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Society for Pediatric Radiology – Poster Archive


Breast
Showing 15 Abstracts.

Johnson Abigail,  Chapman Teresa,  Elezaby Mai,  Fowler Amy

Final Pr. ID: Poster #: SCI-040

Appropriate imaging evaluation and management of pediatric patients with breast symptoms is important to avoid recommending unnecessary imaging follow-up or invasive procedures that cause stress for patients and their caregivers and potential damage to the developing breast. Current practice parameters focus on adults, and there is no evidence-based consensus statement from professional societies to guide management specifically for pediatric breast masses. The objective of this study was to determine the diagnostic performance and outcomes of breast imaging in our pediatric patient population and further contribute to evidence guiding management for this clinical scenario. Read More

Authors:  Johnson Abigail , Chapman Teresa , Elezaby Mai , Fowler Amy

Keywords:  Breast, Ultrasound

Zhang Rebecca

Final Pr. ID: Poster #: CR-026

A 17-year-old female with a history of ulcerative colitis presented to her pediatrician with a palpable and non-painful left breast lump. The patient’s inflammatory bowel disease had been maintained on long-standing infliximab infusions. There was no reported family history of breast or ovarian cancer. Targeted ultrasound of the left breast showed a complex ovoid mass with significant vascularity. Biopsy was notable for extranodal marginal zone lymphoma and the patient underwent a left lumpectomy. Subsequent MRI showed an abnormally enhancing left breast mass, suggestive of residual disease and was treated with radiation. Follow-up breast MRI six months later showed an abnormally enhancing mass in the right breast, and biopsy confirmed marginal zone lymphoma. The decision was made to hold the patient’s infliximab to decrease immunosuppression and allow the patient’s own immune system to clear the lymphoma. Follow up FDG-PET/CT demonstrated a complete metabolic response.

Marginal zone lymphomas (MZLs) describe a group of low-grade non-Hodgkin's lymphomas characterized by the abnormal proliferation of B cells in the marginal zone of lymphoid tissue. Extranodal MZL, or mucosa-associated lymphoid tissue lymphoma, most commonly presents in the stomach. Primary breast lymphomas encompass less than 1% of all non-Hodgkin's lymphomas, and MZLs comprise less than 10% of primary breast lymphomas. The median age of presentation is around 60 years and risk factors remain unclear. Most patients present with a palpable breast mass. Mammography findings are nonspecific but can show a noncalcified round or oval mass with circumscribed or indistinct margins. Ultrasound findings are also nonspecific, typically demonstrating a hypoechoic mass with significant vascularity. Breast MRI can show an abnormally enhancing mass or smaller areas of non-mass enhancement. FDG-PET/CT scans are useful for demonstrating systemic areas of lymphomatous involvement. Core needle or surgical biopsy is required for histologic diagnosis. Primary breast MZL are usually low-grade and respond well to local radiation. Asymptomatic patients are sometimes managed with close observation. This case demonstrates an exceedingly rare case of bilateral breast MZL in an unusual patient age and highlights the typical low-grade nature of disease, as the patient was able to clear her right breast lymphoma after stopping her immunosuppressive agent.
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Authors:  Zhang Rebecca

Keywords:  Breast, Lymphoma, Ultrasound

Nguyen Derek,  Dunn Emily

Final Pr. ID: Poster #: SCI-014

Children and young adults can present with breast complaints in the emergency setting and ultrasound is typically the initial imaging modality of choice for work-up. While many sonographic findings are benign, there are rare presentations of indeterminate and suspicious masses. In these cases, radiologists and clinicians involved in these patient's care may be unfamiliar with the diagnosis and management of lesions that warrant follow-up with dedicated breast imagers. This study is designed to analyze the common characteristics of pediatric breast complaints from the emergency department and if follow-up care was recommended and pursued. Read More

Authors:  Nguyen Derek , Dunn Emily

Keywords:  Emergency, Breast, Ultrasound

Finkle Joshua,  Marshall Emily,  Reiser Ingrid,  Zhang Yue,  Lu Zheng Feng,  Jones Anji,  Feinstein Kate

Final Pr. ID: Poster #: SCI-005

Global mAs reduction is accepted as being superior to bismuth breast shields in reducing breast organ dose for children undergoing CT of the chest. However, in imaging of chest, abdomen, and pelvis (CAP), globally reducing mAs degrades image quality in the abdomen and pelvis. This study compares bismuth shields to global mAs reduction including a region-specific boost feature to maintain abdominal image quality. Read More

Authors:  Finkle Joshua , Marshall Emily , Reiser Ingrid , Zhang Yue , Lu Zheng Feng , Jones Anji , Feinstein Kate

Keywords:  Bismuth breast shields, CT dose

Pfeifer Cory,  Kwon Jeannie,  Oatis Kristi

Final Pr. ID: Poster #: SCI-065

The purpose of this exhibition is to outline practice patterns among breast imaging in the pediatric population while identifying barriers to execution of standard breast imaging practices in pediatric patients. Read More

