Echogenic Debris Research Articles

Imaging features of intravesical urachal cysts in children

Urachal cysts, part of the spectrum of congenital urachal anomalies, are typically extrinsic to the urinary bladder. The purpose of this study is to present the salient imaging features of a pediatric series of unusual intravesical urachal cysts that protrude into the bladder lumen. Five children with intravesical urachal cysts depicted on imaging studies were retrospectively identified during a 6-year period at a children's hospital. The clinical charts and findings on ultrasound (US) and voiding cystourethrogram (VCUG) were reviewed. In all five children, US revealed a thin-walled ovoid cystic structure containing anechoic fluid or echogenic debris and residing along the midline of the anterosuperior aspect of the urinary bladder protruding into the bladder lumen. Histological examination of the partial cystectomy specimen from one child revealed a cystic urachal remnant with intestinal mucosal lining and reactive lymphoid hyperplasia. The cysts in the four other children were managed conservatively without operative intervention. The purpose of this report is to expand the spectrum of urachal remnant anomalies to include these newly recognized intravesical urachal cysts, which are characterized on US by the presence of a thin-walled cyst along the midline anterosuperior aspect of the urinary bladder.

A unusual case of 356 vesical calculii

Multiple vesical calculi are rarely seen in urological practice. Males are affected more than the females. Vesical calculi are usually secondary to bladder outlet obstruction. These patients present with recurrent urinary tract infection, haematuria or with retention of urine. We report a 43 years male patient who presented with acute urinary retention. He had history of trauma over perineal region three years back following which he had recurrent urinary tract infection and thinning of stream. USG abdomen revealed normal upper urinary tract with echogenic debris in partially filled urinary bladder. Renal function test was with in normal limit. Per urethral catheterization failed and over antibiotic cover, patient was posted for cystourethroscopy followed by suprapubic cystostomy under spinal anaesthesia. Membranous urethral stricture found during urethroscopy could be managed by optical internal urethrotomy. On cystoscopy whole of bladder was filled with thick pus like material with multiple large urinary bladder calculi. Open cystolithotomy was done and we were surprised to see 356 stones of various size and shape after removal. Patient made uneventful recovery and discharged after 12 days of hospital stay. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 44-47 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6825

Pyonephrosis and urosepsis in a 41-year old patient with spina bifida: Case report of a preventable death

BackgroundUrological complications are the major cause of ill health in patients with spina bifida. Urinary sepsis accounted for the majority of admissions in patients with spina bifida. As the patient grows older, changes occur in the adult bladder, leading to increases in storage pressure and consequent risk of deterioration of renal function, which may occur insidiously.Case presentationA 34-year-old male spinal bifida patient had been managing neuropathic bladder by penile sheath. Intravenous urography revealed normal kidneys. This patient was advised intermittent catheterisations. But self-catheterisation was not possible because of long, overhanging prepuce and marked spinal curvature. This patient developed repeated urine infections. Five years later, ultrasound examination of urinary tract revealed hydronephrotic right kidney with echogenic debris within the collecting system. There was no evidence of dilatation of the ureter near the vesicoureteric junction. The left kidney appeared normal. There was no evidence of calculus disease seen in either kidney. Indwelling urethral catheter drainage was established.Two years later, MAG-3 renogram revealed normal uptake and excretion by left kidney. The right kidney showed little functioning tissue. Following a routine change of urethral catheter this patient became unwell. Ultrasound examination revealed hydronephrotic right kidney containing thick hyper-echoic internal septations and debris in the right renal pelvis suspicious of pyonephrosis. Under both ultrasound and fluoroscopic guidance, an 8 French pig tail catheter was inserted into the right renal collecting system. 150 ml of turbid urine was aspirated immediately. This patient developed large left pleural effusion, collapse/consolidation of the left lower lobe, a large fluid collection in the abdomen extending into the pelvis and expired twenty days later because of sepsis and respiratory failure.ConclusionAlthough penile sheath drainage may be convenient for a spina bifida patient and the carers, hydronephrosis can occur insidiously. With recurrent urine infections, hydronephrotic kidney can become pyonephrosis, which is life-threatening. Therefore, every effort should be made to carry out intermittent catheterisations along with antimuscarinic drug therapy.

