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

Martinez-sicari Jorge,  Eller Madeline,  Mahdi Eman,  Elbich Jeff,  Jones Kathryn,  Mishra Chakradhar,  Vorona Gregory

Final Pr. ID: Poster #: CR-025

Hydatid cysts caused by larval infection with the tapeworm Echinococcus granulosus commonly affect the liver and lungs, although other organ systems may also be involved. Patients may be asymptomatic for years, presenting only when there is cystic rupture. We present the case of a 12-year-old male with no known prior medical history whose family immigrated from Afghanistan to the United States three years earlier. The patient arrived as a transfer to the emergency department (ED) with acute abdominal pain following blunt trauma. While playing soccer, he collided with another player, who landed on his abdomen. Upon arrival to the ED, he was febrile, tachycardic, and endorsed diffuse abdominal tenderness to palpation. He had no recent fevers, cough, congestion, nausea, vomiting, night sweats, or weight loss. He denied recent travel. Initial labs revealed mild leukocytosis with eosinophilia. Liver function tests and lipase were within normal limits. A contrast-enhanced abdominal-pelvic CT revealed a large, complex cystic structure centered in the right hepatic lobe, containing a peripheral membrane-like structure with evidence of internal hemorrhagic components extending into the peritoneum. Further interrogation with ultrasound confirmed the free-floating internal membrane, known as the “water lily” sign, which is highly specific for hydatid cysts. Using the World Health Organization classification, this was categorized as a CE 3A cyst. A follow-up MRI for drainage localization confirmed hemoperitoneum arising from the ruptured hydatid cyst, as well as peritoneal inflammation. We observed the expected MR features of a hydatid cyst with high T2 signal and low T2 internal debris, as well as overall low T1 mixed signal intensity. Ultrasound-guided percutaneous aspiration and alcohol ablation of the hepatic hydatid cyst was performed using catheter drainage. Fluid analysis demonstrated hooklets and protoscolices confirming the presence of Echinococcus spp. Morbidity and mortality related to echinococcosis is usually due to mass effect from enlarging cysts, which may result in organ disruption, or cyst rupture, potentially leading to anaphylaxis. This case highlights the incidental nature of hydatid cysts, which, although relatively easy to treat, often go undiagnosed until discovered by chance. Read More

Authors:  Martinez-sicari Jorge , Eller Madeline , Mahdi Eman , Elbich Jeff , Jones Kathryn , Mishra Chakradhar , Vorona Gregory

Keywords:  Hydatid, Abdominal Trauma

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

Dykie Adam,  Katzman Philip,  Chaturvedi Apeksha

Final Pr. ID: Poster #: EDU-037

Wilms tumors, also known as nephroblastomas, are overwhelmingly the most common renal tumors in children. While radiologists are abundantly familiar with the imaging appearances of these tumors, their knowledge of underlying histologic features, prognostic variables, and treatment approaches may not be equally robust. Histologically typically triphasic and containing differing proportions of blastemal, epithelial, and stromal components, the prognosis of individual subtypes differs. The “teratoid” variant of Wilms tumor contains components of differentiated tissues such as muscle, bone, cartilage, and fat. Focal and diffuse anaplasia are important histological features with diffuse anaplasia recognized as the most important prognostically unfavorable feature. In addition, there is an intermediate category of “nuclear unrest” which carries some but not all features of anaplasia. Clinical approaches differ between the two major renal tumor clinical research groups: the International Society of Paediatric Oncology (SIOP) Renal Tumor Study Group and the Children's Oncology Group (COG) Renal Tumor Group. This exhibit uses a case-based template of radiologic-pathologic correlation of different Wilms subtypes encountered at our institution, outlining treatment for individual tumor subtypes. We discuss differential diagnoses which may overlap with Wilms tumor on imaging, including nephrogenic rests, mesoblastic nephroma, malignant rhabdoid tumor of the kidney, clear cell sarcoma, and pediatric cystic nephroma (as a mimic of cystic Wilms tumor). We review Wilms tumor classification with known syndromic associations. We provide information on staging through the National Wilms Tumor Study system covering imaging and post-surgical findings. The ultimate goal is to make radiologists more effective members of the interdisciplinary tumor boards through enhancing a holistic understanding of Wilms tumor. Read More

