Infante Juan

Final Pr. ID: Poster #: CR-014

Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.

The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.

Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma. Read More

Authors:  Infante Juan

Keywords:  trauma, bladder, pelvic anatomy

Fuortes Michaelangelo,  Vijapura Charmi,  Dennhardt Joel,  Policeni Bruno,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-104

1) Review the normal development and anatomy of the middle cranial fossa.
2) Describe the variety of pathologies affecting the middle cranial fossa in the pediatric age group with a focus on the typical computed tomography (CT) and magnetic resonance imaging (MRI) characteristics.
3) Discuss clinical management and imaging follow up of middle cranial fossa pathology. Read More

Authors:  Fuortes Michaelangelo , Vijapura Charmi , Dennhardt Joel , Policeni Bruno , Sato Yutaka , Sato T Shawn

Keywords:  skull base anatomy, skull base pathology, middle cranial fossa

Lacroix Caroline,  Ahyad Rayan,  Manson David

Final Pr. ID: Poster #: EDU-107

Pulmonary haemorrhage in children is a non-specific response to a number of varying insults. Many of these insults favour particular anatomic foci along the pulmonary and bronchial arterial trees respectively. Although recent years have seen an emerging interest in the understanding and classification of pulmonary vasculitides, this pathophysiology represents only one subset of the causes of pulmonary haemorrhage in children. Our purpose is to review the imaging and pathophysiologic manifestations of varying causes of pulmonary haemorrhage according to the anatomic region of susceptibilities in the pulmonary arterial and bronchial artery trees.

We aim to provide a perspective of imaging manifestations of the pathophysiologies of pulmonary haemorrhage displayed schematically according to their relative anatomic areas of susceptibility. We aim to focus on useful constellations or associated findings that will serve to help the reader differentiate amongst entities that often have otherwise similar imaging presentation. Read More

Authors:  Lacroix Caroline , Ahyad Rayan , Manson David

Keywords:  haemorrhage, vasculitides, anatomy, pathophysiology, pulmonary

Southard Richard,  Ellsworth Erik,  Moe Tabitha,  Augustyn Robyn,  Thorkelson Marrit,  Bardo Dianna

Final Pr. ID: Poster #: EDU-090

The structure of the heart is more complex than 4 major chambers, 4 major valves, venous inflow and arterial outflow.

Muscular and soft tissue ridges, perforated membranes, tissue flaps, electrical pathways, external grooves, endocardial surface characteristics, and a core architecture structured of fibrous tissue and embryonic tissue remnants form distinguishing anatomic landmarks. These structures provide insight into cardiac development, serve physiologic purpose, define structural and functional elements, as well as offer prognostic information.

Specific details of cardiac anatomy may not be recognized on cardiac MR and CT examinations. Structural anomalies that affect cardiac function and anatomic or physiologic relationships may be abnormal in hearts with congenital malformations. The fine structural details of the heart are typically not part of an imagers search pattern and are therefore overlooked or underreported. Each minute structure and anatomic characteristic provides clues to errors in cardiac formation and may provide clinically relevant diagnostic information. After palliation of CHD defining anatomic structure may be lost, displaced, interrupted or even restored.

Important processes, corresponding anatomic landmarks, and effects of malformation in defining congenital heart disease anatomy, physiology and functional variation from normal include basal structures such as the central fibrous body of the heart, atrial structures including the crista terminalis, the sinus venarum, and eustacian valve, and ventricular structures such as the crista supraventricularis.

Each structure is described along with its normal location, anatomy functional and physiologic importance, the effect of congenital malformation, and imaging findings as in the example of the central fibrous body (table 1).

Minute cardiac anatomy will be shown in illustration as well as in CT and MR images (figure 1). Read More

Authors:  Southard Richard , Ellsworth Erik , Moe Tabitha , Augustyn Robyn , Thorkelson Marrit , Bardo Dianna

Keywords:  Cardiac anatomy, Cardiac MR, Cardiac CT, Congenital heart disease, Embryology

Malkawi Ibraheem,  Bloom David,  Hryhorczuk Anastasia

Final Pr. ID: Poster #: EDU-036

Describe the normal anatomic appearance and anatomic variants of the pediatric coracoid process with representative images.
Evaluate the radiologic fracture patterns and fracture mimics of the pediatric coracoid process with representative images.
Review additional pathology of the pediatric coracoid process that can present incidentally after trauma

Included topics :
I Coracoid process anatomy
Normal pediatric development/ossification
Developmental variations
Associated anatomic structures

II. Sequelae of coracoid process trauma
Multimodality imaging—radiography, CT, MRI
Pediatric fracture patterns
Mimics of fractures