Ultrasound of the paediatric chest

US is increasingly used to study the lung parenchyma, pleural cavity, mediastinum and chest wall, both prenatally and postnatally. Foetal lungs are routinely inspected in the standard cardiac four-chamber view. Owing to their fluid content, the foetal lungs are seen as homogeneous structures of medium echogenicity; the echogenicity increases slightly throughout gestation. Using colour or power Doppler, the examiner can assess lung vascularisation without intravenous contrast, a major advantage of US in clinical practice. Routine use of prenatal US has led to higher detection rates for congenital lung malformations (bronchopulmonary foregut malformations). These are readily identified on US since they are more echogenic than the surrounding lung and produce a mass effect on neighbouring structures, particularly the heart. The malformations tend to be focal and unilateral; hence, a bilateral increase in lung size and echogenicity would rather suggest laryngeal or tracheal atresia. The observation of significant lung enlargement due to accumulated bronchial secretions in foetuses with tracheal atresia inspired prenatal treatment of severe pulmonary hypoplasia secondary to diaphragmatic hernia. This treatment stimulates lung development by artificial tracheal obstruction achieved via endoscopic insertion of an intratracheal balloon. The degree of pulmonary hypoplasia can be determined by calculating the lung-to-heart ratio (LHR) using US, or by calculating the relative foetal lung volume (RFLV) using magnetic resonance planimetry. It is extremely difficult to identify the ipsilateral lung remnant (“ipsilateral cap”) by US, and therefore it is excluded from the LHR calculation. This limitation of US can sometimes be overcome using power Doppler to follow the pulmonary artery and thereby identify the lung cap. Unlike the foetal lung, the postnatal lung appears as echogenic lines with a comet-tail configuration produced by air in the alveoli. The most common condition studied by US in clinical practice is lung consolidation. One characteristic US sign of lung consolidation is the sonobronchogram produced by air-filled bronchi within consolidated lung (Fig. 1). The consolidated lung is vascularised by pulmonary vessels, easily identified by their quadriphasic waveform on pulsed Doppler. US can be used to study several pleural conditions, particularly fluid collections. Classically, when pleural fluid was suspected on plain film, lateral decubitus films were taken to confirm the finding. In our opinion, US should be used instead of decubitus films for this purpose since the fluid can be seen directly, fluid volume calculated and the nature of the fluid characterised to determine the severity of the condition. Thereby, further radiation exposure is avoided. US is the best radiological technique for characterising the nature of pleural collections, which are classified according to their sonographic appearance into two types: simple and complex. Simple effusions are completely anechoic and usually correspond to transudates. Complex effusions or exudates present one or more of these US features: echogenic debris, fibrin strands, septa and a honeycomb appearance. In children, infections are the most common cause of complex effusions (parapneumonic effusions, empyema). Characterisation of pleural collections Disclaimer Dr. Enriquez has no financial interests, investigational or off-label uses to disclose.

Endoscopic treatment of a large gastric duplication cyst with hook-knife and snare (with video)

A 23-year-old woman presented with recurrent epigastric pain of several years' duration. EGD revealed a large gastric subepithelial lesion (A) that on EUS was shown to be a 5.1 × 4.2-cm cyst with anechoic content that contained echogenic debris and 4 distinct walls, suggestive of a gastric duplication cyst. The decision to treat the lesion endoscopically was based on the patient's chronic recurrent pain, which was nonresponsive to a variety of medications including proton pump inhibitors, antispasmodics, and prokinetic agents, as well as the risk of complications because of the lesion's large size.

Tumoral calcinosis: Sonographic sedimentation sign

We present the sonographic findings of tumoral calcinosis in two patients compared with conventional radiography, CT, and MRI. Sonography in both patients demonstrated fluid-sedimentation levels, with more echogenic debris layering dependently. This appearance has been referred to as the "sedimentation sign" on conventional radiography and results from dependent layering of hydroxyapatite crystals within cystic spaces of the lesion. There are only three reported cases in the world literature of sonographic findings in patients with tumoral calcinosis. We describe the first two cases of sonography demonstrating the "sedimentation sign," which may aid in the diagnosis of tumoral calcinosis.