Authors:  Dykie Adam , Katzman Philip , Chaturvedi Apeksha

Keywords:  Wilm's Tumor, Kidneys, Abdominal Imaging

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

Mannuru Sravani,  Hui Jessica,  Lai Lillian

Final Pr. ID: Poster #: EDU-018

Extralobar pulmonary sequestration (EPS) and cystic neuroblastoma (CN) are rare pediatric thoracoabdominal masses with distinct yet sometimes overlapping imaging features, posing diagnostic challenges for radiologists. Accurate differentiation is crucial for guiding clinical management and preventing unnecessary interventions. This review focuses on comparing the imaging characteristics of EPS and CN, with emphasis on key features that aid in distinguishing between these entities. EPS typically presents as a well-defined, homogenous mass located near the lower lobes of the lung, often with systemic arterial supply visualized on contrast-enhanced imaging. It may exhibit smooth margins and is commonly identified in neonates and infants. Conversely, cystic neuroblastoma, while rarer, typically manifests as a retroperitoneal mass, often arising from the adrenal gland, with a more complex appearance, including cystic and solid components. Calcifications, which are frequently seen in neuroblastoma, may provide a critical clue for diagnosis, while the absence of systemic arterial supply differentiates it from EPS. Pitfalls arise from the potential overlap in appearance, such as fluid-filled or cystic components within both lesions, which may lead to confusion. Additionally, both lesions may be incidentally discovered on prenatal or early postnatal imaging, necessitating careful evaluation of ancillary features such as vascular supply, location, and internal characteristics to ensure accurate diagnosis. This review offers radiology residents, fellows, and attending radiologists a comprehensive comparison of EPS and CN imaging findings, with a focus on avoiding common diagnostic traps. Understanding these key differences enhances diagnostic confidence, promotes appropriate management, and improves outcomes for pediatric patients. Read More

Authors:  Mannuru Sravani , Hui Jessica , Lai Lillian

Keywords:  Pediatric Radiology, Abdominal Imaging, Chest

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

Podury Ruchika,  Dagar Saloni,  Weiss Danielle,  Amodio John,  Blumfield Einat,  Levin Terry

Final Pr. ID: Poster #: EDU-035

Intraluminal post bulbar duodenal masses in children may be solid or cystic, congenital, neoplastic or post traumatic. The aim of this educational exhibit is to present the imaging findings of these duodenal masses using fluoroscopy, ultrasonography, computed tomography and magnetic resonance imaging and discuss the role of imaging. In addition, the clinical implications of these entities will be discussed. The cases will include: duodenal duplication cyst, duodenal web, choledochocele, duodenal hematoma, and duodenal adenoma. Read More

Authors:  Podury Ruchika , Dagar Saloni , Weiss Danielle , Amodio John , Blumfield Einat , Levin Terry

Keywords:  Duodenum, Abdominal Imaging, Pediatric Imaging

Mannava Sindhu,  Chen Paula,  Marine Megan,  Cromeens Barrett,  Karmazyn Boaz

Final Pr. ID: Poster #: SCI-020

Neonatal bowel obstruction (NBO) is the first presentation of cystic fibrosis (CF) in approximately 15–20% of cases and is most commonly due to meconium ileus (MI) in this cohort. Contrast enema (CE) is a diagnostic tool which can help discern NBO etiology with variable accuracy. CE can also be a therapeutic tool in cases of simple MI. In this study, we describe our experience with CE in diagnosis and management of meconium ileus and other pathologies causing bowel obstruction in these patients. Read More

