ARRS Case of the Week

CHEST IMAGING: Immunocompromised

Case Author: Stephanie DiPerma, Children's Hospital Boston and Harvard Medical School

History

1-hour-old boy with abdominal distention.

Imaging Findings

Abdominal radiograph (A) shows many dilated loops of bowel, the largest loop (arrow) being in the left upper quadrant. Contrast enema (B) shows small caliber of the colon and an abrupt transition point (arrow) near the splenic flexure in the distal transverse colon. Dilated loops of proximal large and small bowel are not opacified with contrast material.

Diagnosis

Colonic atresia

Teaching Points

Colonic atresia is a very rare cause of distal large-bowel obstruction, which is characterized by microcolon (unused) to the level of the atresia and a disproportionately dilated loop of colon just proximal to the atretic segment.

Hirschsprung disease is functional obstruction of the lower bowel caused by lack of intestinal ganglion cells. It is characterized by small caliber of the rectum relative to the sigmoid colon on a contrast enema.

Meconium ileus is a mechanical distal small-bowel obstruction in neonates with cystic fibrosis. It is characterized by the presence of meconium pellets in the microcolon and dilated distal ileum on a contrast enema.

Suggested Readings

Levy AD, Rohrmann CA Jr, Murakata LA, Lonergan GJ. Caroli’s disease: radiologic spectrum with pathologic correlation. AJR 2002; 179:1053–1057

Summerfield JA, Nagafuchi Y, Sherlock S, Cadafalch J, Scheuer PJ. Hepatobiliary fibropolycystic diseases: a clinical and histological review of 51 patients. J Hepatol 1986; 2:141–156

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