III. Incidental findings of the coracoid process
Neoplasm
Other Read More

Authors:  Malkawi Ibraheem , Bloom David , Hryhorczuk Anastasia

Keywords:  shoulder anatomy, coracoid process, trauma

Kerwin Clara,  Ahmed Umer,  Tippetts Madison,  Setty Bindu

Final Pr. ID: Poster #: EDU-007

Penetrating trauma among pediatric patients, while less common than among adults, carries significant morbidity and mortality. In the pediatric population, penetrating trauma to the torso may be due to accidental injuries with sharp objects, animal bites, and, increasingly, gunshot wounds. While children with penetrating torso trauma are often managed following the same protocols as adults, pediatric patients are anatomically more vulnerable to multi-organ involvement due to the disproportionately large size of their organs, relative paucity of musculature, and elasticity of the ribcage. In addition to solid and hollow organ involvement, blood vessel injuries are crucial to recognize given the smaller intravascular volume of pediatric patients.

The mainstay of imaging evaluation of penetrating trauma to the torso centers on contrast-enhanced CT, often with CT angiography. These modalities enable the radiologist not only to assess for visceral injury, but also to detect the trajectory of penetration, the presence of retained foreign bodies, and any signs of active bleeding. Given the relative rarity of penetrating trauma among children, pediatric radiologists play a pivotal role in promptly identifying injury extent, recognizing subtle patterns of organ/vessel involvement, and informing appropriate surgical management.

The objectives of this educational poster are as follows:
1. To review the demographic risk factors associated with pediatric penetrating trauma to the torso as may be seen at an urban Level 1 trauma center.
2. To detail the common causes of penetrating trauma (e.g. gunshot wounds) and characterize how injury patterns among children are affected by pediatric anatomy.
3. To provide radiologists with pediatric-specific imaging protocol recommendations that can ensure comprehensive evaluation of injury and help guide further management. Read More

Authors:  Kerwin Clara , Ahmed Umer , Tippetts Madison , Setty Bindu

Keywords:  Trauma, Penetrating Complications, Anatomy

Acosta-izquierdo Laura,  Dien-esquivel Maria,  Miller Elka,  Ferretti Emanuela,  Martinez-rios Claudia

Final Pr. ID: Poster #: EDU-017 (S)

Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. Continued advances on therapy and supportive care in the neonatal intensive units have allowed for an improved survival of these infants. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the integrity of the brain during the first weeks of postnatal life, as it provides a closer direct look to the brain. The purpose of this exhibit is to illustrate detailed US characteristics of the normal development and complications of the evolving premature brain of ELGA infants. Read More

Authors:  Acosta-izquierdo Laura , Dien-esquivel Maria , Miller Elka , Ferretti Emanuela , Martinez-rios Claudia

Keywords:  Brain anatomy, Prematurity, Neurodevelopment

Germaine Colton,  Richards Allyson,  Tocchio Shannon,  Welch Kathryn,  Ku Elliot,  Martinez Sam

Final Pr. ID: Poster #: EDU-057

The incidence of cervical spine injuries is much less common in pediatric patients compared to their adult counterparts; however, these injuries result in more severe morbidity and mortality in the pediatric population, with increased rates of permanent neurological damage and death not uncommon. Understanding the physiology and anatomy as well as the clinical presentation of different pathologies is an essential skill when evaluating cervical spine injuries. Imaging the pediatric population presents challenges with variant anatomy and unique injury presentations on imaging. Here, we establish a search pattern for cervical spine imaging and review common pitfalls radiologists will encounter when reviewing cervical spine imaging in the setting of trauma.

CONTENT ORGANIZATION:
1) Epidemiology of pediatric cervical spine injuries.
2) Overview of the pediatric cervical spine with focus on developmental anatomy, common variants and physiologic considerations.
3) Review of search pattern considerations for cervical spine imaging.
4) Imaging examples of traumatic cervical spine injuries with illustration of critical findings and avoidable pitfalls.
5) Brief review of the role of the radiologist when reviewing cervical spine injuries.