Isolated Distal Vaginal Agenesis Masquerading as Recurrent Urinary Infections in an Adolescent Female

Figure 2. A, Sagittal magnetic resonance image showing the lack of vaginal tissue between the distal urethra and anus. B, Sagittalmagnetic resonance image highlighting theblood-filled dilated vagina. C, Axial view of the hematocolpos. D, Coronal view of the normal left ovarian tissue next to the dilated vagina. A healthy 12-year-old girl with an unremarkable history was referred to pediatric urology with recurrent urinary tract infections. She had not yet started menstruation. Her physical examination was unremarkable except for severe labial adhesions that precluded visualization of her urethral meatus and vaginal introitus. Renal/bladder ultrasonography revealed an absent left kidney with compensatory hypertrophy of the right renal unit, and a distended vagina with echogenic debris representing hematocolpos (Figure 1). The patient’s labial adhesions were lysed in the operating room.No vaginal openingwas apparent on the perineum.Magnetic resonance imaging performed to delineate her pelvic genitourinary anatomy revealed a complex malformation with an absent distal one-third of the vagina, alongwith hydrometrocolpos, a solitaryorthotopic cervix, andanormal leftovary; the right ovarywasnot identified (Figure 2).Due to the paucity of vaginal tissue between the distal urethra and anus, the patient was diagnosed with distal vaginal agenesis. Operative intervention was undertaken within two weeks of her referral. Embryologically, the M€ ullerian ducts give rise to the proximal two-thirds of the vagina, cervix, and uterus. At approximately the 10th week of embryonic development, they contact a thickened portion of the urogenital sinus, which ultimately becomes the distal one-third of the vagina. Vaginal canalization is complete between the third and fifth month of embryologic development. Failure of this canalization, known as vaginal agenesis, can be partial or complete and is mainly associated with other M€ ullerian abnormalities. Isolated vaginal agenesis distal to a normal cervix and uterus is very rare.

P33.04: Pitfalls of prenatal ultrasound diagnosis of congenital imperforated hymen

bladder. Severe dilatation of the left renal pelvis was noted with significant caliectasis, thinning of the renal cortex, and hydroureter. Case 2 was an 18 year old G4 P1021 who presented for assessment of fetal growth in the third trimester and was found to have a mass containing echogenic debris in the midline of the lower fetal abdomen. Follow up ultrasounds demonstrated persistence of the mass with progressive bilateral renal and ureteral dilatation. In both cases, postnatal evaluation confirmed the prenatal findings and revealed a diagnosis of imperforate hymen. Both fetuses underwent hymenostomy with subsequent resolution of the mass and improvement in hydronephrosis. Conclusion: Imperforate hymen should be considered as the etiology of renal obstructive disease in female fetuses presenting with a pelvic mass. Postnatal management and hymenostomy resulted in resolution of hydronephrosis.

Obstructive jaundice in an elderly female

A 55-year-old woman presented with 1 month history of right hypochondrium pain, vomiting, and jaundice. On examination, she had tender right hypochondrium and palpable gall bladder. Blood investigations revealed increased white cell count with eosinophilia; serum bilirubin (6 mg/dL) and alkaline phosphatase (900U/L) were raised; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were not significantly elevated. Ultrasonography showed a cyst in the right lobe of liver and dilated common bile duct (CBD) filled with echogenic debris. Gall bladder was distended and transonic. MRCP was performed for further evaluation. Cholangiographic thick slab MRCP revealed a cyst in the right lobe of liver closely related to right lobe ducts, with intracystic linear and irregular hypointensities; intrahepatic bile ducts were dilated and CBD filled with long, low signal intensity mass like structure. GB was distended and pancreatic duct slightly dilated [Figure 1]. Figure 1 Thick slab coronal plane MRCP image showing dilated intrahepatic bile ducts and a cyst closely related to right lobe ducts with equivocal evidence of communication. Cyst shows internal low signal intensity membranes; common bile duct is filled with long, ...

Primary Renal Candidiasis

Primary renal candidiasis is rare but increasing in incidence. The purpose of this series is to provide imaging and clinical findings for diagnosing candidiasis and to discuss imaging in the management of this disease. Ten sonographic, 8 retrograde pyelographic, 2 intravenous pyelographic, 2 antegrade pyelographic, and 2 computed tomographic examinations of 5 patients (4 adult male patients and 1 16-year-old female patient) were reviewed. The clinical presentation was variable. Sonography showed renal pelvic wall thickening (n = 5), echogenic debris (n = 4), and fungus balls (n = 2). Papillary necrosis (n = 4), filling defects due to debris (n = 3), and fungus balls (n = 2) were seen on retrograde pyelography. Untreated candidiasis may progress to fungus ball or abscess formation. Sonography is commonly used as the initial imaging procedure. Retrograde and antegrade pyelography are used for biopsy, diagnosis, and treatment. Awareness of this condition and knowledgeable imaging evaluation can help detect and define the site, infection severity, and subsequent therapy.

