WIDI - CB1427-Duodenal web with windsock deformity

Duodenal web with windsock deformity

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CB1427-Duodenal web with windsock deformity

History

8 month old female with a history of emesis and weight loss

Exam

FLUORO GI UPPER SERIES W/O KUB. Examination from the teeth to the ligament of Treitz.

Prior Study

None

Findings

Single scout view of the abdomen shows no lines tubes, or presence of unexpected foreign objects. There is a non-obstructive bowel gas pattern. There is no organomegaly or abnormal intra-abdominal calcifications. There is no intraperitoneal free air. The visualized bones are normal.

Fluoroscopic examination of the chest shows no pneumonia, atelectasis, or cardiomegaly. The hemidiaphragmatic excursions are equal and synchronous.

The patient was then given 50 cc of barium by mouth. The course and caliber of the esophagus is normal. There are no intrinsic masses, stenosis, or dysmotility. There is no extrinsic mass and there is no vascular ring.

The stomach fills readily and empties normally. There is no gastric outlet obstruction.

The duodenal bulb opacifies well without filling defect. There is no passage of contrast past the second portion of the duodenum while the patient was in the supine or right lateral positions. The proximal duodenum is distended and dilated with abrupt cut off of contrast bolus. The patient was then turned on the left lateral side and contrast was seen passing through to the third and fourth portions of the duodenum. The ligament of Treitz appeared normally placed in the left upper quadrant. The proximal jejunum is not dilated and is normal.

Impression

There is no passage of contrast past the distended and dilated proximal duodenum until the patient is placed in the left lateral position. These imaging findings are consistent with a duodenal web with windsock deformity.