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Case of the Month

April 2011

Patient Data: Female neonate 1 day old

Clinical Info: Abnormal findings during prenatal ultrasound screening


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There is a fluid and air filled structure caudal to the right liver lobe


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Transverse view of the fluid filled structure in the right upper abdomen


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Longitudinal view of the same structure with fluid and air. This stucture proved to be the stomach in the right upper abdomen


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Next to the stomach is a round solid looking structure anterior to the right adrenal which is normal


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Detail of the same structure


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The right adrenal is normal The round solid structure lies medial to the adrenal and lateral to the right sided stomach


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The solid structure is vascularized and is splenic tissue


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There is a smaller round structure between the right liver lobe and the right kidney


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Next to it are 2 even smaller similar looking structures. These round structures are also splenic tissue. The presence of multiple rounded spleens is called polysplenia

The abnormal position of the stomach and the polysplenia can be part of a group of anomalies referred to as polysplenia syndrome which can be a manifestation of heterotaxy. The patient was referred to a childrens hospital to rule out other abnormalities. No cardiac abnormalities were found. The patient will be followed up.


References
Congenital anomalies of the spleen. Gayer G, Hertz M, Strauss S, Zissin R. Semin Ultrasound CT MR. 2006 Oct;27(5):358-69. Review.

Abdominal sonography in the evaluation of heterotaxy in children. Oleszczuk-Raschke K, Set PA, von Lengerke HJ, Tröger J.Pediatr Radiol. 1995 Nov;25 Suppl 1:S150-6.

Heterotaxy syndrome in an adult, with polysplenia, visceral and cardiovascular malposition.
Vanhoenacker FM, De Ruysscher D, De Backer AI, De Schepper AM.
JBR-BTR. 2001 Feb;84(1):1-4.

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