Follow-up imaging after laparoscopic heminephrectomy in children

The radiological findings after laparoscopic heminephrectomy in children are not widely reported. To document the range of imaging appearances following laparoscopic heminephrectomy in children. We reviewed all imaging and all radiology reports performed on children in our institution who had undergone laparoscopic heminephrectomy over a 6-year period. Between 2001 and 2007, 35 patients (24 girls, 11 boys) had laparoscopic heminephrectomy. The mean age at surgery was 3.5 years. The sites of surgery comprised 12 right upper, 5 right lower, 18 left upper and 3 left lower heminephrectomies. These numbers included three patients who had bilateral procedures. The most consistent postoperative finding was an avascular cyst related to the site of surgery, seen after 23 of 38 procedures. Of these 23 cysts, 13 were simple and 10 were septated and/or contained echogenic debris. A cyst related to the site of laparoscopic heminephrectomy is a frequent postoperative occurrence but is not widely recognized for being simply this. Simple, anechoic, and septated appearances are possible. This cyst may be confusing to the radiologist and the clinician if they are not aware of the history of laparoscopic heminephrectomy and the technique that has been used. Whilst the exact aetiology of this cystic lesion is uncertain, all the patients in our series had a heminephrectomy performed with the use of an Endoloop (Ethicon, Somerville, NJ). No patients have required intervention to date.

Ultrasound biomicroscopy of the iridocorneal angle of the eye before and after phacoemulsification and intraocular lens implantation in dogs

To compare the iridocorneal angle (ICA) and angle opening distance (AOD) in dogs with cataractous and noncataractous lenses; evaluate cataractous eyes ultrasono-graphically for association of postoperative ocular hypertension (POH) with the ICA, AOD, and postoperative echogenic anterior chamber debris; and evaluate intraobserver reliability associated with ICA and AOD measurements. 56 dogs with 102 cataracts, and 23 clinically normal dogs. Ultrasound biomicroscopy was performed on 102 eyes of 56 dogs before and after cataract surgery and on 46 nondilated and dilated eyes of 23 clinically normal dogs. Cataract stage, ICA, AOD, and association with POH were assessed. Cataract stage and ICA or AOD were not significantly associated; however, ICA and AOD typically decreased with increasing cataract maturity. Before and after pupillary dilation, AODs were significantly smaller in cataractous eyes than in noncataractous eyes. Before surgery, ICA and AOD in eyes without pupillary dilation were significantly associated with POH. At > 13 degrees , odds of developing POH increased by 11% for each degree increase in the ICA. Postoperative anterior chamber debris was not associated with POH. Coefficient of variation for repeated measurements was 10% for the ICA and 9.5% for the AOD, suggesting good intraobserver reliability. In this study, dogs with larger ICA and AOD measurements before surgery were at greater risk of developing POH. This information may be useful for future studies to determine whether preventative treatment for POH administered prior to surgery may be beneficial.

Cystic Duct Remnant as a Cause of Post-Cholecystectomy Syndrome Diagnosed by Endoscopic Ultrasound

