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

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

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