Authors:  Pfeifer Cory , Kwon Jeannie , Oatis Kristi

Keywords:  breast, BI-RADS, biopsy

Gleason Miranda,  Moredock Elisabeth,  Parish David,  Pfeifer Cory

Final Pr. ID: Poster #: SCI-021

The practice of performing dedicated breast ultrasounds in the pediatric emergency department varies according to institution. In the adult population, breast ultrasounds are commonly interpreted by dedicated breast imagers and/or radiologists appropriately qualified to interpret mammograms. Children's hospitals with dedicated pediatric radiology faculty are less likely to have such individuals on staff. This paper examines the practice of breast ultrasounds ordered in the emergency department throughout a large children's health system. Read More

Authors:  Gleason Miranda , Moredock Elisabeth , Parish David , Pfeifer Cory

Keywords:  Breast Abscess, Breast Ultrasound, Emergency Radiology

Dhami Alysha,  Seekins Jayne

Final Pr. ID: Poster #: EDU-087

Pediatric breast lesions are uncommon and can be a source of alarm to both pediatric patients and their caretakers. Lesions may be incidentally detected on imaging or may be associated with clinical symptoms prompting presentation. Prior to reviewing pathology, it is important for the radiologist to first have a clear understanding of the natural course of breast development in pediatric patients. We provide a multi-modal imaging review of breast bud development from the neonatal period through puberty. Next, we present a breadth of multimodal imaging cases of both benign and malignant lesions within the pediatric breast, including accessory breast tissue, gynecomastia, masses of the breast, masses of the chest wall mimicking breast masses, infection, trauma, and more. Lastly, this exhibit highlights key imaging characteristics that may prompt concern or need for further workup, offers optimization and best practices for imaging, and reviews appropriate management and referral recommendations for common entities. Read More

Authors:  Dhami Alysha , Seekins Jayne

Keywords:  Breast, Ultrasound and MRI, Multimodality

Nguyen Derek,  Dunn Emily

Final Pr. ID: Poster #: EDU-063

Children and young adults occasionally present with breast complaints in the emergency setting, typically with palpable abnormalities or pain. Ultrasound is the imaging of modality of choice in this setting due to its wide availability, resolution for superficial soft tissue structures, and lack of ionizing radiation. In this presentation, we review breast lesions seen in children and young adults undergoing sonographic evaluation in the emergency department at a tertiary pediatric hospital with the final diagnosis. The aim of this exhibit is to review pediatric breast anatomy and depict representative ultrasound imaging features of normal variants, benign lesions, and findings which should raise suspicion for malignancy. Cases will include but not limited to: premature glandular tissue, ductal ectasia, breast edema, breast cellulitis, breast abscess, periductal mastitis, complicated cyst, intraductal papilloma, fibroadenoma, phyllodes tumor, and breast cancer. Read More

Authors:  Nguyen Derek , Dunn Emily

Keywords:  Emergency, Breast, Ultrasound

Thompson Allison,  Alazraki Adina,  Tade Funmilayo,  Loewen Jonathan,  Dickson Paula,  Milla Sarah

Final Pr. ID: Poster #: SCI-007

A trend of increased utilization of pediatric breast ultrasound has been suggested in our pediatric healthcare system. Despite this perceived increase in cases, the number of concerning breast findings in our population remains extremely low. Our hypothesis is that there has been significant increase in the number of pediatric breast ultrasounds, yet examinations remain overwhelmingly benign. Read More

Authors:  Thompson Allison , Alazraki Adina , Tade Funmilayo , Loewen Jonathan , Dickson Paula , Milla Sarah

Keywords:  Ultrasound, Breast, Pediatric

Vijapura Charmi,  Kao Simon,  Amarneh Mohammad,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-014

1. Describe the variety of pathologies affecting the chest wall and breast in the pediatric male.
2. Explain the ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of pediatric chest well including breast masses.
3. Recognize pitfalls on ultrasound imaging in evaluation of male chest wall and breast.
4. Discuss follow up and management of these lesions.
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Authors:  Vijapura Charmi , Kao Simon , Amarneh Mohammad , Sato Yutaka , Sato T Shawn

Keywords:  Male Breast, Chest Wall, Ultrasound

Yañez Camila,  Fuentealba Isabel,  Vargas Fabiola,  Pérez-marrero Lizbet

Final Pr. ID: Poster #: EDU-091

Introduction: Breast pathology in pediatrics is rare and mostly benign, though it often causes significant concern for parents and the medical team, posing a clinical and radiological diagnostic challenge. To accurately identify abnormalities, it is essential to understand breast development and its pathological conditions, which vary depending on age and sex.
Objective: To review the ultrasound findings of common and uncommon breast lesions in the pediatric population.
Development: This review will address the main pathological conditions affecting the breast from the neonatal period to adolescence. As in adults, pediatric breast pathology can be benign or malignant, with benign conditions being far more common at this age. We present cases related to breast development, such as neonatal thelarche, ductal ectasia in infants, gynecomastia, pseudogynecomastia, precocious thelarche, and congenital anomalies such as Poland syndrome. Regarding inflammatory pathology, we include neonatal mastitis, abscesses, eczema, and complicated cysts. Among the cystic lesions, we review galactocele and retroareolar cysts in adolescents, while for solid lesions, we highlight fibroadenoma and granular cell tumors. Although malignant breast lesions are rare in pediatrics, we illustrate cases of metastasis and carcinoma. Finally, we present differential diagnoses of pectoral region pathology, such as pilomatrixoma, hemangioma, and lymphatic malformation.
Conclusion: Most pathological findings in the pediatric breast are benign, and many are associated with developmental variants. These conditions present diverse manifestations that often cause concern, underscoring the importance of recognizing their ultrasound features and various etiologies.
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Authors:  Yañez Camila , Fuentealba Isabel , Vargas Fabiola , Pérez-marrero Lizbet

