (C) with irregular hypoattenuating wall (arrows). Wall margins are indistinct, and increased attenuation within adjacent fat and loss of fascial planes support inflammatory nature.

View larger version (156K): [in a new window]   Fig. 3C. —Case 3: 3-year-old girl with infected duplication cyst. Patient presented with 3-week history of nausea and diarrhea and palpable left upper quadrant abdominal mass. Histologic photomicrograph shows collapsed duplication cyst lumen (C). Note lack of inner mucosal layer in cyst. Surrounding wall shows inflammatory changes with inner granulation tissue (arrows) partially obscuring underlying shared smooth-muscle layer. B = bowel.

View larger version (68K): [in a new window]   Fig. 4A. —Intestinal duplication cyst specimen from 5-month-old girl. Photograph shows cross-section of intestinal duplication cyst (gross specimen). Boxed area is shown in B.

View larger version (134K): [in a new window]   Fig. 4B. —Intestinal duplication cyst specimen from 5-month-old girl. Histologic photomicrograph of boxed area from gross specimen (A) shows convergence of cyst and small-bowel walls: duplication cyst mucosa (arrowhead), shared muscularis propria (upper left arrow), and mucosa of native ileum (upper right arrow). Asterisks = muscularis propria course, C = duplication cyst lumen, lower arrow = gut lumen.

View larger version (127K): [in a new window]   Fig. 4C. —Intestinal duplication cyst specimen from 5-month-old girl. Sonogram of specimen depicts echogenic cyst mucosa (arrowheads) and hypoechoic shared muscularis (white arrows). Note thicker native ileal mucosa (black arrow). Asterisks show course of muscularis propria. Gut lumen and walls are enveloped by ultrasound gel.

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