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Diagnostic Discordance-based Inferences Regarding Imaging Modalities in Children with a Preliminary Diagnosis of Choledochal Cyst: Clinical Experience and Review of Literature/Koledok Kisti On Tanisi Konan Cocuklarda Goruntuleme Modalitelerine Iliskin Tanisal Uyumsuzluk Temelli Cikarimlar: Klinik Deneyim ve Literatur Taramasi

Ozcakir, Esra ; Kaya, Mete

Güncel pediatri, 2021-08, Vol.19 (2), p.185 [Periódico revisado por pares]

Galenos Yayinevi Tic. Ltd

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  • Título:
    Diagnostic Discordance-based Inferences Regarding Imaging Modalities in Children with a Preliminary Diagnosis of Choledochal Cyst: Clinical Experience and Review of Literature/Koledok Kisti On Tanisi Konan Cocuklarda Goruntuleme Modalitelerine Iliskin Tanisal Uyumsuzluk Temelli Cikarimlar: Klinik Deneyim ve Literatur Taramasi
  • Autor: Ozcakir, Esra ; Kaya, Mete
  • Assuntos: Birth defects ; Diagnosis ; Magnetic resonance imaging ; Pediatric research
  • É parte de: Güncel pediatri, 2021-08, Vol.19 (2), p.185
  • Descrição: Introduction: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with a preliminary diagnosis of a choledochal cyst. Our study aimed to investigate the roles of Magnetic Resonance Cholangiopancreatography (MRCP), Intraoperative Cholangiography (IOC) in differential and definitive diagnosis of choledochal cyst by comparing their results with the intraoperative gross pathological appearance. Materials and Methods: The medical records of seven pediatric patients preliminary diagnosed with choledochal cyst between May 2014 and January 2021 in our clinic, were retrospectively reviewed. We investigated the clinical characteristics, the MRCP and IOC results, and compared their results with the intraoperative gross pathological findings of patients with preliminarily diagnosed choledochal cyst. We evaluated the outcomes involving the preliminary diagnosis and subtype of choledochal cyst with MRCP preoperatively and with IOC and gross pathological findings intraoperatively. Results: Six patients had undergone a laparotomy and IOC procedure, and their results were: in three, the MRCP and IOC results were consistent, both revealing a Type-I choledochal cyst; in another patient, MRCP revealed a Type-IV choledochal cyst, whereas IOC showed a Type-I choledochal cyst; one patient reported having a Type-II choledochal cyst in MRCP turned out to have a duodenal duplication cyst intraoperatively; the sixth operated patient had an MRCP result of Type-I choledochal cyst, but the IOC was consistent with biliary atresia and severe hydropic bile stasis. The last child was a non-operated patient whose MRCP revealed a Type-I choledochal cyst whereas contrast-enhanced liver magnetic resonance showed a simple liver cyst. Conclusions: Even though MRCP is valuable regarding choledochal cyst's differential diagnosis, we should confirm its diagnosis by IOC and intraoperative gross pathological view because other pathologies might appear similar to choledochal cyst in MRCP. Keywords Choledochal cyst, magnetic resonance cholangiopancreatography, MRCP, intraoperative cholangiography, IOC Giris: Koledok kistlerinin degerlendirilmesinde kullanilan Manyetik rezonans kolanjiyopankreatografi (MRCP) Koledok kist'nin tiplerini belirleyen en onemli goruntuleme calismasidir. Koledok kisti on tanisi ile basvuran cocuk hastalarda uygulanacak cerrahi yaklasimi belirlemek icin kesin tani sarttir. Calismamiz, Koledok kist on tanisi ile degerlendirdigimiz hastalarin, ayirici ve kesin tanisinda intraoperatif bulgular esliginde, Manyetik Rezonans Kolanjiyopankreatografi (MRCP) ve intraoperatif Kolanjiyografi (IOC) 'nin rolunu arastirmayi amacladi. Gerec ve Yontem: Klinigimizde Mayis 2014-Ocak 2021 tarihleri arasinda koledok kisti on tanisi almis yedi pediatrik hastanin tibbi kayitlari retrospektif olarak incelendi. Onceden koledok kisti tanisi almis hastalarin klinik ozellikleri, MRCP ve IOC sonuclarini arastirdik ve sonuclarini intraoperatif brut patolojik bulgular ile karsilastirdik. Koledok kistinin on tani ve alt tipini iceren sonuclari ameliyat oncesi MRCP, intraoperatif IOC ve brut patolojik bulgular ile degerlendirdik. Bulgular: Yedi hastadan altisina laparotomi ve IOC proseduru uygulandi. Uc hastada MRCP ve IOC sonuclari tutarliydi, her ikisi de bir Tip-I koledok kistini dogruladi. Bir hastada, MRCP bir Tip-IV koledok kisti ortaya koyarken, bu hastada IOC Tip-I koledok kisti oldugunu gosterdi; MRCP'de Tip-II koledok kisti oldugunu bildiren bir hastada intraoperatif duodenal duplikasyon kisti oldugu goruldu; ameliyat edilen altinci hastada Tip-I koledokal kist MRCP sonucu vardi, ancak laparatomide cekilen IOC biliyer atrezi ve siddetli hidropik safra stazi ile uyumluydu. Diger bir hastada MRCP Tip-I koledok kisti tariflerken, hastanin cekilen hepatosite spesifik kontrastli manyetik rezonans goruntulemesi basit karaciger kisti ile uyumlu oldugu icin hasta cerrahiye alinmadi. Sonuc: MRCP, koledok kistinin ayirici tanisi acisindan oldukca degerli olsa da, hastalarin kesin tanisi icin laparatomi sirasindaki degerlendirme ve IOC ile dogrulama gerekmektedir. Batin ici farkli patolojilerin de MRCP'de koledok kisti ile benzer gorunum sergileyebilecegi unutulmamalidir. Anahtar kelimeler Koledok kisti, manyetik rezonans kolanjiyopankreatografi, MRCP, intraoperatif kolanjiyografi, IOK
  • Editor: Galenos Yayinevi Tic. Ltd
  • Idioma: Turco
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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