Authors:  Mannava Sindhu , Chen Paula , Marine Megan , Cromeens Barrett , Karmazyn Boaz

Keywords:  Abdominal Imaging, Contrast Enema, Obstruction

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

Ro Esther,  Schooler Gary,  Morin Cara,  Khanna Geetika,  Towbin Alexander

Final Pr. ID: Poster #: EDU-029

The American College of Radiology Pediatric LI-RADS Working Group was formed in 2017 with the task of advancing the imaging work up, diagnosis, and management of pediatric liver tumors, particularly pediatric hepatic malignancies. This exhibit will present how the Pediatric LI-RADS Working Group is working towards this goal by means of advocacy, education, and research. In regard to advocacy, the Working Group is a strong proponent for the standardization of imaging practice for pediatric liver tumors. Based on expert interpretation of the literature, the Working Group established consensus imaging recommendations for children with a known or suspected liver neoplasm. This exhibit will highlight the key recommendations for choosing imaging modality and protocol for the work up of a pediatric liver tumor. Education is another major component of the Working Group’s mission. The group has presented at meetings and published manuscripts on various topics. Topics include age and indication-based imaging strategies for pediatric liver tumors and liver masses in children with predisposition syndromes. This exhibit will touch on the major teaching points of these papers. Lastly, this exhibit will present the research conducted by the Pediatric LI-RADS Working Group. Their research studied the utility of applying adult LI-RADS criteria to children. Another study analyzed the imaging features of hepatocellular carcinoma in children with and without an underlying predisposition. To summarize, through discussion of the major accomplishments of the Pediatric LI-RADS Working Group, this exhibit will provide insight, education, and resources for the radiologist interpreting pediatric liver tumors. Read More

Authors:  Ro Esther , Schooler Gary , Morin Cara , Khanna Geetika , Towbin Alexander

Keywords:  Liver Tumor, Malignancy, Abdominal Imaging

Priya Sarv,  Nagpal Prashant

Final Pr. ID: Poster #: CR-030

Pediatric polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting medium-sized arteries, leading to inflammation and organ damage. It often involves the skin, kidneys, and gastrointestinal tract, with symptoms such as fever, abdominal pain, and hypertension. Early diagnosis and treatment are essential to managing this condition. This report discusses renal imaging findings in two pediatric patients with PAN.

A 10-year-old male presented with abdominal pain, nausea, and acute renal failure. A left renal biopsy revealed medium vessel arteritis, raising suspicion for polyarteritis nodosa. Renal Doppler ultrasound showed normal renal arteries but increased echogenicity of the kidneys. CTA demonstrated patent renal arteries without beading, but bilateral cortical hypoenhancement was observed, indicating cortical necrosis consistent with vasculitis. MRA further confirmed the suspicion of PAN by revealing minimal contrast blushing and nodularity at the corticomedullary junction, suggestive of microaneurysms. Imaging played a key role in confirming the diagnosis of PAN in this patient.

A 16-year-old male presented with a six-month history of abdominal pain, fatigue, weight loss, chills, and hypertension. Laboratory results showed elevated inflammatory markers. MRA of the chest, abdomen, and pelvis revealed numerous bilateral arterial enhancing foci within the renal parenchyma, measuring 2 to 5 mm, suggestive of microaneurysms. A renal biopsy confirmed secondary focal segmental glomerulosclerosis.

