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Society for Pediatric Radiology – Poster Archive

Showing 20 Abstracts.

Becker Richard,  Rubio Eva,  Bulas Dorothy,  Blask Anna,  Loomis Judyta,  Oetgen Matthew

Final Pr. ID: Poster #: EDU-014

Congenital anomalies causing lower extremity shortening can result from dysgenesis or agenesis of the bones of the thigh, leg or foot; they are generally a very uncommon occurrence, with an incidence on the order of one case per 1,000,000 to one case per 100,000 births. These conditions result in varying degrees of morbidity, ranging from gait dysfunction to complete lack of the ability to ambulate. The accurate characterization of such an anomaly may be challenging prenatally, but can have significant impact on prognosis and treatment planning.
We present a collection of cases depicting the spectrum of prenatally diagnosed anomalies of limb development, including proximal focal femoral deficiency, multiple cases of varying degrees of fibular and tibial hemimelia, amniotic band syndrome, benign uterine packing, neurofibromatosis, clubfoot anomaly and rocker bottom foot, all of which were evaluated on prenatal ultrasound and/or fetal MRI.
Accurate prenatal diagnosis is extremely important for prognosis, treatment planning and risk-stratification for associated congenital anomalies. The purpose of this poster will be to highlight the imaging features by both fetal MRI and prenatal US, discuss potential diagnostic pitfalls and review the clinical implications of this interesting spectrum of congenital disorders. We will describe a methodical approach to assessment of these patients. Our recommendations include: prenatal US to include a complete set of bilateral long bone and foot length measurements; lateral and footprint views of the fetal foot; views of both tibiae and fibulae bilaterally; views of the spine and upper extremities, a thorough search for other abnormalities; fetal MRI for complex cases or when US findings are limited; and a complete family and maternal history, including notation of family stature.
Examples of the classic appearance of these conditions will be presented. Several missed diagnoses and the lessons learned will also be discussed. Counseling points addressed by the orthopedic surgeon will be included. Outcome management will be reviewed.
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Authors:  Becker Richard , Rubio Eva , Bulas Dorothy , Blask Anna , Loomis Judyta , Oetgen Matthew

Keywords:  extremity, anomaly, fetal

Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Final Pr. ID: Poster #: EDU-065

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

Authors:  Gual Fabiana , Lima Natalia , Matsuoka Marcia , Sameshima Yoshino

Keywords:  vascular anomalies, hemangioma, vascular malformations

Suryaningrat Windu,  Amal Mohamad,  Sekarsari Damayanti

Final Pr. ID: Poster #: CR-031

The bridging bronchus is a rare bronchus anomaly which mostly found in infants and children. Aberrant bronchus that arises from either right or left main bronchus and crosses the mediastinum to supply the collateral lung lobe has come to the term of bridging bronchus. The diagnosis is often challenging as the bridging bronchus itself can be asymptomatic or presented by recurrent respiratory distress, but the use of right protocol in cross-sectional imaging is helpful enough to find the bridging bronchus.
This case report aims to present a case of a 5-month-old boy with recurrent pneumonia. He experienced episodes of severe dyspnea, fever, and desaturation, with negative PCR for covid-19. His echocardiography showed a moderate ventricular septal defect (VSD), worsening his dyspnea episodes which were accompanied by the decrease of oxygen saturation to 92% in room air. He underwent VSD closure procedure, which omitted the desaturation episodes, yet still experienced recurrent episodes of dyspnea and fever within 4 months of follow-up. In each episode, he had to be hospitalized and received conventional therapy by using antibiotics, bronchodilators, corticosteroids. Computed tomography (CT) scan of thorax using the pediatric radiation dose was done to evaluate the cause of recurrent pneumonia. Imaging findings in post-contrast slices (taken in inspiration phase) showed no connection between right lower lobe and left main bronchus, which was then suspected as esophageal bronchus. Then, in pre-contrast slices (taken in expiration phase) showed branch of the trachea into a right main bronchus and a stenotic aberrant bronchus (bridging bronchus, type 2) to the left hemithorax, and branching as right lower lobe bronchus and left main bronchus. Further evaluation of all slices in CT scan of thorax showed the stenotic bridging bronchus occluded in post-contrast slices, which were accidentally taken in inspiration phase. The occluded bridging bronchus led to non-optimal ventilation of the left lung lobes and right lower lobe, causing an imbalance of mucus clearance. Thus, increases the risk of mucus accumulation and rise the bacterial risk of infection which manifests as recurrent pneumonia in this patient. Nevertheless, within four months of follow up the patient was discharged with stable condition and symptoms-free.
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Authors:  Suryaningrat Windu , Amal Mohamad , Sekarsari Damayanti