Background: Post-cholecystectomy syndrome can be the result of a cystic duct remnant. These patients may present with symptoms of cholecystitis in the setting of an absent gallbladder. The pathophysiology of this condition may be the result of sludge, stones, or debris in the remnant cystic duct. Its incidence has been correlated to the length of the remnant cystic duct. Case: An 86 year-old man status post-cholecystectomy seven years prior secondary to gallstone pancreatitis presented with several episodes of right-sided chest discomfort. He had fever, abnormal liver chemistry and leukocytosis. Blood cultures grew gram negative rods. He was placed on intravenous antibiotics and underwent endoscopic ultrasound (EUS) to evaluate his biliary tree. This demonstrated a common bile duct of 7-mm. In the proximal portion of the CBD, there was an outpocket representing a cystic duct remnant with echogenic debris (Fig. 1). An endoscopic retrograde cholangiogram (ERC) was then performed. This revealed a cystic stump greater than 1 cm in length which contained a small stone. The stone was removed and a sphincterotomy was performed. The patient's clinical symptoms and laboratory abnormalities resolved. Four weeks later, the patient reported no further episodes of pain. Discussion: Post-cholecystectomy syndrome may be the sequela of a remnant cystic duct. The incidence is unknown although it is thought to be more common in the age of laparoscopic cholecystectomy. When suspected, MRCP is the diagnostic test of choice. In our case, EUS suggested the disease which was confirmed and treated by ERC. In patients presenting with post-cholecystectomy syndrome it is important to consider cystic duct remnant in the differential diagnosis. Sources: Zhou PH, Liu FL, Yao LQ, Qin XY. Endoscopic diagnosis and treatment of post-cholecystectomy syndrome. Hepatobiliary & Pancreatic Diseases International 2003; 2(1): 117–120. Shaw C, O'Hanlon DM, Fenlon HM, McEntee GP. Cysic duct remnant and the ‘Post-cholecystectomy Syndrome.’ Hepato-Gastroenterology 2004; 51: 36–38.[figure1]Figure

Hematocele crónico calcificado: A propósito de un caso

Chronic hematoceles are rare scrotal masses. Most of them include trauma, torsion, tumor, and surgery as possible causes. We describe the case of an old diabetic patient, who is attended for presenting a marked increase in size of the right hemiescrotum and pain. We described computed tomography and sonographic findings. Frequently, a varicocele is an associated finding. Presumibly, minor trauma results in rupture of dilated vessels. In sonographic exploration, they have a more complex heterogeneous appearance with echogenic debris and septations. Most hematoceles spontaneously resolve with conservative therapy.

Acute Renal Papillary Necrosis with Complete Bilateral Ureteral Obstruction in a Child

A 9-year-old girl presented with apparent meningococcal septicemia and developed acute renal failure after 48 hours of treatment with antibiotics and analgesics. Early ultrasound scanning demonstrated mild bilateral hydronephrosis and hydroureter. Intravenous urography showed slow contrast uptake with delay nephrogram and no contrast entering the bladder. Repeat ultrasonography revealed bilateral papillary irregularity and echogenic debris in the distal ureters. Bilateral double-J stents were inserted cystoscopically, resulting in prompt polyuria and a return of normal renal function. Although rare, recognition of sloughed papilla in papillary necrosis causing ureteral obstruction can lead to early management with no long-term sequelae.

Pyogenic Liver Abscesses Caused byKlebsiella pneumoniae: US Appearance and Aspiration Findings

To retrospectively compare the ultrasonographic (US) appearance and amount of pus obtained at initial aspiration for liver abscesses caused by Klebsiella pneumoniae with those for liver abscesses caused by other bacterial pathogens. This study had medical ethics committee approval; informed consent was not required. Asian patients with pyogenic liver abscesses in a 5-year period were included. Abscess clinical, laboratory, and microbiologic characteristics and treatment and outcome were analyzed. US images were classified according to the size of the largest liver abscess, the echogenic pattern of the lesion, the presence of any echogenic debris within the lesion, increased through transmission in the posterior aspect of the lesion, and the lesion margin. Clinical and US characteristics of patients with K pneumoniae monomicrobial liver abscesses and those with non-K pneumoniae monomicrobial or polymicrobial liver abscesses were compared. The chi(2) or Fisher exact test was used for categorical variables; the Student t test was used for continuous variables. There were 120 patients with pyogenic liver abscesses. Median patient age was 69 years (range, 13-94 years). Fifty-nine patients were male, and 61 were female. Fifty patients with K pneumoniae monomicrobial and 33 patients with non-K pneumoniae monomicrobial or polymicrobial liver abscesses underwent US. K pneumoniae monomicrobial liver abscesses were associated with diabetes mellitus (P < .001), higher blood glucose levels at admission (P < .05), predominantly solid US appearances (P < .001), irregular or indistinct lesion margins (P < .05), less than 2 mL of pus aspirated (P < .001), and longer duration of antibiotic treatment (P < .05). A predominantly solid appearance at US is associated with K pneumoniae monomicrobial liver abscess. K pneumoniae liver abscess is associated with a much smaller quantity of pus at initial aspiration.

