CASE 7359 Published on 31.03.2009

Duodenal duplication cyst in adulthood

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Armas, Mónica; Castanha, Guida; Loureiro, Rui; Gonçalves, Marília; Andrade, Carlos
Department of Radiology
CHF – Funchal, Portugal

Patient

39 years, female

Clinical History
39-year-old woman presenting with longstanding vague epigastric pain, without clinical examination nor analytical changes.
Imaging Findings
A 39-year-old woman with previous colecistectomy complaining of longstanding vague epigastric pain was referred to our department for a barium study. A large filling defect on the medial border of the duodenum displacing and indenting the lumen was found suggesting an extrinsic mass. An abdominal ultrasonography was performed, showing a cystic epigastric mass with a double lined wall and a calcification within it. Posteriorly, abdominal CT and MRI were also performed in order to define a diagnosis.
Discussion
Duodenal duplication cysts (DDCs) are rare congenital anomalies (4% to 5% of intestinal duplications) usually encountered during infancy or in early childhood. They are mostly noncommunicating, spherical cysts, located in or adjacent to the wall along the first and second portions of the duodenum. They are lined most frequently by alimentary tract mucosa or pancreatic tissue.
Clinically, DDCs may be silent for many years before they cause any symptoms including pain, bowel obstruction, hemorrhage, jaundice and pancreatitis.
On barium studies, the duodenum may appear compressed and displaced by an extrinsic mass, since only about 10%-20% of reported DDCs communicate with the lumen.
Ultrasonography demonstrates DDC’s cystic nature. The evidence of an echogenic inner lining (mucosa) and a surrounding hypoechoic rim (muscular wall) is useful to exclude other cystic masses. DDCs can be recognized on CT as smooth walled fluid-filled structures contiguous with the duodenum but separated from the biliary system and the pancreas. Air or calcifications can be seen within them.
Associated vertebral anomalies are a helpful clue in the radiographic diagnosis of duplications.
MRI shows a cystic structure adjacent to the wall of duodenum and can be useful to confirm its independency from the biliary tract.
DDC is most often detected in children, only a few cases presenting in adulthood. Because of their rarity, DDcs can represent a diagnostic challenge, but in the appropriate clinical setting should be considered in the differential diagnosis of cystic abdominal masses in adulthood.
Surgical excision is the usual treatment.
Differential Diagnosis List
Duodenal Duplication Cyst
Final Diagnosis
Duodenal Duplication Cyst
Case information
URL: https://www.eurorad.org/case/7359
DOI: 10.1594/EURORAD/CASE.7359
ISSN: 1563-4086

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