Keywords:  bridging bronchus, congenital airway anomaly, airway anomaly

Frank Matt,  List Jeb,  Harris Katherine

Final Pr. ID: Poster #: CR-07 (R)

12 year old female presented with history of ureteral re-implantation and severe pelvic pain for a month. Pelvic ultrasound showed a bi-lobed hypoechoic mass in the pelvis markedly distended with internal intermediate and low level echoes and septations suggestive of hematometrocolpos thought to be secondary to imperforate hymen. Subsequent MRI evaluation of the pelvis demonstrated a complete septate uterus with longitudinal vaginal septum, atresia of the lower 1/3 of the vagina, and hematocolpos. The patient was placed on Lupron and referred for reconstructive surgery. Read More

Authors:  Frank Matt , List Jeb , Harris Katherine

Keywords:  Septate uterus, longitudinal vaginal septum, Mullerian duct anomaly, Septate uterus MRI, longitudinal vaginal septum MRI

Prasad Preeti,  Khan Muhammad,  Maller Vijetha

Final Pr. ID: Poster #: EDU-062

Congenital anomalies of lungs are heterogenous group of developmental disorders which vary widely in their clinical manifestations, imaging appearance and pathology, but with a considerable overlap. There has been substantial improvement in our understanding of these lesions due to advances in prenatal and postnatal imaging. The purpose of this educational exhibit is to describe the radiological appearance of various congenital lung abnormalities and facilitate our fellow radiologists to accurately diagnose these anomalies and contribute to the patient management. Read More

Authors:  Prasad Preeti , Khan Muhammad , Maller Vijetha

Keywords:  pulmonary, anomalies, congenital

Neveu Melissa,  Jaju Alok,  Ryan Maura,  Maddalozzo John

Final Pr. ID: Poster #: SCI-031

Branchial apparatus anomalies (BAA) due to aberrations in the development and involution of the branchial apparatus can present as a cyst, fistula, or sinus tract. Definitive treatment for a BAA is complete surgical excision. The embryology of BAA has been well described, but few reports in the published literature discuss optimally imaging these patients. The purpose of this study is to describe the CT and MR imaging findings of BAA, and to correlate the imaging findings with surgery and pathology results. The goal is to develop a standardized imaging approach and search pattern specific to each subtype of BAA that would answer the most pertinent clinical questions for surgical planning. Read More

Authors:  Neveu Melissa , Jaju Alok , Ryan Maura , Maddalozzo John

Keywords:  Branchial Apparatus Anomalies

Zhong Yumin,  Sun Aimin,  Gao Wei

Final Pr. ID: Poster #: SCI-086

Tracheobronchial anomalies including tracheobronchial stenosis, tracheal bronchus, cardiac bronchus and bronchial isomerism are common in congenital heart disease. Cardiovascular anomaly is the principal extrinsic lesion causing tracheobronchial stenosis. MRI has the advantage of being non-ionizing and providing excellent soft tissue contrast for the diagnosis of congenital heart disease and tracheobronchial anomalies
Purpose: To define diagnostic accuracy of three-dimensional turbo field echo (3D-TFE) to detect tracheobronchial anomalies in patients with congenital heart disease
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Authors:  Zhong Yumin , Sun Aimin , Gao Wei

Keywords:  Tracheobronchial Anomalies, congenital heart disease, Magnetic Resonance Imaging Sequence

Jordan Gregory,  Zavaletta Vaz,  Malone Ladonna,  Katz Danielle,  Nakano Taizo,  Kulungowski Ann,  Annam Aparna

Final Pr. ID: Poster #: EDU-051

Generalized Lymphatic Anomaly (GLA) is a rare multisystem congenital disorder originating from the abnormal development of the lymphatic system which occur under the spectrum of Complex Lymphatic Anomaly (CLA). In addition to GLA, other CLAs include Kaposiform Lymphatic Anomaly (KLA) and Gorham-Stout Disease (GSD). Lymphatic malformations (LM) associated with GLA are usually apparent at birth or by two years of age. GLA can affect almost any organ of the body but is most commonly associated with lymphatic abnormalities in the skin, abdominal/thoracic viscera and bone.

