CLINICAL HISTORY

The patient was a 30-year-old woman who had right lower quadrant pain for several months. Her past medical history was noncontributory. She has regular menstrual cycles, was not pregnant, and had no pertinent travel history. Routine lab studies revealed a normal white blood cell count and normal erythrocyte sedimentation rate. On physical exam there was minimal tenderness and fullness in the right lower quadrant. She was not febrile.

A contrast CT of the abdomen and pelvis was performed (Figure 1). This was followed by a contrast MRI of the abdomen.

DISCUSSION

The CT image demonstrates a cystic mass with a lobulated border within the right lower quadrant, adjacent to the cecum, which appears separate from the appendix. The mass has several thin septations and has some enhancement of its wall. MRI (Figures 2 and 3) confirms this, in addition to showing the mass to be likely arising from the mesentery and not from an intestinal loop. The mass was not believed to be ovarian in etiology.

 The patient was referred for surgery and the mass was removed. Pathology revealed the mass to be a mesenteric midgut duplication cyst.

There was evidence of smooth muscle layer and a ciliated respiratory epithelial layer as well. The mass was separate from the bowel and likely had developed its own blood supply.


Dr. Spitzer is associate director of radiology at Montgomery Hospital in Norristown, PA. He can be reached at lspitzer@mont-hosp.com.