CT and MR imaging are essential for diagnosing pediatric polyarteritis nodosa by identifying key vascular abnormalities such as microaneurysms and ischemic damage. These imaging techniques not only confirm the diagnosis but also guide timely intervention, improving the management of this rare condition in pediatric patients. Read More

Authors:  Priya Sarv , Nagpal Prashant

Keywords:  Renovascular Hypertension, Vasculitis, Abdominal Imaging

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

Prasad Shashank,  Goodyear Abbey,  Mcfarland Joseph,  Munjal Havisha,  Phiip Sijo,  Ngoc Giang Thanh,  Kwon Jeannie

Final Pr. ID: Poster #: EDU-019

1. Review the advantages and approach to using ultrasound for the evaluation of emergent pediatric-specific abdominal conditions.
2. Discuss specific examples and demonstrate ultrasound findings for common and rare pediatric abdominal emergencies and correlation with other modalities. Read More

Authors:  Prasad Shashank , Goodyear Abbey , Mcfarland Joseph , Munjal Havisha , Phiip Sijo , Ngoc Giang Thanh , Kwon Jeannie

Keywords:  Abdominal, Ultrasound, Emergencies

Mannuru Sravani,  Hui Jessica,  Lai Lillian

Final Pr. ID: Poster #: EDU-089

Pediatric adrenal masses are rare but significant findings in clinical radiology, requiring careful evaluation due to their varied etiologies ranging from benign lesions to malignant tumors. For radiology residents, fellows, and attending radiologists, a systematic approach is essential for accurate diagnosis and management. This review highlights key imaging pearls and common pitfalls associated with pediatric adrenal lesions. The "pearls" include recognizing age-specific differentials, the importance of correlating clinical and biochemical findings, and the utility of advanced imaging techniques such as MRI for tissue characterization. Neuroblastoma, the most common malignant pediatric adrenal tumor, should be distinguished from benign entities like adrenal hemorrhage or hyperplasia based on imaging characteristics such as calcification, organ displacement, and vascular encasement. In contrast, pitfalls often arise from misinterpreting normal anatomic variations or failing to account for the dynamic nature of some lesions, such as hemorrhage or pheochromocytoma, which may change in size or appearance over time. Furthermore, the overlap in imaging features between benign and malignant lesions can lead to diagnostic uncertainty. This review emphasizes the need for a multidisciplinary approach, incorporating clinical, laboratory, and imaging data to avoid misdiagnosis and unnecessary interventions. Understanding the pearls and pitfalls of pediatric adrenal mass imaging will aid radiologists in providing more accurate and timely diagnoses, ultimately improving patient outcomes. Read More

Authors:  Mannuru Sravani , Hui Jessica , Lai Lillian

Keywords:  Abdominal Imaging, Adrenal, Pediatric Imaging

Van Antwerp Emily,  Makris Joseph

Final Pr. ID: Poster #: CR-024

Inspissated bile syndrome (IBS) is a rare pediatric condition, with an estimated incidence of 1 in 175,000 live births. It results from the thickening or "inspissation" of bile, often leading to biliary obstruction, cholestasis, and pale or acholic stools. While IBS is typically associated with predisposing factors such as prematurity, sepsis, total parenteral nutrition, or certain medications, it can occur without identifiable risk factors, as seen in this case. Early recognition and treatment are critical in preventing more serious complications such as liver dysfunction or cirrhosis. We report the case of a 4-week-old full-term infant (born at 40 weeks’ gestation) presenting with acholic (white) stools and mild jaundice. Initial laboratory tests showed a total bilirubin level of 5.0 mg/dL (3.9 direct), gamma-glutamyl transferase (GGT) of 352 U/L, alkaline phosphatase (ALP) of 586 U/L, and mildly elevated liver function tests. An abdominal ultrasound demonstrated intra- and extrahepatic biliary dilatation, with echogenic material obstructing the distal common bile duct just proximal to the ampulla, findings highly suggestive of inspissated bile syndrome. The patient was started on ursodiol 40 mg twice daily, a bile acid that promotes bile flow and decreases the viscosity of bile. A follow-up MRCP performed 10 days later showed complete resolution of the biliary obstruction and no evidence of intra- or extrahepatic dilation. This case highlights not only the rarity of IBS but also its ability to present in the absence of typical risk factors such as prematurity, malabsorption disorders, or prolonged total parenteral nutrition. Additionally, it underscores the essential role of imaging modalities such as ultrasound and MRCP in diagnosing biliary obstruction and guiding appropriate management. IBS should be considered in the differential diagnosis for any neonate presenting with jaundice and acholic stools, as timely diagnosis and medical management can lead to full recovery and prevent more serious hepatobiliary complications. Read More

