Malrotation in the setting of Heterotaxy
Claim CME CreditPOINT 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.
CB1517-Malrotation in the setting of Heterotaxy
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CB1517-Malrotation in the setting of Heterotaxy
Case ReportHistory
Exam
Prior Study
Findings
Findings:
Single scout view of the abdomen shows: There is an umbilical arterial line with its tip at the T8 vertebral body level. There is also an umbilical venous line with its tip at the inferior cavoatrial junction. The remaining lines are external to the patient. There are no 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 thin barium to drink 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 is located in the right upper quadrant and fills readily and empties normally. There is no gastric outlet obstruction.
On the lateral view the duodenum initially coursed posteriorly; however, then demonstrated a redundant course in the midline of the abdomen. The ligament of Treitz is identified inferior to the duodenal bulb and along the midline of the spine, just at the right pedicle in a few images. This is somewhat medially displaced and does not cross to the right of the pedicle, as would be expected in this patient with this anatomy. The proximal jejunum is not dilated and is normal. There is no volvulus.
There is reflux to the distal thoracic esophagus. The reflux cleared quickly.
Impression
The duodenum is redundant and the expected location of the ligament of Treitz is inferiorly and minimally medially displaced consistent with subtype of malrotation, as detailed above. There is no volvulus.
