Obi Chrystal,  Nadel Helen,  Seekins Jayne

Final Pr. ID: Poster #: EDU-015

To identify patterns of calcifications and location on abdominal radiography to help diagnose their disease processes. We retrospectively reviewed abdominal x-rays with abnormal calcifications and correlated the findings with additional imaging such as ultrasound, CT or MR. We grouped calcifications by quadrant or diffuse to correlate with the differential diagnosis and disease process. Assessing the location and characteristics of calcifications on abdominal radiography can be highly useful in aiding in the formation of a differential diagnosis and guide next imaging steps. Read More

Authors:  Obi Chrystal , Nadel Helen , Seekins Jayne

Keywords:  Abdominal, Calcification

Henry M Katherine,  Bennett Colleen,  Servaes Sabah

Final Pr. ID: Poster #: EDU-032

Intra-abdominal injuries are a less common manifestation of child abuse, but can be associated with high mortality. These injuries may be difficult to detect on physical exam alone, as many children do not have external cutaneous signs of abdominal injury, and symptomatology may be non-specific. Once detected, no specific intra-abdominal injury is pathognomonic for abuse, though some are more common in physical abuse. Determination of the likelihood of abuse as a mechanism relies on the plausibility of the history provided in the context of the constellation of identified injuries.

In this multidisciplinary educational presentation made in collaboration with pediatric radiologists and child abuse pediatricians, we will: (1) review physical exam and laboratory indicators to obtain abdominal imaging; (2) review imaging examples of intra-abdominal solid organ injuries; (3) review imaging examples of hollow viscus injuries; (4) discuss the types of trauma that causes solid organ and hollow viscus injuries; (5) review imaging modalities available, and (6) briefly discuss medical management. Read More

Authors:  Henry M Katherine , Bennett Colleen , Servaes Sabah

Keywords:  Child Abuse, Trauma, Abdominal

Cartagena Claudia,  Herliczek Thaddeus,  Dibble Elizabeth,  Swenson David

Final Pr. ID: Poster #: SCI-035

To describe the spectrum and incidence of alternative etiologies for lower abdominal and pelvic pain identified on magnetic resonance imaging (MRI) following indeterminate appendix ultrasound (US) in pediatric patients. Read More

Authors:  Cartagena Claudia , Herliczek Thaddeus , Dibble Elizabeth , Swenson David

Keywords:  abdominal, pelvic, appendix

Verma Nupur,  Patel Pratik,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-108

Accidents remain a top cause of morbidity and mortality in pediatric patient. Assessment for blunt trauma to the abdomen is difficult in the trauma patient and findings of bowel injury can be subtly or confounded by visceral injuries. The most specific finding of free air in blunt hollow visceral organ is often minimally present, or entirely unseen. The pediatric radiologist must be familiarity with the more often seen and less specific secondary signs on CT, including free fluid, bowel wall thickening, and mesenteric contusion injury. We present, by case example, bowel injuries in the traumatic pediatric patient and their management and outcomes, while addressing common pearls and pitfalls. As many of these patients do well with non-operative treatment the radiologist must also be familiar with findings that would allow such option, to appropriately advice referring providers and manage potential re-image of the pediatric patient. Read More

Authors:  Verma Nupur , Patel Pratik , Rajderkar Dhanashree

Keywords:  Trauma, Pediatrics, Dose Reduction in CT, Abdominal Injury

Fink Adam,  Levin Terry,  Blumfield Einat,  Liszewski Mark,  Nemerofsky Sheri,  George Kandie,  Eddington K.,  Nafday Suhas,  Ushay H.

Final Pr. ID: Poster #: SCI-008

In the PICU and NICU, radiographs are frequently obtained and preliminarily interpreted by intensivists several hours before a board certified pediatric radiologist provides an official interpretation. These preliminary interpretations often result in a change in clinical management. We quantified the discrepancy rates between intensivists at different levels of training and pediatric radiologists to determine areas for intensivist improvement via an educational initiative. Read More

Authors:  Fink Adam , Levin Terry , Blumfield Einat , Liszewski Mark , Nemerofsky Sheri , George Kandie , Eddington K. , Nafday Suhas , Ushay H.