Multisite soft tissue LM can occur in all CLAs, with macrocystic lymphatic malformations being most common in GLA. These lesions can be found in the mediastinum, retroperitoneum, and subcutaneous tissue. Abdominal viscera involved include the spleen and liver. The frequency of focal splenic lesions is higher with GLA and KLA in comparison to GSD. On MRI, the lesions exhibit marked T2 hyperintensity with no discernable enhancement. In patients with larger splenic lesions, areas of T1 hyperintensity have been documented. Liver lesions in GLA have a similar appearance to the previously described splenic lesions. Nakamura et al. found that more than 30 focal splenic lesions and/or focal splenic lesions with maximum diameters greater than >10 mm were observed only in patients with GLA. On contrast enhanced CT, the lesions are generally well-circumscribed and hypodense. Within the thorax, mediastinal LMs can be seen in GLA but are more common in KLA and GSD. Chylous effusions can occur in all of the CLAs, although it has been reported that effusions in GLA were more likely to be associated with mediastinal involvement. Osseus involvement is common in patients with GLA. GLA has a predilection for the appendicular skeleton, in which the ribs are most affected although cranial, vertebral and lower extremity lesions have been reported. The lesions are usually non-contiguous with medullary destruction and sparing of the cortex. This is in contrast to GSD where cortical destruction, progressive osteolysis, contiguous lesions, and soft tissue infiltration are more common.

Educational Goals:
1) Illustrate the most common imaging characteristics by each organ system affected by GLA and how to differentiate GLA from other CLAs.
2) Raise awareness of the optimal imaging evaluation in patients with GLA.
3) Outline an approach to multidisciplinary management of patients with GLA through a vascular anomalies center.
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Authors:  Jordan Gregory , Zavaletta Vaz , Malone Ladonna , Katz Danielle , Nakano Taizo , Kulungowski Ann , Annam Aparna

Keywords:  Generalized Lymphatic Anomaly, Lymphatic Malformations, Complex Lymphatic Anomaly

Snyder Elizabeth,  Sarma Asha,  Krishnasarma Rekha,  Engelstad Holly,  Pruthi Sumit

Final Pr. ID: Poster #: EDU-012

Although head ultrasound (HUS) is most often used in the neonatal intensive care unit (NICU) setting as a screening exam for emergencies such as hydrocephalus, intracranial hemorrhage, and ischemic injury, a spectrum of congenital brain abnormalities may also be diagnosed, especially with state-of-the-art US technology that enables detection of more subtle malformations.

While brain MRI remains the gold standard for comprehensive evaluation of congenital CNS anomalies, knowledge of the appearance of such pathologies on HUS is vital: HUS is often the first exam performed, and some infants are too critically ill to undergo MRI. Identification of congenital anomalies by the radiologist may generate prognostic information that can impact critical medical decision-making and patient/family counseling in the NICU.

The goals of this educational poster are to provide a systematic approach to evaluating congenital brain anomalies on HUS and illustrate the ultrasound appearance of common and less common congenital abnormalities with MRI comparisons, as well as highlight potential pitfalls in making these diagnoses.

Covered entities include:
Posterior fossa malformations: e.g., Chiari II, Dandy-Walker
Midline anomalies: e.g., Holoprosencencephaly, agenesis of the corpus callosum, pericallosal lipoma
Cortical malformations: e.g., Gray matter heterotopia, schizencephaly, lissencephaly
Vascular malformations: e.g., Vein of Galen malformation
Congenital infections: e.g., Congenital cytomegalovirus
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Authors:  Snyder Elizabeth , Sarma Asha , Krishnasarma Rekha , Engelstad Holly , Pruthi Sumit

Keywords:  Head ultrasound, Congenital anomalies, Ultrasound MRI correlation

Khan Muhammad,  Prasad Preeti,  Sandhu Preet

Final Pr. ID: Poster #: EDU-014

Abnormalities of the portal venous system are a heterogenous group which include congenital anomalies and changes in portal vein secondary to iatrogenic causes or inflammatory and neoplastic conditions. Detailed knowledge of the normal embryology, anatomy of the portal vein and its variants is crucial in the understanding of portal vein anomalies. Identification of normal or variant portal vein anatomy is important part of pre surgical and pre liver transplant evaluation and helps minimize post-surgical/interventional complications. Read More