Keywords:  Breast, Male Breast

Thakor Dipakkumar,  Barreto David,  Cielma Tara,  Rossi Christopher,  Shet Narendra

Final Pr. ID: Poster #: EDU-080

Pediatric patients are frequently referred for imaging of palpable breast lesions, but pathologic breast conditions are rare in childhood and adolescence. While evaluation of the pediatric breast can be daunting to non-breast imaging facilities, commonly encountered conditions have recognizable imaging features on ultrasound, the modality of choice for work up. In rare cases, indeterminate or suspicious conditions can be encountered. The purpose of this poster is to present cases of commonly encountered pediatric breast conditions, with histopathologic correlation when available, as well as to present imaging findings of more concerning entities. The goal of this poster is to provide the reader familiarity with pediatric breast conditions to increase confidence in interpreting these studies. Read More

Authors:  Thakor Dipakkumar , Barreto David , Cielma Tara , Rossi Christopher , Shet Narendra

Keywords:  Breast

Lee Bonmyong,  Whitehead Matthew

Final Pr. ID: Poster #: SCI-049

Imaging evaluation of the pediatric breast is often necessary to evaluate suspected disease in immature and developing mammary tissue. The initial assessment of these patients commonly occurs at a children’s hospital. In this retrospective study, we aim to demonstrate the landscape of pediatric breast imaging by providing the prevalence of various breast-related imaging techniques, diagnoses, and demographics encountered at an academic children’s hospital over a 10 year period. Read More

Authors:  Lee Bonmyong , Whitehead Matthew

Keywords:  breast, pediatrics, ultrasound

Saini Rimpi,  Wermers Joshua,  Larson Shelby,  Mitchell Grace,  Patel Amy

Final Pr. ID: Poster #: EDU-093

With an incidence of 3.25%, breast masses in the pediatric population are a relatively rare phenomenon. Despite this, breast masses are a substantial source of anxiety and concern for parents and patients alike, largely due to the increased awareness of breast cancer in the adult population. Fortunately, the vast majority of masses are benign, and pediatric breast malignancies constitute less than 1% of all pediatric malignancies. Moreover, malignancy tends to be secondary to metastatic disease from lymphoma, leukemia, or rhabdomyosarcoma, as primary breast carcinoma is exceedingly rare. Although initial sonographic characteristics of breast masses may be nonspecific, recommendation for further evaluation with biopsy and/or excision of the mass is usually not recommended due to the rarity of malignancy, and avoidance of disrupting immature breast parenchymal tissue. In adults, the Breast Imaging-Reporting and Data System classification is quite accurate for dictating management recommendations. However, this system grossly over-emphasizes the risk of malignancy in pediatric patients, as imaging findings are usually discordant with histology. Currently, there are no standardized guidelines for management recommendations of pediatric breast masses, and short-term follow-up ultrasound is usually recommended to evaluate for malignant potential. The purpose of this educational exhibit is to compare the sonographic abnormalities of breast pathologies arising from normal breast development, including but not limited to gynecomastia, mastitis, and abscesses, from those arising from neoplastic processes including fibroadenomas, hemangiomas, arterio-venous malformations, and phyllodes tumors. In addition, the current literature on management recommendations, including indications for MRI and biopsy/excision of breast masses, will be reviewed. Finally, this exhibit will discuss the important role pediatric radiologists play in understanding the epidemiology and natural history of breast pathologies, enabling accurate characterization of masses and appropriate treatment recommendations to further guide patient management. Read More

Authors:  Saini Rimpi , Wermers Joshua , Larson Shelby , Mitchell Grace , Patel Amy

Keywords:  Breast, Ultrasound, hemangioma

Gleason Miranda,  Sharma Pooja,  Omar Lena,  Pfeifer Cory,  Kwon Jeannie

Final Pr. ID: Poster #: SCI-035

The purpose of this exhibit is to demonstrate the characteristic sonographic appearance of benign masses in the pediatric population in order to address the wide variation in management of palpable, hypoechoic, circumscribed masses seen on ultrasound. Currently, management includes fine needle aspiration/core needle biopsy, excision, imaging follow-up, and reassurance. This exhibit proposes guidelines for management of palpable pediatric breast masses with ultrasound findings most suggestive of fibroadenomas. Read More

Authors:  Gleason Miranda , Sharma Pooja , Omar Lena , Pfeifer Cory , Kwon Jeannie

Keywords:  Breast, Mass, Benign