My son just had an abdominal MRI and the results came in today. I am curious what your opinion is regarding the findings of possible lymphoma vs. the altered lymphatic drainage due to his irregular rotated bowel. Note, he is 7.10 years old and has had a malrotation correction at 3 months old and partial bowel resection last year due to scar tissue from his original surgery obstructing the bowel. What course of action would you recommend?

Here are the results

MRI ABDOMEN with and without CONTRAST dated: 3/1/2016 8:54 AM
CLINICAL DATA: Quantify hepatic iron content in patient with recurrent iron
infusions for Restless Legs Syndrome, Rubinstein?Taybi syndrome, low ferritin,
ASD

COMPARISON STUDIES: None.

TECHNIQUE: Multi-sequence multiplanar images of the abdomen were obtained.
Sequences included T1 and in and out of phase, T2 with fat saturation. Axial
gradient echo star iron quantification study also obtained also obtained. Post
processing of T2* sequences with color mapping and T2*to R2* ratios were also
performed on an independent workstation. Pre and postcontrast LAVA sequences
with fat saturation obtained. 4 mL of MultiHance utilized. Due to length of the
procedure and necessity of still imagery, patient was sedated using the services
of the pediatric anesthesia department.

FINDINGS:
Near complete atelectasis of the left lower lobe may be related to anesthesia
required for the procedure. The visualized lung bases are otherwise normal
without evidence of pleural effusion or lung nodules. Borderline cardiomegaly.

Abdomen: No discrete lesions are detected within the liver, spleen, kidneys,
adrenals or pancreas. Spleen is in the upper limits of normal range for size
measuring 9.7 cm. The gallbladder is smooth without visualized stones or
intrahepatic bile ductal dilation. No free fluid is noted in the abdomen.
Symmetric uptake of contrast in the kidneys without evidence of urinary tract
obstruction.

Relatively low signal within the liver suggest iron deposition. Gradient echo
iron quantification mapping is consistent with T2*/ R2* ratios were
calculated to range between 28.8 - 21.8, with an estimated iron deposition of
1.1-1.4 mg/g. (Normal value of < 1.2 mg/g)

There is no evidence of obstructive uropathy. No discrete renal lesions.

Large amount of stool is seen within the colon, appearing entirely in the left
abdomen. There are multiple conspicuous mesenteric lymph nodes, largest in the
epigastric region measuring 1 cm small axis. Gastrostomy tube overlying the
distal stomach. Periportal and perigastric lymph nodes also conspicuous.

The visualized osseous structures appear normal without infiltrative lesion.
Mild S-shaped scoliosis of the thoracolumbar spine.

The retroperitoneal structures including the vasculature appear normal without
pathologic lymphadenopathy.

The partially visualized pelvis shows no discrete abnormalities. No conspicuous
diffuse infiltrative marrow irregularity.


IMPRESSION:

Borderline high iron deposition noted in the liver.

Diffuse conspicuous mesenteric adenitis. Given history of Rubinstein?Taybi
syndrome, lymphoma is a consideration. Altered lymphatic drainage from partially
irregularly rotated bowel also considered. Colonic nonrotation, large bowel
located in the left abdomen. Presumed constipation.

Left basilar atelectasis, presumably secondary to anesthesia required for the
procedure. Underlying infiltrate not excluded.