Authors:  Van Antwerp Emily , Makris Joseph

Keywords:  Biliary, Abdominal Imaging, Abdominal Ultrasound

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

Ocal Selin,  Lee Jason,  Alizadeh Houman

Final Pr. ID: Poster #: CR-019

This case elucidates a 20mo male with history of chronic granulomatous disease (CGD) who presented with PO intolerance, recurrent emesis, fussiness, and abdominal pain. The patient was diagnosed with CGD at age 11mo after developing upper extremity cellulitis from Serratia marescens. Just 1 month before this presentation, he underwent colonoscopy/endoscopy for persistent anorexia and fussiness after clean-out for severe constipation and was found with ulcerative pancolitis. Initiation of vendolizumab was recommended; just a few days before his first dose, he developed increased vomiting, lethargy, and PO refusal. Ten days after symptom onset (5 days after first venolizumab dose) he presented to the emergency department. Initial abdominal radiograph was largely unrevealing with clinical suspicion for constipation. However, subsequent upper GI series revealed a diffusely narrowed and elongated pyloric channel with mild delay in gastric emptying, suspicious for pyloric stenosis. Follow-up ultrasound depicted increased pyloric length with mucosal and muscularis thickening consistent with pyloric stenosis in the setting of CGD. An ensuing CT of the abdomen demonstrated segmental circumferential proximal jejunal wall thickening compatible with chronic granulomatous disease enteropathy. Pyloric stenosis, which typically presents in the first 2 months of life, is an unusual finding in a child of age 20mo. Though pulmonary infections are the most commonly affected organ system in CGD, the gastrointestinal (GI) manifestations—beyond just hepatic abscesses, which occur in 25-50% of patients—are infrequently discussed. The patient presented here exhibits predominantly GI-related effects. Granulomatous inflammation can affect any part of the GI tract and may mimic Crohn's disease via bowel wall thickening, luminal narrowing, fistulation, or mucosal cobblestone/skip lesions. Gastric antral wall thickening is estimated in 16% of CGD patients, and more commonly reported upper GI study findings in patients with CGD include delayed gastric emptying, circumferential antral narrowing, gastric fold thickening, or esophageal strictures with dysmotility. Though gastric outlet obstruction from antral or diffuse gastric wall thickening has been described, there are no other prior reports of pyloric stenosis due to CGD. From this case, we posit that CGD should be considered as a causative etiology for older infants/children with new radiological findings of pyloric stenosis. Read More

Authors:  Ocal Selin , Lee Jason , Alizadeh Houman

Keywords:  Pyloric Stenosis, Abdominal Imaging, Upper GI Series

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

Cheeseman George,  Torikai Hideyuki,  Smith Leah,  Walls Robert,  Patrie James,  Ahn Ju Hee

Final Pr. ID: Poster #: SCI-019

Pediatric acute appendicitis is the most common surgically treated disease in the United States. Evaluation via ultrasonography is recommended as the most appropriate initial modality to diagnose acute appendicitis in the pediatric population by the American College of Radiology. However, nonvisualization of the appendix creates diagnostic challenges leading to additional imaging and laboratory studies as well as costs. The purpose of this study is to determine the value of identifying the ileocecal valve as a reliable initial landmark for identification of the appendix via ultrasonography. Read More

Authors:  Cheeseman George , Torikai Hideyuki , Smith Leah , Walls Robert , Patrie James , Ahn Ju Hee