Authors:  Khan Muhammad , Prasad Preeti , Sandhu Preet

Keywords:  portal vein, congenital, anomalies

Tan Timothy Shao Ern,  Teo Eu Leong Harvey James

Final Pr. ID: Poster #: EDU-060

Vascular anomalies are commonly encountered in paediatrics, often presenting as clinically palpable superficial lesions, and may be associated with an underlying syndrome or congenital disease. According to the ISSVA classification, vascular anomalies are broadly categorized into proliferating vascular tumours and vascular malformations. Vascular tumours may be benign (infantile and congenital haemangiomas), locally aggressive (kaposiform hemangioendothelioma) and malignant (angiosarcoma). Vascular malformations are further subdivided into high-flow (e.g. arterio-venous malformations or fistulas), low-flow (capillary, venous and lymphatic malformations) and complex combined malformations.

Ultrasound is usually the first-line imaging modality of choice to evaluate these lesions, particularly in children, due to its advantages such as excellent superficial spatial resolution, lack of ionizing radiation, negating any need for sedation, wide availability, low-cost and ability to assess vascularity and flow dynamics. Moreover, ultrasound is also useful in detecting complications, guiding further work-up and can be used for routine follow-up after treatment. Transducer selection is typically determined by lesion size and depth. However, mixed complex vascular malformations and deep extensive lesions, particularly those located in poorly accessible regions (e.g. near bony or air-filled structures) may not be well delineated on ultrasound and further evaluation with cross-sectional imaging, usually magnetic resonance imaging/angiography, would be warranted.

The goals of this educational exhibit are to review and familiarize radiologists with the ISSVA classification as well as clinical and imaging features of commonly encountered soft tissue vascular anomalies occurring in children, with emphasis on the utility of ultrasound as a useful diagnostic tool. Sonographic and clinical features of the above mentioned conditions will be illustrated and reviewed.
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Authors:  Tan Timothy Shao Ern , Teo Eu Leong Harvey James

Keywords:  Vascular Anomalies, Hemangioma, Ultrasound

Hutchinson J.,  Haig Ian,  Sebire Neil,  Arthurs Owen

Final Pr. ID: Poster #: CR-008

Autopsy examination of early miscarriages (<20 weeks’ gestation) can be technically challenging, with an associated error rate due to small size. Imaging is increasingly used to guide the autopsy process and post mortem MRI (PMMRI) at 1.5T shows excellent correlation with autopsy findings over 18gw / 500g bodyweight, however, its diagnostic accuracy is reduced below these thresholds. We have evaluated the use of Micro-CT, which has been used in animal imaging and industry for many years. We present a radiological / pathological correlation of a case from the first clinical use of micro-CT in perinatal autopsy practice, under an ethically approved study with full consent.

A termination of pregnancy was performed at approximately 14gw for presumed sacrococcygeal teratoma. Standard CT and 1.5T PMMRI was non-diagnostic for every organ system. Following immersion of the fetus in potassium triiodide and formalin for 48 hours, a micro-CT scan was performed using a Nikon XTH225 micro-CT scanner, reconstructed using proprietary software (CT Pro 3D, Nikon Metrology) and post-processed using VG Studio MAX (Volume Graphics GmbH).

Views of all organ systems were obtained that were used to guide subsequent unblinded autopsy. Micro-CT demonstrated multiple abnormalities, including amniotic membranes in contact with the fetal skin, multiple disruptions of the abdomen and limbs, and externalisation of internal organs including the kidneys and liver. These were confirmed at the subsequent autopsy and a final diagnosis of ADAM complex (amniotic deformity, adhesions, mutilations) was made.