Keywords:  chest, Abdominal

Kikke Stacy,  Ritze Kimberly

Final Pr. ID: Poster #: CR-003 (T)

The purpose of this submission is to educate technologists in performing magnetic resonance (MR) lymphangiography in conjunction with intranodal gadolium contrast injection in the pediatric patient. MR lymphangiography is a new procedure in the pediatric population. The lymphatic system plays the important role of transporting fluid from tissue back into the venous system via lymphovenous connections. Despite this key role, there has been a poor understanding of lymphatic flow physiology. The recent development of dynamic contrast intranodal MR lymphangiography, which provides quick and reliable access to the central lymphatic system, has provided insight into understanding the pathophysiology of several lymphatic flow disorders and provides guidance for interventional procedures. It also makes it possible to see central lymphatic anatomy with high spatial and temporal resolution. This allows clinicians to map the anatomy of the lymphatic system to determine the location of lymphatic leaks. MR lymphangiography may reduce the need for conventional IR lymphangiogram and spare patient’s radiation exposure. Read More

Authors:  Kikke Stacy , Ritze Kimberly

Keywords:  mrI, lymphangiography, abdominal

Heitzmann Mark,  Shalaby-rana Eglal,  Deye Katherine

Final Pr. ID: Poster #: SCI-077

Abdominal injuries account for a relatively small percentage of non-accidental trauma. Previous estimates range from 0.5% to 11%. Despite this, abdominal injuries are the second leading cause of death in non-accidental trauma after head injury. Our objective is to assess the prevalence of abdominal injuries in the setting of suspected non-accidental trauma within a large urban children's medical center. Read More

Authors:  Heitzmann Mark , Shalaby-rana Eglal , Deye Katherine

Keywords:  non-accidental trauma, abdominal injuries

Griffin Walter,  Simmons Curtis,  Southard Richard,  Jorgensen Scott,  Van Tassel Dane

Final Pr. ID: Poster #: SCI-002

Pediatric abdominal trauma can be challenging and often necessitates rapid and accurate identification of injuries for optimal patient care. This study aimed to assess the potential workflow improvements in diagnostic accuracy achieved with semi-automated analysis of Dual Energy CT (DECT) image reconstruction in the setting of abdominal solid organ injury, as compared to conventional Multi-Detector CT (MDCT) images. The data sets from dual energy reconstructions have superior tissue differentiation and can be used to train a simple artificial intelligence (AI) program to recognize these patterns and expedite care. Read More

Authors:  Griffin Walter , Simmons Curtis , Southard Richard , Jorgensen Scott , Van Tassel Dane

Keywords:  Dual Energy, abdominal trauma

Cheng Jocelyn,  Durand Rachelle,  Zapala Matthew,  Cort Kayla,  Bhuller Jeanie,  Courtier Jesse

Final Pr. ID: Poster #: EDU-024

MRI of the abdomen faces several technical challenges owing to respiratory motion, bowel peristalsis, and the need for large volumetric coverage. In adult patients, imaging is typically performed during multiple breath holds to avoid motion artifact; however pediatric patients may be unable to perform consistent breath holds or remain motionless during MRI acquisition. Although techniques such as child life specialists, MRI video goggles, and dedicated MR suite environments have reduced the need for anesthesia in MRI, general anesthesia may be necessary in some patients. Simulating breath holds in anesthetized patients is a technically difficult procedure requiring timed ventilation of the patient's abdomen during MRI acquisition, and results in progressive image degradation due to retained air artifact.

Dynamic Scan Optimization (DISCO) combines 3D DCEMRI + 2 pt Dixon + Parallel Imaging + Temporal Acceleration to provide high spatiotemporal resolution while drastically reducing scan time. Because pediatric patients have relatively low respiratory volumes, this technique enables acquisition of diagnostic quality images without breath-holding.

The purpose of this exhibit is to: (1) provide a guide for successful application of navigated spontaneous breathing multiphase DISCO sequence (2) review common use cases of the DISCO sequence (3) provide practical suggestions for troubleshooting DISCO Read More

Authors:  Cheng Jocelyn , Durand Rachelle , Zapala Matthew , Cort Kayla , Bhuller Jeanie , Courtier Jesse

Keywords:  Dynamic contrast enhanced MRI, DIfferential Sub-sampling with Cartesian Ordering, pediatric abdominal MRI

Sostarich Cortney,  Brown Brandon

Final Pr. ID: Poster #: EDU-013

Various types of cystic structures are present in the fetal abdomen. Preliminary evaluation of cystic lesions utilizes ultrasound. Given the wide range of manifestations of cysts in the fetal abdomen including but not limited to mesenteric, duplication, choledochal, ovarian, to lymphatic malformations proper diagnosis can prove difficult. When ultrasound yields inconclusive results, the next step is further investigation with fetal MRI. Fetal MRI provides increased resolution to fully characterize an abdominal cyst. Proper identification of a cyst provides useful guidance for appropriate perinatal management. Clinical management of fetal cysts consists of watchful watching, serial ultrasounds after birth, to surgical intervention. Recognition of the various types of cysts by a radiologist can help allow a clinician to appropriately counsel families about the next steps in the medical care of their child.

