 Hello everyone. I am Dr. Naima, a final year resident going to present my Cape paper on a case report that is multi-imaging modality including 3D CT and MRI used in diagnosis of a porcupine duplication cyst that is neuroendocrine cyst. Therefore, this paper includes Dr. Shakuntha Bhav, Professor and Chief Person and Dr. Saima, Assistant Professor in the Department of Radio Diagnosis of Gavila Nehru Medical College and Hospital, Aligarh. Coming to the introduction, cystic masses in the medial syndrome are well-marginated fluid relations lined by an epithelium. Major cystic masses in medial syndrome include congenital benign cysts, which include four-cut duplications, pericardial cysts, and tynexist. Many interesting metrocystic keratoma, lymph angioma, medial syndrome lapses, and pancreatic cirrhosis as other differential languages. Cystic masses are mostly due to developmental abnormalities. Most common developmental cysts in the posterior medial syndrome include four-cut duplications, which include dungogenesis, neuroendocrine cysts, and esophageal duplications. Incidents of four-cut duplication cysts are very rare. However, they are almost asymptomatic and are found incidentally, or they can present with vague abdominal respiratory conveyance due to their pressure effect. Coming to our case, a six-month-old child presented with failure to thrive and join this. The child underwent a routine workup, hemogram showed anemia, which on further workup was diagnosed as hemolytic anemia. Liver function test showed normal liver nuisance with a taste unconjugated bilirubin. Rest of the blood examination was with a normal limit. On routine test x-ray shows a suspicious abnormality, which was, with abnormality was found for which the baby under further workup. On test x-ray APVU shows severe dextrocolysis of the thoracic spine with likely hemivortibular of T2 on left and T6 on right, with widened posterior as the 57th, 8th, 9th and 10th rips on the left side. Also shows an increased radiopacity in the left upper and middle lung zone, which is not crossing up of the cladical, and vessels are clearly visualized through the mass, that is, thylem ovalescine, and the cardiac margins are also separately and clearly visualized, indicating there is no siloing. Also noted, blundered left safety angle, which indicates that there is pleural effusion. All these points favours towards a slightly posterior mediastrand mass, for which the patient underwent a U.S.G. of the rags, which showed an unequal relation with a well-defined wall in the posterior mediastrand, which is actually extending from the tail of pancreas. However, the separately visualized pleins, stomach and pancreas appears to be normal. The wall of the lesion shows positive gut signature. The fluid from the lesion was aspirated under a septic precaution, which showed reactive fluid, amylase and lipase was estimated to rule out the remote possibility of pancreatic cirrhosis. For example, the child underwent a CT scan, which shows dorsal kyphoscoleosis with fully segmental hemivotibular of T2 on left and T6 on right, that is, Vectable Segmentation Anomaly with ribidomodelling of the shape of posterior aspect of 7, 8, and 9, and 10 ribs on the left side. On axial cuts of bone windows shows hemivotibular of T2 on left and T6 on right. Also shows a large well-defined irregular, thick-enhancing wall toblocystic lesion involving the posterior mediastrand on left paravirtible space adjacent to the aesophagus on left side, and left main bronchus, which is being displaced anteriorly and superiorly, and lesion found to be extending from the T2 superiorly to elven vertebra inferiorly. The lesion is insinuating through the left tend intracosal space into the paraspinal muscles on left side, and few insinuating areas into the left neural paramina. However, there was no obvious connection with the spinal cord was noted, shows minimales free fluid in left fluorescence suggestive of pleural effusion, and even the lesion is causing passive subsegmental collapse of the posterior segment of left lower, lingular low, and the basic segments of left lower low. Further, an MRI was done to rule out any possible communication with to the spinal cord, which again showed dorsal kyphoscoleosis, that is, texture of the upper thoracic spine with fully segmental hemivotegra of T2 on left and T6 on right, with remodelling of the shape of posterior aspect of 7, 8, 9, 10 steps on the left side. Axial cuts showing hemivotegra of T2 on left and T6 on right. Again, sagittal section shows a large, well-defined irregular thick-enhancing wall toblocystic lesion in the posterior midiast anum, adjacent to the left paravortable space, adjacent to esophagus and the left main bronchus, extending from T2 to L1 vertebrae. The lesion appears to be hyperenhanced on T2 with hyperenhanced walls, and which appears to be iso-enhanced on T1 with hyperenhanced walls, and the wall appears to be significantly enhancing after contrast and administration. The lesion is insinuating through the left tent in the coastal space into the paracetamino muscles on the left side, and few insinuating areas into the left neural tramina on left side with no obvious communication with the spine canal was not. There was no evidence of any diffusion restriction, which also excludes the remote possibility of abscess in the midiast anum. Final impression made was that the doses kyphoscoleosis with vertebral segmentation anomaly and remodelling of the left lower ribs in the posterior aspect with the last well-defined irregular enhancing thick wall tubular cystic lesion involving the left paravortable space adjacent to esophagus and left main bronchus. Hence, the baby was provisionally diagnosed as a case of foregur duplications that is likely neuronexist. This was considered a neuronexist because along with the cystic lesion we found vertebral segmentation anomaly. Baby was planned for thoracotomy. However, operative procedures delayed to improve the health status of the baby. Coming to the discussion, foregur duplication cyst is an abrupt development of the primitive cut. This includes predominately of three types that is neuronexist, bronchogenesis and esophageal duplication cyst. Neuronexist as we saw these have the failure of elementary tract to separate from the primitive neuronexist, leaving a persistent communication between the foregurt and the spinal cord, or herniation of the endoderm of the embryonic foregurt into the dorsal exoderm. Histologically, both neural elements and gastro-industrial epithelium is present. Half of the cases are associated with cervical and upper thoracic vertebral anomalies like hemivertebrae, butterfly vertebrae, anterior spinal bifida and skull ulcers. Vertebral defects are located cranial through medial stenosis. They may or may not have a spinal connection. Sometimes a fibrous band connection with the spinal cord is seen. Coming to bronchogenesis, these are abnormal budding of the ventral foregurt that is destined to form the tracheal bronchial trig. These are located in the middle medial stynum. Histologically, it shows typical respiratory epithelium. May have congenital pulmonary malformations. Esophageal duplication cysts arise from the dorsal foregurt that are destined to form the elementary tract. Majority are located in the right posterior inferior medial stynum. Histology shows submucosal or muscular layer of the gastro-industrial tract. 12% have gastro-industrial malformation. Imaging shows solitary belt circumsets round or oval mass with fluid attenuation. Bronchogenesis are usually found in the middle medial stynum near carina, less frequent in other areas of medial stynum. Esophageal duplication cysts are located along the esophagus in lower posterior medial stynum. Most of the neuroendocytists are located in the posterior medial stynum and the associate anomalies are again a clue for differentiating types of cysts. Associated anomalies like gastro-industrial malformations are associated with esophageal duplication cysts and pulmonary malformations are associated with bronchogenesis and vertebral segmentation anomalies are associated with neuroendocytists. Treatment includes surgical removal of the cystic lesion as a definitive treatment. Malignant degeneration of the duplication cyst is possible, hence surgical dissection is advocated. These are my references. Thank you.