This case report demonstrates the potential of micro-CT to provide detailed PM imaging of entire fetuses whilst maintaining tissue integrity, allowing pre-autopsy identification of multiple congenital abnormalities in cases where 1.5T PMMRI and standard CT fail to achieve diagnostic resolutions.
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Authors:  Hutchinson J. , Haig Ian , Sebire Neil , Arthurs Owen

Keywords:  Micro-CT, Fetal, Anomalies, Congenital, Postmortem

Snyder Elizabeth,  Puttgen Kate,  Mitchell Sally,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-073

Vascular anomalies comprise both vascular tumors and vascular malformations which can occur anywhere in the body; the trunk and extremities being the second most common location following the head and neck. Accurate identification of these anomalies is important for proper clinical evaluation and management, particularly since these patients often require multidisciplinary care. The International Society for the Study of Vascular Anomalies (ISSVA) classification, recently updated in 2014, is widely accepted and offers comprehensive classification for all medical subspecialties involved in the care of these complex anomalies, thus providing common language among caregivers. The purpose of this educational exhibit is to highlight the most important MRI and MRA imaging findings in order to identify these lesions according to the 2014 ISSVA classification. Read More

Authors:  Snyder Elizabeth , Puttgen Kate , Mitchell Sally , Tekes-brady Aylin

Keywords:  vascular anomalies, MRI/MRA, time-resolved MRA

Ganapathy Shankar,  Hunter Kyle,  Janitz Emily,  Sreedher Gayathri

Final Pr. ID: Poster #: EDU-017

Neuronal migration and cortical organization takes place primarily during the second trimester and early third trimester. Therefore, detection of cortical malformations and migrational anomalies on a fetal MRI in a maturing brain is difficult and may not be evident in some cases, if performed early.
Familiarity with normal sulcation pattern in a fetus at various ages of gestation and a basic understanding of the embryogenesis of neuronal migration is essential to be able to make a diagnosis of these entities.

Goals of the exhibit
-Understand development of cerebral cortex and normal fetal MRI appearance at various stages of gestation.
- Using this knowledge, be able to recognize various cortical malformations in a fetus and provide a comprehensive diagnosis regarding etiology, whenever feasible or when the appearance is typical or when there are ancillary findings
- Avoid certain pitfalls and improve accuracy without overcalling or undercalling migrational anomalies in a fetal MRI

Outline of the exhibit
Embryology of neuronal migration (during second and third trimesters)
Normal sulcation pattern during mid and late trimesters
Etiology of neuronal migration and cortical malformations
- Infectious
- Genetic mutation/chromosomal
- Ischemic insult
- Metabolic disorders like Zellweger
Appearance of various migrational anomalies and cortical malformations in a fetal brain
Polymicrogyria – subtle and extensive forms, appearance during various stages of gestation, correlation with post-natal imaging, typical appearance in certain genetic mutations, TORCH infections etc
Schizencephaly – associations with absence of septum pellucidum and other abnormalities
Gray matter heterotopia – How to differentiate from subependymal nodules and hemorrhage?
Lissencephaly – How to identify a true lissencephaly/pachygyria in a developing brain with immature sulcal pattern?
Hemimegalencephaly, Microcephaly with simplified gyral pattern and other cortical malformations
Evolution of cortical malformations on imaging
-Comparison between early and late gestation fetal MRIs in the same patient when available
- Prenatal and post-natal MRI correlation of migrational anomalies, when available
Ancillary CNS and extra-CNS abnormalities identified in fetuses with migrational anomalies
Pitfalls and false positive/ false negative cases and how to avoid them.
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Authors:  Ganapathy Shankar , Hunter Kyle , Janitz Emily , Sreedher Gayathri

Keywords:  migrational anomalies, cortical malformations

Andres Mariaem

Final Pr. ID: Poster #: EDU-004

To review and present the MDCT angiography features of the congenital aortic anomalies in a comprehensive manner with supplemental description of their association to the adjacent airway and/or esophageal structures.

Congenital thoracic aortic anomalies manifest in a wide array of imaging presentations that are enumerated in this pictorial review. Multidetector CT (MDCT) angiography in reformatted and 3D images provides noninvasive technique to visualize the aortic anomalies, in addition to assessment of the airways and esophagus.

MDCT provides comprehensive non-invasive imaging of the congenital thoracic aortic anomalies as follows:
A. Vascular Ring. This is an anomalous formation of vessels that may completely or incompletely encircle the trachea and esophagus with potential of causing airway and/or esophageal compromise [1]. Anomalies included are the left aortic arch with aberrant right subclavian artery (the most common congenital aortic arch anomaly that commonly clinically cause dysphagia lusoria), the right aortic arch with mirror-image branching (the second most common type of arch anomaly), and the double aortic arch (the most common cause of symptomatic vascular ring).