This presentation highlights the spectrum cystic lesions seen on MRI in the fetal abdomen. We outline a systemic method for identification of fetal abdominal cysts. Various examples of abdominal cysts will be reviewed focusing on key differences which can narrow the differential diagnosis and allow for proper identification. Results from fetal MRI will be correlated with an ultrasound shortly after birth to ensure appropriate diagnosis. Read More

Authors:  Sostarich Cortney , Brown Brandon

Keywords:  cyst, abdominal, fetal

Shewarega Annabella,  Lin Tony,  Christison-lagay Emily,  Stitelman David,  Hittelman Adam,  Morotti Raffaella,  Silva Cicero,  Rowe Erin

Final Pr. ID: Poster #: CR-018

Multicystic renal tumors (MCRTs) in children encompass a rare and diverse group of neoplastic entities, including cystic nephroma (CN), cystic partially differentiated nephroblastoma (CPDN), and cystic Wilms' tumor (CWT). CPDN occupies an intermediate status between the benign CN and the malignant CWT. Despite marked histological differences, distinguishing these tumors clinically is a complex undertaking.
A 33-month-old male child presented with abdominal pain and recurrent episodes of screaming and knee-drawn postures during sleep. The patient had a recent history of mild gastroenteritis, but no recent travel or sick contacts. Physical examination revealed a palpable abdominal mass. Abdominal ultrasound detected a distinct multicystic lesion in the upper left quadrant, separated from the spleen. While gastric involvement was considered, the lesion appeared isolated from the gastric bubble and fixed. Potential diagnoses included a unique gastric bezoar, vascular mass lesions, and an exophytic renal lesion. MRI revealed a large, multiloculated cystic lesion with septations, primarily contained within the renal boundaries, but protruding medially. Noticeable enlargement of adjacent retroperitoneal lymph nodes prompted consideration of an MCRT, including CWT. An atypical multicystic dysplastic kidney was also considered. The patient underwent surgical resection followed by histopathological analysis, which confirmed the diagnosis of CN.
While radiological imaging aids in diagnosing MCRT, distinguishing between CN, CPDN, and CWT often necessitates histopathological analysis. Vascular invasion can point to a diagnosis of CWT. The presence of solid elements is less helpful, as discerning whether these are part of the tumor or part of the native kidney can be difficult. The accuracy of the diagnosis plays a crucial role in determining the necessity for chemotherapy and/or radiation therapy. This case report highlights the diagnostic complexities associated with MCRTs in pediatric patients and underscores the significance of a multidisciplinary approach that incorporates clinical, radiological, and histopathological evaluations to provide the best possible care for these young patients. Read More

Authors:  Shewarega Annabella , Lin Tony , Christison-lagay Emily , Stitelman David , Hittelman Adam , Morotti Raffaella , Silva Cicero , Rowe Erin

Keywords:  Cystic Nephroma, Abdominal, Tumor

Park Ji Eun,  Choi Young Hun,  Cheon Jung-eun,  Kim Woo Sun,  Kim In-one,  Cho Hyun Suk

Final Pr. ID: Poster #: SCI-013

The use of pediatric abdominal CT has been increasing rapidly. However increased radiation exposure is a public health concern for children because of children are more sensitive to radiation than adults. The purpose of this study is to estimate which patient-related factors affect radiation dose, to pediatric patients undergoing abdominal CT Read More

Authors:  Park Ji Eun , Choi Young Hun , Cheon Jung-eun , Kim Woo Sun , Kim In-one , Cho Hyun Suk

Keywords:  Radiation dose, Abdominal CT

Oliver Edward,  Gitman Olga,  Gebb Juliana,  Weiss Dana,  Canning Douglas,  Hedrick Holly,  Howell Lori,  Coleman Beverly

Final Pr. ID: Poster #: CR-007

To report the prenatal ultrasound (US) and magnetic resonance imaging (MRI) findings in a prenatally diagnosed case of closed (i.e. skin-covered) cloacal exstrophy. Read More

Authors:  Oliver Edward , Gitman Olga , Gebb Juliana , Weiss Dana , Canning Douglas , Hedrick Holly , Howell Lori , Coleman Beverly

