Figure 1
Barium follow through
Barium follow through shows marked enlargement of the presacral space and anterior displacement of the rectum. Small bowel loops are situated high in the pelvis.
Clinical History
Vomiting and refusing to drink for two weeks. History of premature birth.
Imaging Findings
The premature girl was admitted to the hospital because of vomiting and refusing to drink for two weeks. Physical examination and laboratory tests were normal. A barium follow through examination revealed an anterior displacement of the rectosigmoid. US disclosed a huge presacral mass, which was further evaluated by CT scan and IV urography.
Discussion
Teratomas are common, usually benign, abdominal masses in the pediatric age group that may be found at different sites within the abdomen and pelvis. The most common location in childhood is presacral. Sacrococcygeal teratoma occurs in about one per 35.000 newborns with a four times more frequent occurrence in females. The etiology of the tumor is unknown.
On conventional radiographic examinations the tumor presents as a soft tissue mass with calcification in 60% of the cases. The rectum is usually displaced anteriorly, the bladder may be compressed and distorted by the mass. Urography should be performed in all cases to exclude urinary involvement, especially in malignant forms of teratomas. CT and MRI precisely delineate the extent of the tumor within the pelvis and its relationship to the adjacent structures. There is evidence that these tumors undergo malignant degeneration in elderly children, therefore early diagnosis and surgical removal is mandatory.
The differential diagnosis of sacrococcygeal tumors in the neonate should include liomas, lipomeningoceles, hemangiomas, epidermal cysts, sarcomas and rectal duplication cysts.
Differential Diagnosis List
Sacrococcygeal Teratoma
Final Diagnosis
Sacrococcygeal Teratoma
References
[1] Abel RM, Alpert J, Fisch D et al. Rupture of thoracic aneurysm into the right pleural space. The Journal of the medical society of New Jersey 1980; 77: 199-202. (PMID: 6929344)
[2] Grosso M, Spalluto F, Anselmetti G et al. Percutaneous transcatheter embolization of deep visceral pseudoaneurysms. Radiol Med 1992; 83: 795-799. (PMID: 1502360)
[3] Rogers DW, Lumeng L, Goulet RJ et al. Ruptured myotic pseudoaneurysm of the gastroduodenal artery presenting with hemoperitoneum and subcapsular liver hematoma. Dig Dis Sci 1990; 35: 661-664. (PMID: 2331959)
[4] Salam TA, Lumsden AB, Martin IG et al. Nonoperative management of visceral aneurysms and pseudoaneurysms. Am J Surg 1992; 164: 215-219. (PMID: 1415917)
Case information
| URL: | https://eurorad.org/case/907 |
| DOI: | 10.1594/EURORAD/CASE.907 |
| ISSN: | 1563-4086 |
Figure 2
Transverse US image of the lower pelvis
Demonstrates a completely solid, inhomogeneous, ill-defined, soft tissue mass with a diameter of 4 centimeters.
Figure 3
Contrast enhanced CT scan of the lower pelvis
Contrast enhanced CT scan of the lower pelvis visualizes a huge ovoid presacral mass containing mainly fat (f), dense linear structures and calcifications (arrows). The mass is poorly demarcated from the surrounding organs, and causes displacement of the rectum (R) anteriorly.
Figure 4
IV urography
IV urography shows normal contrast excretion by both kidneys. There are no signs of obstruction. The lower ureters are splayed apart and stretched around the tumor. the bladder is compressed and slightly displaced superiorly.
Barium follow through
Barium follow through shows marked enlargement of the presacral space and anterior displacement of the rectum. Small bowel loops are situated high in the pelvis.
Transverse US image of the lower pelvis
Demonstrates a completely solid, inhomogeneous, ill-defined, soft tissue mass with a diameter of 4 centimeters.
Contrast enhanced CT scan of the lower pelvis
Contrast enhanced CT scan of the lower pelvis visualizes a huge ovoid presacral mass containing mainly fat (f), dense linear structures and calcifications (arrows). The mass is poorly demarcated from the surrounding organs, and causes displacement of the rectum (R) anteriorly.
IV urography
IV urography shows normal contrast excretion by both kidneys. There are no signs of obstruction. The lower ureters are splayed apart and stretched around the tumor. the bladder is compressed and slightly displaced superiorly.