B. Interrupted Aortic Arch. Major characteristics is complete discontinuity of aortic lumen between the ascending and the descending aorta. There are three (3) types in this pictorial review: Type A- aortic interruption between the left subclavian artery and descending aorta, Type B- aortic interruption between the left subclavian artery and the left common carotid artery, and Type C- aortic interruption between the left common carotid artery and the innominate artery.

C. Coarctation of the Aorta. Focal narrowing of the aortic lumen which is located at the level of the isthmus in majority of cases. This has two classifications which are the preductal form and the other the postductal form.

Congenital anomalies of the thoracic aorta comes in many forms. MDCT has advantages of ultra short scanning time and high spatial resolution that enables this modality to become a principal imaging method that equips Radiologists to evaluate the aortic anatomy and its congenital anomalies along with its association with the adjacent airway and esophageal structures.
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Authors:  Andres Mariaem

Keywords:  congenital, thoracic, aortic anomalies

Mehta Nimisha,  Bulas Dorothy,  Blask Anna,  Rubio Eva

Final Pr. ID: Poster #: EDU-111

To describe the prenatal imaging appearance of Congenital Vertical Talus (CVT) by US and MRI and detail the associated anomalies and outcome. The postnatal imaging appearance will also be discussed. Read More

Authors:  Mehta Nimisha , Bulas Dorothy , Blask Anna , Rubio Eva

Keywords:  Congenital Vertical Talus, Rocker bottom foot, Fetal anomalies, Congenital Talipes Equinovarus, Clubfoot

Weitz Carolina,  Leiter Francisca,  Arce Jose,  Figueroa Hugo

Final Pr. ID: Poster #: CR-076

The right aortic arch (RAA) is a relatively frequent congenital anomaly, occurring in approximately 0.05% of the general population. It is classified into three types, according to the branching pattern of the aortic arch vessels: a RAA with an aberrant left subclavian artery, an RAA with mirror image branching and RRA with an isolated left subclavian artery.

The RRA with an isolated left subclavian artery is the least common type of the aortic arch anomalies, with a prevalence of 0.8 %. It occurs when the left subclavian artery losses its connection with the aorta, arising from the ipsilateral pulmonary artery through a left ductus arteriosus, which may be either patent or closed. If the ductus arteriosus is patent, a shunt between the pulmonary and the systemic circulation is established which leads to the congenital subclavian steal phenomenon. The latter is clinically manifested by asymmetric pulse, blood pressure meassurement and size between the upper extremities. This phenomenon will not manifest clinically if there are accompanying cardiac anomalies which balance the preassures of the pulmonary and systemic circulation, which occurs in approximately in 60% of cases.
The diagnosis of this anomaly can be established by invasive arteriography or CT angiography, where late retrograde opacification of the left subclavian artery from the left vertebral artery is observed, with no connection with the aortic arch. The treatment of this anomaly is surgical or endovascular in the presence of symptoms of subclavian steal syndrome.

We present a case report of a five year old female patient with history of a right aortic arch and patent ductus arteriosus with clinically significant hemodynamic effect. On physical examination, there was important asymmetry in pulse palpation, blood pressure readings and size of the upper extremities, which motivated invasive angiographic study which confirmed a right aortic arch, a permeable ductus arteriosus with filiform flow, as well as an isolated subclavian artery with steal phenomenon and direct communication with the main pulmonary artery, leading to significant left heart overload. CT angiography of head and neck was consistent with these findings. Surgical management consisted in reimplantation of the left subclavian artery into the left common carotid artery with favorable clinical outcome.
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Authors:  Weitz Carolina , Leiter Francisca , Arce Jose , Figueroa Hugo

Keywords:  isolated subclavian artery, right aortic arch, anomaly of the aortic arch

Basavalingu Deepashri,  Bhutta Sadaf

Final Pr. ID: Poster #: EDU-039

- To discuss the etiopathogenesis of MRKH syndrome including new advances.

- To illustrate the varying imaging appearances of MRKH syndrome, including isolated MRKH (Type I) and MRKH with other associated congenital anomalies (Type II)

- To present a multimodality imaging approach for the diagnosis of MRKH syndrome and to distinguish it from other uterine anomalies.