Keywords:  Appendix, Ultrasonography, Abdominal Imaging

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

Ng Evonne,  Dawani Anuradha

Final Pr. ID: Poster #: CR-022

Enteric Duplication cysts (EDCs) are uncommon congenital anomalies of the alimentary tract. These can arise from anywhere along the gut including the foregut, midgut and hindgut duplications with most common location being ileum. Majority of the EDCs are symptomatic within the first 2 years of life and early surgery is the treatment of choice for symptomatic EDCs. Radiologically, gut signature sign is pathognomonic on the ultrasound for the more common (80%) cystic/spherical EDCs. However, the less common (20%) tubular subtype can be difficult to interpret on imaging and mimics other pathologies. We present an atypical case of a long tubular duplication cyst in an infant that posed imaging diagnostic challenge.
An 8 week old female child presented with fresh red blood in stools, intermittent drawing up of legs and tachycardia with low dropping haemoglobin levels. Intussusception was suspected clinically and ultrasound was initially performed which showed a grossly dilated (up to 4 cm diameter) small bowel loop in left abdomen with mild wall thickening and hyperemia. Rest of the bowel was normal. Incidentally, gall bladder duplication was noted. Subsequently, CT was also performed to delineate the full extent of the abnormality which demonstrated similar findings of a very long segment of dilated jejunal loop with features of enteritis and possibility of congenital segmental intestinal dilatation was considered. Surgery revealed that the dilated bowel loop was in fact a tubular EDC intimately associated with a long segment of jejunum approx. 45 cm in length and complete resection with end to end anastomosis was done.
Our case highlights that the tubular subtype of enteric duplications cysts is a rare entity that poses a diagnostic challenge and must be included as plausible differential diagnosis in the appropriate clinical setting and supporting imaging features. Read More

Authors:  Ng Evonne , Dawani Anuradha

Keywords:  Abdominal Imaging, Bowel, Enteric Cyst

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

Dawani Anuradha,  Jagani Sumit

Final Pr. ID: Poster #: CR-018

Bezoars are an uncommon cause of small bowel obstruction (SBO) in children. Trichobezoars are typically seen in adolescent girls who swallow their hair. Lactobezoars are another unusual cause of intestinal obstruction in neonates/infants. Phytobezoars, foreign body bezoars and pharmacobezoars are other types of bezoars. CT is a useful tool in diagnosing the cause of SBO, however, SBO caused by bezoars may not be detected on a CT exam as it presents as faeces like material proximal to the transition point. Ultrasound (US) can help differentiate a bezoar from faeces. The diagnostic signs of a bezoar on US include an echogenic, arc-like surfaced intraluminal mass, strong posterior acoustic shadowing and twinkling artefacts from the front of the mass resulting from the rough hard surface and high acoustic impedance differences within the internal structure of a bezoar. These features are not seen with faecal material.

We present two cases of bezoar induced SBO. The first case was a small intestinal trichobezoar in an 11 year old female child who presented with abdominal pain and bilious vomiting since 4 days. US demonstrated dilated small bowel with classic appearances of a bezoar in distal ileum. CT was not done in this instance and patient underwent surgery based on US findings. Same patient was also shown to have a large gastric bezoar on further endoscopic and ultrasound evaluation. Second case was a lactobezoar in a 9 month old infant that presented with copious bilious aspirates in NG tube, post difficult hernia reduction. CT demonstrated acute SBO with transition point at IC junction and faeces like intraluminal material proximal to it. US again showed characteristic appearances of a bezoar thus clinching the diagnosis. First patient underwent extraction via enterotomy and the second patient was treated with fragmentation and milking out.

Our cases highlight following learning points: 1. US shows characteristic appearances and improves diagnostic accuracy in conjunction with CT thus helping radiologists to quickly and easily diagnose bezoar. US can also suffice as first line and only imaging investigation needed. 2. Lactobezoar should be kept as a differential for SBO in neonates/infants. 3. In cases of intestinal bezoars, possibility of further proximal/gastric bezoars must be explored. Read More

Authors:  Dawani Anuradha , Jagani Sumit

Keywords:  Abdominal Ultrasound, Bezoar, Diagnostic Accuracy