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

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

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.
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Authors:  Tong Jane , Luo Yu

Keywords:  reactive appendicitis, abdominal trauma, ultrasound