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Case of the Month

December 2005

Patient Data: Male neonate

Clinical Info: A mass was suspected during a routine prenatal ultrasound examination.


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Transverse image of the upper abdomen with an inhomogeneous mass with small cystic areas in the left upper abdomen.


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Transverse image of the same mass in the left upper abdomen. The mass is vascularized.


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Longitudinal image of the left adrenal. There is a close relation between the left adrenal and the mass. The adrenal is normal.


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Transverse image of the left adrenal showing the relation to the mass.


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The mass contains tiny cystic areas and a few larger cystic parts.


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Transverse image of the upper abdomen showing the close relationship of the lesion to the pancreatic tail.

A definitive diagnosis could not be made. During the prenatal ultrasound examination a neuroblastoma was considered. The multicystic appearance however is very unusual for a neuroblastoma. Because of the microcystic appearance of the lesion and its relation to the pancreas a microcystic adenoma was also considered. This lesion however occurs mainly in adults.

The patient was referred to a pediatric university hospital where an MRI was performed (not shown). A pancreaticoblastoma was there considered to be the most likely diagnosis.

The patient was operated and to everyone's surprise the mass appeared to be none of the above mentioned lesions. The definitive diagnosis was an extrapulmonary lung sequestration.

Extrapulmonary lung sequestration is a rare lesion. In the literature a number of cases have been reported and a number of the lesions have been detected during prenatal examinations. The microcystic appearance is characteristic for the lesion. The multiple interfaces caused by the cysts can make the lesion hyperechoic on ultrasound.

For more abdominal tumors in children see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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