Supakul Nucharin

Final Pr. ID: Poster #: EDU-017

To summarize our experience using Computed Tomography Angiography (CTA) of the liver as an imaging tool for pre-living donor liver transplantation (LDLT) evaluation in biliary atresia (BA) patients. This pictorial review will illustrate and discuss several aspects of imaging techniques and the important findings that clinician need to know before LDLT.

Key imaging findings for vascular anatomy/collateral vessels will be made, emphasizing what clinicians need to know. Correlation with intraoperative findings will also be provided.
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Authors:  Supakul Nucharin

Keywords:  Biliary atresia, LDLT, liver transplantation, CTA liver, Pediatric

Gould Sharon,  Harty M.,  Ostrowski John,  Tsuda Takeshi

Final Pr. ID: Poster #: SCI-008

Diseases of the coronary arteries are rare in children, but can present as unexpected catastrophic events without preceding symptoms. It is essential to identify patients at risk to prevent potentially serious cardiovascular events. Coronary CT angiography (CCTA) has been widely studied in adults, but its clinical applications are not well established in children. Read More

Authors:  Gould Sharon , Harty M. , Ostrowski John , Tsuda Takeshi

Keywords:  Coronary, CTA, Pediatric

Ordonez Alvaro,  Stecher Priscilla,  Rogers Lindsay,  Bhatti Tricia,  Noor Abass

Final Pr. ID: Poster #: CR-006

Single ventricle heart defects (SVHD) refer to a rare and diverse group of severe congenital cardiac abnormalities in which the systemic and pulmonary venous return enter a functionally single ventricular chamber. This condition is typically caused by underdevelopment of an atrioventricular valve and/or a ventricular chamber, leading to a range of complex congenital heart defects. With an incidence of approximately 3 to 5 per 10,000 live births, newborns with SVHD are critically ill, and without medical intervention, the condition is fatal. Advancements in surgical techniques, namely staged palliation and orthotopic heart transplantation, have enabled more patients with SVHD to survive into adulthood. However, despite these improvements, the perinatal period remains tenuous.

We present a five-week-old male infant born at 38 weeks of gestation with a functional SVHD in the form of severe subaortic stenosis, arcade-like mitral valve, left ventricular dilation and dysfunction, and restrictive atrial septum. He received multiple surgical interventions, including atrial septal stenting with pulmonary artery banding and stage I reconstruction with a right Blalock-Thomas-Taussig shunt. Postoperative course was complicated by delayed sternal closure, cardiac arrest, right hemidiaphragm plication, and progressive heart failure. At five weeks, CT angiography showed a functional single ventricle status post Damus-Kaye-Stansel anastomosis, hypoperfusion of the left ventricle myocardium, and pneumoperitoneum. Exploratory laparotomy with segmental bowel resection revealed perforated acute appendicitis and mucosal ulceration of the cecum. Following the procedure, he developed acute hypoxemia and bradycardia. Life-sustaining support was withdrawn. Postmortem examination of the heart was notable for severe aortic stenosis with subaortic obstruction, stenotic mitral valve with arcade-like fibrous plaques, and biventricular hypertrophy. Histopathology of the left ventricle showed significant subendocardial fibrosis without areas of myocyte injury.

Due to the complexities involved in its management, SVHD demands special attention from radiologists. While advancements in medical and surgical care have improved outcomes, ongoing progress depends on a deeper understanding of the factors contributing to ventricular dysfunction and heart failure in this vulnerable population. Read More

Authors:  Ordonez Alvaro , Stecher Priscilla , Rogers Lindsay , Bhatti Tricia , Noor Abass

Keywords:  Ventricular Dysfunction, Cardiac CTA, Cardiovascular Disease

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-002

Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially.

A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal.
The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion.
The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification.
On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised.
This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Cardiovascular, Congenital

Bee Stella,  Woon Tian Kai,  Yap Kok Hooi,  Fortier Marielle

Final Pr. ID: Poster #: EDU-004

In congenital heart disease (CHD), CT cardiac angiography (CTCA) has an important role in surgical planning and evaluating post-surgical complications, complementing echocardiography and cardiac magnetic resonance imaging (cMRI). Its strengths are in its high spatial resolution, rapid acquisition, and excellent 3D reconstruction capabilities for visualization of complex vascular and intracardiac relationships. However, unless radiologists tailor reconstructions and reports to address the surgeons’ needs, its full potential is underutilized. To do this, radiologists need to be aware of at least broad strokes of cardiac pathophysiology, as well as modern surgical approaches and potential post-surgical complications, for the most common CHDs. This will ensure that the utility of CTCA reports transcend volumetric and vascular measurements, and instead, anticipate technical challenges, identify hidden hazards, shape surgical strategy and pick up specific post-surgical complications.
We propose structured CTCA reporting framework for CHD centred on the needs of the surgeon, by prioritising specific information surgeons find most useful across various CHD conditions. The objectives of this poster are a) to review, by consensus with paediatric cardiac surgeons, the key imaging features in CTCA based on different CHD lesions. b) To propose a reporting checklist for CTCA that emphasizes those key features. c) To demonstrate application of this surgeon centric framework via illustrative cases, focusing on the tetralogy of Fallot, transposition of great arteries, total or partial anomalous pulmonary venous return, and coarctation of the aorta. Read More

