Presentation
Epigastric pain.
Patient Data
A unilocular thin-walled well defined round cystic structure was seen at the right paracolic gutter at the caecal pole / ascending colon junction measures 36x43x45 mm (APxTRAxCC) with homogeneous near-water attenuation (mean density <5 HU), although it locates at proximity/minimally deforming the ascending colon however fat plane of separation seen in between, no septa or solid components, no fat- fluid level, no calcification, no perceptible wall or internal enhancement noted, clear fat in its vicinity, no feature of haemorrhage, infection, torsion or rupture. On targeted US ,the cyst is easily deformable on probe pressure, no gut signature seen, no tenderness, no luminal continuity, and no peristalsis.
Gallbladder: localised fundal somewhat nodular enhancing wall thickening (4.5-5mm), no calcified gallstones , clear pericholecystic fat, three regional subcentrimetric lymph nodes seen, it was undetectable on ultrasound scan, histologic confirmation wasn't possible as the patient prefer not to be followed up.
Non-enhancing cyst 4.5x5.3 mm at the superior aspect of segment 8 with internal fluid density and no perceptible wall, feature of simple liver cyst per se need no further workup.
Bilateral L5 pars defect with grade I spondylolisthesis, L5/S1 level degenerative change with diffuse disc bulge.
Case Discussion
Benign-appearing, non-complicated right para-colic cyst and in view of its imaging feature, location, and the absence of previous abdominal surgery, trauma, or infection it is likely to represent congenital mesenteric cyst/ peritoneal simple mesothelial cyst.
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