SUMMARY:
This exhibit will provide education on important anatomy, imaging findings and pitfalls to avoid when reviewing cervical spine trauma imaging in pediatric patients. Teaching points will include:
1) Normal versus variant anatomy of the cervical spine.
2) Vital anatomical locations to review in the setting of cervical spine injury.
3) Detection of imaging features significant for cervical spine injuries using a wide variety of unique cases.
4) Effectively identifying and reporting the type and extent of the injury. Read More

Authors:  Germaine Colton , Richards Allyson , Tocchio Shannon , Welch Kathryn , Ku Elliot , Martinez Sam

Keywords:  Cervical Spine Injury, Anatomy, Pitfalls

Masood Sehban,  Newman Christopher

Final Pr. ID: Poster #: EDU-075

Developmental variations of the meniscus are common in pediatric musculoskeletal imaging. These range from normal anatomical variants to anomalies causing pain, instability, and secondary injuries. The purpose of this educational poster is to review developmental variations that result in normal anatomic variants or congenital disease.

Normal prenatal and postnatal mensical development is reviewed along with a discussion of the relevant mechanical stabilizers (e.g., intermeniscal and mensicofemoral ligaments, meniscocapsular ligaments, popliteomeniscal fascicles). Sequential embryologic milestones are outlined to demonstrate the formation of the normal meniscal morphology. The role of collagen and vascular organization is discussed to provide insight into the developmental basis of meniscal shape.

Normal anatomic variants (including discoid meniscus, ring-shaped meniscus, hypermobile meniscus, and meniscal flounce) are illustrated. Congenital anomalies (including duplication, hypoplasia, and abnormal attachment) are reviewed. Associated developmental anomalies are also discussed (e.g., thrombocytopenia absent radius syndrome, Larsen syndrome, Ellis-van Creveld syndrome). Important differential diagnoses (e.g., bucket handle tears) will be considered that can result in substantial differences in patient management.

A diagnostic approach is provided for differentiating the various causes of abnormal meniscal development using radiographic and MR imaging. When available, longitudinal imaging, physical examination, and arthroscopic correlations are provided for diagnostic confirmation. Possible complications, associated abnormalities, imaging considerations, and reporting recommendations are also provided to better support next steps in patient care. Read More

Authors:  Masood Sehban , Newman Christopher

Keywords:  Knee, Congenital, Anatomy

Alucozai Doonyah,  Marine Megan,  Karmazyn Boaz,  Newman Christopher

Final Pr. ID: Poster #: EDU-060

Fractures are among the most common injuries detected radiologically in cases of suspected child abuse. However, normal developmental variants may resemble fractures on imaging and can pose a challenge for accurate diagnosis. The aim of this educational exhibit is to review normal anatomic variants that can mimic child abuse injuries and outline key imaging features that help distinguish these normal variants from traumatic injuries.

Examples from the skull include include accessory sutures and vascular channels, which can mimic linear calvarial fractures. Examples from the thorax include accessory ossification centers, bifid ribs, pseudarthroses, costochondral junction variants, and sternal ossification centers, which can mimic healing rib fractures. Examples from the long bones include metaphyseal collars, cortical stepoffs, metaphyseal spurs, and metaphyseal fragmentation, all of which can mimic classic metaphyseal lesions.

Anatomic variants are presented alongside the injuries that they often mimic in order to demonstrate the key imaging features that permit improved discrimination. Further imaging and clinical correlation are provided to demonstrate the benign nature of anatomic variations. A diagnostic checklist is provided for differentiating these variants from fractures in unknown cases.

Understanding normal developmental patterns and the radiological appearance of common variants in the pediatric skeleton is critical for the accurate interpretation of imaging studies in order to avoid overdiagnosing fractures that would otherwise cause high concern for child abuse. Read More

Authors:  Alucozai Doonyah , Marine Megan , Karmazyn Boaz , Newman Christopher

Keywords:  NAT/Abuse, Musculoskeletal, Anatomy

Cheeseman George,  Mack Marie,  Hook Marcus

Final Pr. ID: Poster #: EDU-100

The breadth of heterotaxy syndromes is a topic commonly covered in the education of radiology providers, however is often neglected in graduate medical education and in the scope of general pediatric practice. Although some heterotaxy syndromes are discovered incidentally, others can lead to severe morbidity and mortality secondary to congenital abnormalities including heart defects and intestinal malrotation. Early recognition of heterotaxy syndromes associated with severe congenital defects such as right-sided isomerism can help to reduce negative patient outcomes and lead to appropriate referral from an outpatient basis to the appropriate medical subspecialists. Conversely, knowledge of heterotaxy syndromes and associated clinical manifestations can aid in identifying which syndromes which are incidental and avoid further imaging work up or costly examinations for patients when not indicated. This exhibit aims to educate providers about the different classifications of heterotaxy syndromes with a focus on clinical features and recommended follow-up based on multidisciplinary guidelines. Read More

Authors:  Cheeseman George , Mack Marie , Hook Marcus

Keywords:  Heterotaxy, Isomerism, Anatomy