1172: Assessment of cystic adnexal masses

The sonographic assessment includes a transabdominal and an endovaginal exam or endorectal in virginal patients. The endocavitary probe allows identification of tender organs and can assess the fallopian tubes, ovaries and sigmoid colon. Simple cysts are the most common ovarian masses. It is anechoic, smoothly marginated, unilocular with posterior enhancement. Usually functional and disappear within two cycles. If it does not resolve after three cycles, it is not functional. Theca lutein cysts are small, bilateral cysts associated with PCOD, mole or ovarian stimulation and resolve after treatment. Para-ovarian and para-tubal cysts are remnants of the Wolffian duct. They are mistaken for ovarian cysts. They are small, thin walled, nontender, unchanging in size and separate from the ovary. Complex ovarian masses can be benign or malignant. The primary criteria for a malignant ovarian mass usually are a diameter >4 cm, thick wall or septum >3 mm, large solid or mostly solid mass or nodularity. Ascites, large nodes or a mass fixed or nonmovable on EV exam, are signs of extension locally from the primary mass. A serous cystadenoma or cystadenocarcinoma is the most common ovarian neoplasm. Masses are thin walled, unilocular and may have thin septa or papilla. The malignant ones are thick walled, multilocular with multiple papilla and ascites. Mucinous cystadenoma or carcinoma comprises 20% of all benign and 10% of malignant ovarian masses. They are usually very large, often exceeding 15 cm. They have multiple septa with low-level internal echoes due to the mucin. Hemorrhagic cyst is echogenic and as clot forms, fibrin bands appear as fine septations giving a fishnet appearance. Retracting clot is triangular. An endometrioma may have a varied appearance on US often with a ground glass appearance and low level echoes. There may be layering of echogenic material and the mass may look solid or cystic. The mass is usually tender to palpation with the EV probe. Ectopic pregnancy may have a wide variety of presentations. Echogenic free fluid does not always mean a ruptured ectopic. Dermoid cyst is the most common germ cell tumor. About 30% are malignant if present is a preadolescent. There may be fat-fluid levels, calcification, and an echogenic mass with shadowing and/or bright linear bands that may represent hair. Abscess. There is usually fever and increased white count with a multilocular mass with thick walls that is tender to the touch. The mass is nonmobile. Treatment is antibiotics and/or drainage. Hematosalpinx and hydrosalpinx may be called a septated ovarian cyst but in the correct scan plane the tubular nature of the mass is evident. It is separate from, but adjacent to the ovary with layering of echogenic debris, pus or blood. May be previous PID or tubal ligation. Ovarian torsion. The ovary is enlarged with small peripheral cysts. A larger cyst may also be present. No vascularity seen. If a small amount of flow is present then the ovary can be salvaged if it is untwisted. There may be increased flow if there has been inflammation or it has de-torted.

Jejunal diverticulosis: Sonographic diagnosis

We report the sonographic appearance of jejunal diverticulosis in 4 cases. Jejunal diverticula appear as multiple peri-intestinal hypoechoic structures on sonographic examination. Many diverticula show communication with the bowel lumen. The diverticular neck formed by the prolapsed mucosal and submucosal layers can be seen as a parallel, echogenic structure traversing the bowel wall. Most diverticula also contain echogenic debris and air-related artifacts. Because jejunal diverticula may be encountered during a sonographic examination, sonologists should be aware of their sonographic appearance to prevent diagnostic errors.

Caeco-vesical fistula--an unusual sequel of colonic tuberculosis.

Extracted from text ... Letter to the Editor SAJS 38 VOL 44, NO. 1, FEBRUARY 2006 SAJS To the Editor: We would like to report on a rare case of caeco-vesical fistula complicating ileo-caecal tuberculosis, a condition that has not been described in the literature. A 4-year-old boy, with a positive family history of tuberculosis, presented to hospital with a month's history of dysuria and faecaluria. He was pyrexial, with a tender right suprapubic mass and leucocytosis. The chest radiograph was normal; abdominal ultrasonography demonstrated the presence of a fistula with echogenic debris originating from within a bowel loop and extending into a ..

Spontaneous gastric perforation in a neonate presenting with massive hydroperitoneum

We report the imaging findings in a case of neonatal spontaneous gastric perforation presenting as massive hydroperitoneum rather than pneumoperitoneum. Plain abdominal radiography showed a diffuse ground-glass opacity with paucity of bowel gas. Subsequent ultrasonography demonstrated numerous echogenic peritoneal fluid collections containing echogenic debris shown at surgery to be due to milk and bile.