Authors:  Bee Stella , Woon Tian Kai , Yap Kok Hooi , Fortier Marielle

Keywords:  Cardiac CTA, Reporting, Congenital Heart Disease

Stern Joseph,  Ramirez Suarez Karen,  Victoria Teresa,  Otero Hansel

Final Pr. ID: Poster #: CR-033

Hepatopulmonary fusion (HPF) is a very rare type of right-sided congenital diaphragmatic hernia (CDH) with a reported prevalence of 3 in 1000 right-sided CDH cases. By June 2020, less than 50 cases have been reported in the literature. Out of 147 patients with right CDH managed at our institution, we found only one case (0.68%) of HPF, which is presented here.

HPF is typically not identified preoperatively, and the presence of HPF changes the operative management. It has been reported that a large right CDH without leftward cardiomediastinal shift and atelectatic lung adherent to the liver are imaging features of HPF.

This patient was a full-term, newborn girl with a normal prenatal course who developed respiratory distress immediately after birth. Chest radiograph at birth demonstrated a right CDH. On day four of life, the patient underwent surgical repair of right CDH. During the procedure, hepatopulmonary fusion involving the cephalad portion of the liver was discovered. The lung and liver could not be separated safely so the diaphragmatic defect was closed around the portion of the liver that extended into the thorax. Postoperative CT angiography of the chest and abdomen demonstrated no abnormal vascular communication between the lungs and liver; however, anomalies of systemic veins were identified. Follow-up chest radiograph at 9 months of age demonstrated a large right CDH that did not include bowel or right-sided colon and was without leftward mediastinal deviation. Concurrent contrast-enhanced CT images of the thorax at this time confirm the right CDH with herniated liver occupying most of the right hemothorax and expected rightward traction of the liver vasculature. However, no significant leftward mediastinal deviation was noted. A small amount of atelectatic lung overlying the liver was also noted, another imaging sign expected with HPF. Last follow-up at age 4, patient was thriving with normal growth and development. Read More

Authors:  Stern Joseph , Ramirez Suarez Karen , Victoria Teresa , Otero Hansel

Keywords:  Hepatopulmonary Fusion, Congenital diaphragmatic hernia, CTA

Rapp Jordan,  Poletto Erica,  Urbine Jaqueline,  Malik Archana,  Kazmi Faaiza,  Mallon Mea

Final Pr. ID: Poster #: EDU-007

The rare entity of an absent pulmonary artery has appeared in the literature since 1868, with most cases associated with congenital heart disease of various types. It has also long been observed that the absent pulmonary artery is contralateral to the aortic arch in almost every case. Isolated absence of a single pulmonary artery without associated congenital heart disease is less common, and these patients may present at any time from prenatal screening, neonatal period, early childhood, or even adolescence and adulthood. We will discuss the embryologic origins, clinical presentations, expected imaging findings, and treatment options based on patient ages from newborn to adolescence.

In neonates with an isolated absent pulmonary artery, a patent ductus arteriosus will allow for continued systemic blood supply. Even early on, narrowing of the PDA may be seen as involution is inevitable without intervention. The lung parenchyma is typically preserved, without yet evidence of hypoplasia or oligemia. Once the PDA has closed, robust collateral formation will occur. As patients age without repair, the lung parenchyma may become hypoplastic with diminished lung volumes and vascular markings. Findings suggestive of recurrent infection such as bronchiectasis may also be evident.

Early discovery and treatment is ideal as this will allow for prevention of long term sequelae and the greatest restoration of lung function as the options for repair are limited in the older patient. There is no universal standard approach for repairing the underlying mechanism of providing blood flow to the intrapulmonary pulmonary artery. Early intervention in neonates included PDA stenting or anastomosing the main pulmonary artery with the intrapulmonary pulmonary artery using a synthetic graft. Patients that present after the neonatal period are not likely to be eligible for surgical repair. The most common long term effect of an absent pulmonary artery is pulmonary hypertension, seen in 40% of patients.

The entity of isolated unilateral absence of a pulmonary artery is rare, however demonstrates typical cardiothoracic findings depending on age at presentation. Understanding of embryology, specifically the 4th and 6th primitive aortic arches, allows one to understand why this malformation occurred and what findings to expect on imaging. The maintained PDA is vital for early lung blood supply and development and can aid in repair. Read More

Authors:  Rapp Jordan , Poletto Erica , Urbine Jaqueline , Malik Archana , Kazmi Faaiza , Mallon Mea

Keywords:  Pulmonary artery, congenital, CTA

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-004

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description.

