Chern Joshua,  Mallon Mea,  Urbine Jaqueline,  Malik Archana,  Kazmi Faaiza,  Poletto Erica,  Faerber Eric

Final Pr. ID: Poster #: EDU-095

Soft tissue vascular malformations encompass a wide variety of lesions throughout the body. Appropriate treatment for these lesions is dependant on accurate classification and diagnosis. Unfortunately, inappropriate nomenclature and description by the radiologist can lead to confusion and possibly mismanagement. Read More

Authors:  Chern Joshua , Mallon Mea , Urbine Jaqueline , Malik Archana , Kazmi Faaiza , Poletto Erica , Faerber Eric

Keywords:  Arteriovenous malformation, Vascular malformation, Lymphatic malformation, Vascular tumor

Hammer Matthew,  Kim Joseph,  Shukla Neal,  Hajibeygi Ramtin,  Tu Long

Final Pr. ID: Poster #: CR-043

Spinal arteriovenous malformations (AVMs) are rare vascular lesions within the spinal cord with incidence rates as low as 300 cases per year (Patchana 2020). They are associated with significant neurologic morbidity and are characterized by abnormal connections between arteries and veins, either bypassing the capillary system or passing through a dysplastic capillary bed. Using the Takai classification system, spinal AVMs can be classified into 5 types based on their shunt location. Type 2 spinal AVM, the intradural intramedullary glomus AVM, is typically seen within the thoracolumbar spinal cord and diagnosed in the third decade (Greenberg 2010, Patchana 2020). It is usually treated with resection and/or embolization, with recurrence rates reported as low as 2.3% and 27.7% for resection and embolization respectively (Mamaril-Davis 2023).

Our patient is a 17-year-old male with a history of C4-C7 AVM status post embolization and partial resection, who was post-operatively asymptomatic for 10 years. He initially presented with left upper extremity paresthesia after exercise. His symptoms progressed to bilateral lower extremity paresthesia and upper extremity hyperreflexia and clonus. Labs and vitals were unremarkable. Neurosurgery was consulted and MRI and MRA cervical spine with and without contrast were ordered to further evaluate symptoms. Findings were consistent with: recurrent C3-C4 left-sided type 2 spinal AVM with adjacent dilated vascular channels along the dorsal and ventral aspects of the spinal cord, C3-C4 cord expansion, and C2-C4 cord edema. There was no evidence of intra-nidal aneurysm or hemorrhage within the limitations of non-gradient sequences. Feeding arteries were difficult to identify but likely originated from adjacent left radicular or vertebral artery branches.

Although spinal AVM recurrence is incredibly uncommon after treatment, especially after surgical resection, it should always remain on the differential for patients with contributory history and new onset neurologic symptoms. This case reminds us that type 2 spinal AVMs can occur anywhere along the spinal cord and can manifest at any age. MRI and MRA sequences are best equipped to assess the extent of disease, and additional gradient sequences may be obtained if there is concern for hemorrhage. Read More

Authors:  Hammer Matthew , Kim Joseph , Shukla Neal , Hajibeygi Ramtin , Tu Long

Keywords:  Spinal Cord, Arteriovenous Malformation

Chughtai Komal,  Saul David,  Chaturvedi Apeksha

Final Pr. ID: Poster #: EDU-002

Congenital hepatic vascular shunts occur secondary to abnormal formation and aberrant communication of blood vessels during fetal development. This spectrum of anomalies can be challenging to diagnose without a strong understanding of their embryology and clinical and imaging manifestations. Ultrasound is among the most widely used modalities in pediatric imaging, given its real-time nature, easy portability and lack of radiation exposure. This case-based exhibit reviews ultrasound and doppler imaging findings of congenital vascular shunts in the pediatric liver.

The broad categories of congenital hepatic vascular shunts include: arteriovenous (hepatic artery to hepatic vein), arterioportal (hepatic artery to portal vein), and portovenous (portal vein to hepatic vein). This exhibit starts by demonstrating the formation of normal hepatic vasculature during fetal development. This is followed by a discussion of embryological aberrations which lead to vascular shunts, clinical context of each anomaly (when to wait, worry or intervene), and the role of imaging in detection, quantification, prognostication and treatment of these anomalies.

There are case presentations and discussion of the following vascular anomalies: extrahepatic portosystemic shunt (also known as Abernethy Malformation), intrahepatic portosystemic shunt, arterioportal fistula, intrahepatic arteriovenous malformation, patent ductus venosus, infradiaphragmatic total anomalous pulmonary venous return, and hepatic hemangioma. Illustrations and ultrasound/Doppler images are included for most of these cases.

Besides providing a clinical and imaging review of anomalous hepatic vascular communications, this exhibit will reinforce an understanding of physiologic hepatic vascular shunts in fetal life and describe the sequence of successful transition to neonatal circulation. This understanding can be applied to clinical decision making.

Supplemental Files- legends:
1. File 1: Hepatic vascular shunts.
2. File 2: Portosystemic shunt. Turbulent flow within an aberrant vessel connecting left portal to left hepatic vein. Flow pulsatility/triphasicity within the portal vein.
3. File 3: Intrahepatic Arteriovenous Malformation. Tangle of enlarged vessels within left liver lobe. High velocity, low resistance arterial waveforms and pulsatile venous flow. Read More

Authors:  Chughtai Komal , Saul David , Chaturvedi Apeksha

Keywords:  Arteriovenous malformation, Patent ductus venosus, Arterioportal fistula