Keywords:  Abdominal Wall Defect, Prenatal Imaging

Tong Jane,  Luo Yu

Final Pr. ID: Poster #: CR-007

Although acute appendicitis is thought to be result from luminal obstruction of the appendix, rarely it may develop following abdominal trauma. Traumatic appendicitis is thought to occur through direct injury to the appendix, or as a response to other abdominal organ injury. On the other hand, in patients with other organ injury, some distension of the appendix can occur with surrounding free fluid secondary to trauma, mimicking appendicitis. While the clinical presentation of traumatic appendicitis is similar to that of traditional appendicitis, differentiation between reactive appendiceal changes in the setting of traumatic injury to other intra-abdominal organs is important, as the latter will not require appendectomy. We present two pediatric patients in whom following initial suspicion of acute appendicitis, ultrasonography (US) identified mildly enlarged fluid-filled and hyperemic appendix with out of proportion complex fluid, raising the suspicion of previously unsuspected abdominal trauma. Upon further examination, injury to other abdominal solid organs was discovered as the primary cause of patient's presentation and appendiceal findings were reactive to abdominal solid organ injury. In cases of suspected appendicitis, visualization of significant free fluid with dense debris on ultrasonography (US) calls for more careful examination to assess clues of other abdominal injury.
Read More

Authors:  Tong Jane , Luo Yu

Keywords:  reactive appendicitis, abdominal trauma, ultrasound

Sams Cassandra,  Ayyala Rama

Final Pr. ID: Poster #: CR-014

Mesenteric lymphatic malformations are rare intra abdominal masses. Large mesenteric malformations can present soon after birth secondary to abdominal distention or failure to thrive. However, they can also remain clinically inapparent throughout childhood. In this series, three patients, ranging in age from 8 to 16 years, present with acute or acute on chronic abdominal pain. Subsequent imaging studies demonstrated macrocystic, mesenteric lymphatic malformations. These malformations may become painful in the setting of hemorrhage or superimposed infection. As this condition is likely not at the forefront of the clinician's mind, it is incumbent upon the radiologist to recognize the imaging findings. This case study will present a multimodality approach to the diagnosis of macrocystic, mesenteric lymphatic malformations. Read More

Authors:  Sams Cassandra , Ayyala Rama

Keywords:  Vascular Malformation, Abdominal

Sundaram Karthik,  Singh Sudha,  Hernanz-schulman Marta

Final Pr. ID: Poster #: EDU-027

Introduction

Torsion or volvulus of upper abdominal viscera is rare and related to incomplete development and laxity of suspensory ligaments, or to poorly developed supernumerary accessory lobes. Clinical symptoms at presentation can be confusing and nonspecific, yet prompt recognition is essential to avoid life-threatening complications. Radiologists play an essential role in prompt recognition of these conditions. Our exhibit will review congenital anomalies of upper abdominal solid viscera that can lead to volvulus within an embryologic and anatomic framework. As examples, we include cases of mesenteroaxial gastric volvulus (Figure 1), torsion of an accessory hepatic lobe (Figure 2), and splenic torsion in the setting of polysplenia (Figure 3). Our cases include radiologic-pathologic correlations and therapeutic implications of solid visceral torsions.

Table of Contents/Outline:

Review of the embryology and anatomy of upper abdominal organs including a detailed pictorial of suspensory and anchoring ligaments.
Review and examples of types of gastric volvulus and treatment.

Review of variants of liver anatomy and of incidence and location of accessory hepatic lobes, with examples.

Review of splenic anatomy and normal variants, splenic torsion and gross malformations including variants seen in heterotaxy, with review of treatment options in splenic torsion, including observation, surgical pexy or resection.

Review of associated congenital anomalies (e.g. omphalocele, diaphragmatic hernia, and malrotation, etc.) Read More

Authors:  Sundaram Karthik , Singh Sudha , Hernanz-schulman Marta

Keywords:  Torsion, Volvulus, Abdominal

Williams Avery,  Groth Nicholas,  Southard Richard

Final Pr. ID: Poster #: EDU-025

Trauma is a leading cause of death and disability in children ages 1-18, with blunt trauma causing the majority of abdominal injuries. For radiologists, cases of trauma elicit the necessity of timely reads to determine if a patient requires immediate surgical intervention, or is a candidate for conservative, non-operative management. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both standard anatomic and material-specific analysis. This allows accurate demonstration and grading of solid organ injury, differentiation between acute hematoma from ongoing vascular extravasation, detection of subtle injuries and visualization of compromised vascular structures all of which are imperative in determining the proper course of treatment in the acute trauma setting. Read More

Authors:  Williams Avery , Groth Nicholas , Southard Richard

Keywords:  Spectral CT, Abdominal injury, Solid organ injury