A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting.
This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning.
This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Authors:  Priya Sarv , Narayanasamy Sabarish , Nagpal Prashant

Keywords:  Cardiac CTA, Complex Congenital Heart Disease, Cardiovascular

Scace Candace

Final Pr. ID: Poster #: EDU-009

To provide a working knowledge of normal cardiac anatomy and a systematic guide to findings in common and uncommon congenital heart disease as seen on cardiac CTA. Read More

Authors:  Scace Candace

Keywords:  Congenital Heart Disease, Cardiac CTA, Presurgical CHD

Zucker Evan,  Kino Aya,  Vasanawala Shreyas,  Newman Beverley,  Barth Richard,  Chan Frandics

Final Pr. ID: Paper #: 013

To evaluate by CCTA the prevalence and morphology of pediatric LAD MBs (coronary segments that contact or tunnel within myocardium), which are common and usually incidental in adults but only sporadically reported in children. Read More

Authors:  Zucker Evan , Kino Aya , Vasanawala Shreyas , Newman Beverley , Barth Richard , Chan Frandics

Keywords:  Myocardial Bridge, Coronary CTA, Coronary

Patel Alisha,  Lefebvre Melissa,  Ahmed Asmaa

Final Pr. ID: Poster #: CR-003

Congenital anomalies of the coronary sinus can present with a variety of morphological features. An unroofed coronary sinus is a rare type of atrial septal defect (ASD), also known as a coronary sinus ASD. This partial or complete absence of the roof of the coronary sinus results in a communication between the coronary sinus and left atrium. We present the first reported case of this rare intra-atrial communication in the setting of a right-sided aortic arch and a Kommerell diverticulum (KD) in an asymptomatic pediatric patient. A 16-year-old male presented for cardiology consultation for an asymptomatic heart murmur. Cardiac auscultation revealed a soft, low-pitched continuous hum audible in the right clavicular region, consistent with a venous hum and a soft grade I/VI systolic murmur heard along the left sternal border. Electrocardiography (ECG) showed a normal sinus rhythm with early repolarization. Given his age and new onset murmur, an echocardiogram was obtained, demonstrating flow acceleration in the coronary sinus as it opened into the right atrium, a right-sided aortic arch, and a dilated coronary sinus. Further evaluation with an ECG gated cardiac computed tomography (CT) angiography illustrated unroofing of the coronary venous sinus with a jet of contrast from the coronary sinus into the right atrium. The cardiac CT also confirmed a right-sided aortic arch with mirror image branching pattern and an isolated diverticulum of Kommerell without the presence of an aberrant left subclavian artery. Given an oxygen saturation of 100% and lack of any symptoms, no surgical intervention was recommended and regular follow-up was scheduled. The presence of an unroofed coronary sinus is most often found as part of a complex congenital heart defect. While an isolated coronary sinus ASD is often difficult to diagnose, patients are considered to have excellent prognosis. However, both the unroofed coronary sinus and KD predispose a patient to long-term complications if not diagnosed and monitored in a timely manner. This case highlights the importance of clinical judgement in the setting of new heart murmurs, the use of sensitive imaging modalities for diagnosis of rare cardiac anomalies, and the need for long-term follow-up. Read More

Authors:  Patel Alisha , Lefebvre Melissa , Ahmed Asmaa

Keywords:  Congenital Heart Disease, Cardiac CTA, Stenosis

Liu Elizabeth,  Pomeranz Christy

Final Pr. ID: Poster #: EDU-009

Coronary artery anomalies span a broad spectrum of clinical outcomes from clinically insignificant to deadly. Although uncommon, these conditions can be devastating and reflect a significant proportion of premature deaths in young people, particularly young athletes. As imaging becomes more common in the pediatric and young adult population, as well as the increase of cardiac imaging in adults, many of these anomalies can be found incidentally. The purpose of this educational exhibit is to provide a framework for assessing coronary artery anomalies and to review several classic cases. The exhibit will discuss anomalies of origin, course, and termination, as well as hemodynamically significant and non-hemodynamically significant anomalies. Specific cases include interarterial course, prepulmonic course, retro aortic course, ALCAPA, ARCAPA, coronary artery fistula, and coronary artery aneurysms (Kawasaki, MIS-C). Examples of post-procedural findings will also be included. Given the variety of coronary artery anomalies and varied clinical presentations, it is important for radiologists to recognize and correctly diagnose these diseases to ensure appropriate management. Read More

Authors:  Liu Elizabeth , Pomeranz Christy

Keywords:  Cardiac, Cardiac CTA, Coronary Artery

Smitthimedhin Anilawan,  Otero Hansel,  Cahill Anne Marie,  Durand Rachelle

Final Pr. ID: Paper #: 143

Renal artery stenosis (RAS) is an important cause of hypertension in children. When suspected, imaging options include Doppler US, CTA and MRA. However, conventional angiography remains the gold standard. We investigate the accuracy and inter-reader reliability of CTA in children with suspected renal artery stenosis. Read More

Authors:  Smitthimedhin Anilawan , Otero Hansel , Cahill Anne Marie , Durand Rachelle

Keywords:  Renal Artery Stenosis, CTA, Angiography