Caudal regression is a rare syndrome with a spectrum of structural defects involving multiple organ systems. Spinal anomalies, a charecteristic feature of the entity, can vary from isolated partial agenesis of the coccyx to lumbosacral agenesis with involvement of the thoracic spine in the most severe cases. The aetiology of this syndrome is not well-known. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. Severe forms of the disease are commonly associated with cardiac, renal and respiratory problems with overlapping feature of VACTERL complex (vertebral, anorectal, cardiac, tracheoesophageal, renal and limb anomalies). In this case report, we describe imaging appearances of severe caudal regression syndrome, VACTERL complex associated with multisystem anomalies, detected on a screening antenatal scan during second trimester. Some unusual features of the syndrome including sternal anomaly and absent bony hemithorax are highlighted.
Counterclockwise barber pole sign (also known as reverse barber pole sign) is an angiographic sign described in patients with small bowel volvulus due to counterclockwise twisting of mesenteric vessels around the superior mesenteric artery (SMA). The sign was first described in a catheter angiographic examination; however, the concept can be translated to the display methods of computed tomography (CT). This sign can be depicted clearly on multiplanar and three-dimensionally rendered images of multidetector computed tomography (MDCT) examination. In the current report, the reverse barber pole sign is illustrated in a child with partial small bowel volvulus secondary to mesenteric lymphatic malformation. The clinical course, management, and imaging appearances are presented, highlighting the observation of counterclockwise barber pole sign on MDCT imaging. The importance of the sign in identification of volvulus and implications for patient management are emphasized.
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