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2001-06-21-20 Answer to the case of the week #52 © Jeanty http://www.thefetus.net/

Answer to case #52

June 8-21,  2001

Philippe Jeanty, MD, PhD

Women"s Health Alliance, Nashville, TN, USA

One of the changes that the Internet is bringing to Medicine, is the very different type of access to information that patients have now. This case illustrates some of the new challenges of working over the Internet.

The mother of this fetus send me an E-mail one day saying that on her baby"s ultrasound her sonographer and her doctor had found a "white spot" in the abdomen (plus mild pyelectasis and a choroid plexus cyst). She wanted to know what the "white spot" could be. I asked if this was a little 2-3 mm white dot in the liver, representing most likely one of those idiopathic liver calcification. "No" came the reply it is bigger then that. "It is above the stomach". With this little information I cockily suggested a diagnosis. That from the person who keeps saying: "Do not shoot from the hip !" Oh well... do what I say not what I do !

When the mother went for her next visit she told her doctor: "I went on the Internet and someone suggested that my baby has _____ ". You can imagine what wild-eye look she must have received ! However, her doctor very kindly provided a copy of the videotape of her following examination from which the following images and video clips were obtained. 

Videoclips: Macintosh Windows
Color Doppler 1 MB 1.6 MB
Gray scale 3 MB 2.3 MB (small screen size)
6.1 MB (larger screen size)

The longitudinal views demonstrated a echogenic mass connected to the lung (notice on the second image that little black vessel that extends through what should be the diaphragm.

 

 

Axial views demonstrate the intimate contact of this mass with the aorta.

 

Yet on color Doppler no large feeder vessel is seen.

  

 

 

So the findings include a echogenic mass that is below the diaphragm (mostly visible in the videoclips) and has no large feeder vessel. It is also located on the left side of the abdomen and tightly wraps around the aorta.

Although this might also be the appearance of a neuroblastoma, this appearance is very typical of a extralobar, infradiaphragmatic lung sequestration.

The mother of this baby has kindly provided a patient"s perspective of the condition.

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