- To briefly discuss similar phenotypic associations (ARCS/AUCS) in males and their identification on imaging.
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Authors:  Basavalingu Deepashri , Bhutta Sadaf

Keywords:  Anomaly, MRKH, Genitourinary

Vansyckel Arielle,  Brown Brandon

Final Pr. ID: Poster #: EDU-016

Midface anomalies in the fetus can present with a range of severity and corresponding neonatal morbidity, on a spectrum from cosmetic disturbance to airway obstruction. Immediate postpartum complications include life-threatening hypoxia and feeding disturbances. These anomalies not only present immediate difficulties but also often exist within a variety of syndromes with long-term consequences, affecting various organ systems. While screening ultrasound frequently can identify deviations from normal, fetal MRI may provide more detailed and high-resolution imaging for the characterization of midface anomalies and associated prenatal disease.
The identification of facial anomalies in utero should prompt further investigation for associated abnormalities, and will also allow for improved prenatal counseling, which can prepare parents for the immediate postpartum management including surgical planning and resource allocation. It furthermore provides a foundation to shape family expectations and to begin to frame psychosocial support, allowing parents to engage mentally and emotionally with the medical and surgical course that awaits.

In this presentation, we highlight the normal fetal midface as seen on MRI at various stages of development, and outline a systematic approach for evaluation of the fetal midface structures. Recognition of this typical appearance will allow the radiologist to identify the range of possible abnormalities that can occur and which can shape prognosis when properly identified. Various cases of midface anomalies will be reviewed and linked to their clinical significance, including cases with associated intracranial anomalies and deficiencies in swallowing and respiration.
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Authors:  Vansyckel Arielle , Brown Brandon

Keywords:  Fetal imaging, Midface anomaly

Myers Ross,  Li Tianyang,  Wu Jennifer,  Sadowsky David,  Paul Mary,  Gerard Perry,  Brudnicki Adele,  Lecompte Lesli

Final Pr. ID: Poster #: EDU-034

Müllerian Duct Anomalies (MDA) are a broad category of congenital deformities of the urogenital structures due to abnormal development, fusion, or resorption of the fetal Müllerian Ducts. By definition, the Müllerian Ducts are the paired fetal structures that are located medially to the Wolffian Ducts and develop into the Fallopian Tubes, uterus, cervix, and upper two-thirds of the vagina. The multitude of symptoms associated with MDAs vary broadly in severity, ranging from patients with no symptoms and incidentally discovered MDAs to patients with primary infertility, recurrent pregnancy loss and other reproductive problems.

There are well documented associations of MDAs with other genitourinary malformations. The most commonly reported is renal agenesis, which accounts for up to 30% of all associated renal anomalies in the setting of MDA, however abnormalities including ureteral remnants with ectopic insertion or collecting system duplication have been reported as well. The overall incidence of MDAs varies, but have been estimated to be approximately 1-5% within the general population and up to 13-25% in patients with recurrent pregnancy loss.

The most commonly accepted system of classification of the various types of MDAs is that of the American Fertility Society, which divides MDAs into seven categories. However, there is often confusion as to how to categorize MDAs demonstrating characteristics of more than one class. Medical imaging is of essential importance for both this reason and for appropriate planning of therapy. The imaging of suspected MDAs involves the implementation of a combination of 3D Ultrasound, Magnetic Resonance Imaging, Sonohysterography, Hysterosalpingraphy and/or laparoscopy. Sonography and MRI have the benefits of being the least invasive methods of diagnosis.

The goal of our educational exhibit will provide an overview of the embryology and pathophysiology related to a broad variety Müllerian Duct Anomalies. We will discuss the common imaging techniques employed in the workup of patients with Müllerian Anomalies. In addition, we provide a plethora of interesting cases from our home institution including a case of Mayer-Rokitansky-Küster-Hauser Syndrome, Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA), cloacal abnormality, bicornuate uterus and other complex cases utilizing a variety of imaging modalities.
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Authors:  Myers Ross , Li Tianyang , Wu Jennifer , Sadowsky David , Paul Mary , Gerard Perry , Brudnicki Adele , Lecompte Lesli

Keywords:  Mullerian Duct Anomalies, OHVIRA