Final Pr. ID: Poster #: EDU-012
The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist.
Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More
Final Pr. ID: Poster #: EDU-013
To offer a complete overview of the diagnostic hypotheses of the various fluid-containing masses which can be found in the neonatal abdomen. Read More
Final Pr. ID: Poster #: SCI-041
Intraabdominal cystic lesions are relatively common prenatal diagnoses. Determining its etiology and diagnosis can be challenging on prenatal imaging. Fetal MR is a helpful imaging modality that can provide additional anatomic and physiologic information. The purpose of this study is to evaluate MR imaging findings of fetal intraabdominal cystic lesions with correlation with postnatal imaging and outcome. Read More
Final Pr. ID: Poster #: CR-005
Atretic cephalocele is a rare disruption of neural tube closure. The reported incidence ranges from 1 in 3500 to 1 in 5000 live births. Is a small subscalp lesion that consist of dura, fibrous tissue, and dysplastic brain tissue. Its most common presentation it is a palpable midline parietal soft tissue mass, occasionally occipital, with a wide range of clinical presentations, the patient may have normal neurological development or have severe mental retardations, since it could be associated with multiple intracranial malformations including a fenestrated superior sagittal sinus (the most common), persistent falcine sinus, vertical embryonic positioning of the straight sinus, holoprosencephaly, hydrocephalus, eye anomalies, agenesis of the corpus callosum, among others, therefore is important to know about this condition as well as to identify its radiological characteristics using different diagnostic imaging methods to make a certain diagnostic. Transfontanellar brain ultrasound could be used as the first imaging method as it enables a non-invasive method, in addition the patients are not exposed to ionizing radiation, being the most consistent finding a subcutaneous, hypoechoic mass, with a solid fibrous tract connecting the extracranial lesion, through a small bony cranium defect, to the intracranial space; additionally in order to evaluate a further extension of the fibrous tract or the presence of other anomalies, CT or MRI can be performed, considering to the MRI as a better study because it can be used in pediatric population since there is no exposure to radiation. Main differential diagnoses of atretic cephalocele are sinus pericranii and dermoid cyst, other possible causes include haemangioma, sebaceous cyst, inclusion cyst, lipoma, tumors (Langerhans cell histiocytosis, sarcomas, etc.), bone and soft tissue infections and traumatic lesions. This educational poster pretends to review the radiological findings of two cases of patients with atretic cephalocele moreover a literature review since the published works regarding is limited and few case series or case reports have been documented. Read More
Final Pr. ID: Poster #: CR-04 (R)
Three cases of dermoid cyst will be described with different clinical presentation and location. MRI and CT finding will be reviewed and correlated with pathological finding.
The first case is a 7 year- old child, with suspected diagnosis of stroke which MRI shows a midline posterior fossa tumor with fine occipital dermal sinus, better visualized in CT. The second case is 1 year- old enfant with delayed psychomotor development, a dimple with lock of hair and dorsal hemangioma, which MRI shows a dermal sinus at D4 – D5 level which continues with an intra and extramedullary mass. The last case is 2 year- old child postoperated of mielomeningocele at birth that has neurogenic blader and Chiari II with a cyst mass at conus and low spinal cord insertion. Read More
Final Pr. ID: Poster #: CR-080
Congenital generalized lipodystrophy, also known as Berardinelli-Seip syndrome, is a rare autosomal recessive disorder associated with osteosclerosis and cystic intramedullary bone lesions. However, the transition from generalized osteosclerosis in the young patient to the development of cystic intramedullary bone lesions in areas converting from red to yellow marrow in the growing child has not been previously described. We present a young man with congenital generalized lipodystrophy, followed in our clinic from age 5 years through age 14 years, and document the development over time of dramatic cystic lesions within previously sclerotic long bones. The location of these intramedullary bone cysts appears to mirror the transition of red (hematopoietic) to yellow (fatty) marrow in the maturing child. Recognition of this pattern may affect recommended physical activity and subsequent orthopedic management. Read More
Final Pr. ID: Poster #: SCI-040
Aneurysmal bone cysts are benign expansile osseous lesions which may behave locally aggressively, leading to growth plate destruction, angular deformity, and pathologic fracture. Current treatments such as curettage and bone graft reconstruction, sclerosis, and intra-arterial embolization have high recurrence rates and morbidity. Percutaneous cryoablation is a promising new treatment modality. Three patients with ABCs underwent cryoablation at our institution and follow-up MRIs over the span of a year were obtained. This is the first study of its kind to elucidate the imaging findings post-cryoablation of ABCs, which may help the radiologist interpret response to treatment. Read More
Final Pr. ID: Poster #: EDU-038
Cystic ovarian lesions frequently occur in the female pediatric population, and they present with a varied clinical picture or can be incidentally found in imaging studies. The clinical approach and treatment considerations differ from their adult counterpart, considering the need for ovarian salvage and preservation of fertility. Also, the histologic distribution of ovarian tumors differs in pediatric and adult populations, which will alter the treatment algorithm.
We will present a pictorial review demonstrating comprehensive imaging features of adnexal cystic lesions in fetuses, infants, pre-pubertal, and peripubertal girls.
We will discuss the similar and dissimilar findings in the radiologic presentation of adnexal cystic lesions in the pediatric population versus adults for proper management. Read More
Keywords: ovarian, cyst
Final Pr. ID: Poster #: EDU-013
Various types of cystic structures are present in the fetal abdomen. Preliminary evaluation of cystic lesions utilizes ultrasound. Given the wide range of manifestations of cysts in the fetal abdomen including but not limited to mesenteric, duplication, choledochal, ovarian, to lymphatic malformations proper diagnosis can prove difficult. When ultrasound yields inconclusive results, the next step is further investigation with fetal MRI. Fetal MRI provides increased resolution to fully characterize an abdominal cyst. Proper identification of a cyst provides useful guidance for appropriate perinatal management. Clinical management of fetal cysts consists of watchful watching, serial ultrasounds after birth, to surgical intervention. Recognition of the various types of cysts by a radiologist can help allow a clinician to appropriately counsel families about the next steps in the medical care of their child.
This presentation highlights the spectrum cystic lesions seen on MRI in the fetal abdomen. We outline a systemic method for identification of fetal abdominal cysts. Various examples of abdominal cysts will be reviewed focusing on key differences which can narrow the differential diagnosis and allow for proper identification. Results from fetal MRI will be correlated with an ultrasound shortly after birth to ensure appropriate diagnosis. Read More
Final Pr. ID: Poster #: EDU-046
A broad spectrum of intracranial cysts and cystic-appearing lesions exist with unique imaging and pathologic characteristics. Some cysts have a predilection for certain intracranial locations, which, in combination with specific imaging features, can help point towards a particular pathology and, in some cases, associated syndromes. Herein, we describe a pattern-based approach for evaluation of intracranial cysts and cystic lesions in order to narrow the differential diagnosis and assist in diagnosing an associated syndrome. Cyst pathologies to be discussed include: Arachnoid cysts, dermoid/epidermoid cysts, subependymal cysts, connatal cysts, cystic encephalomalacia, neuroglial cyst, perivascular spaces, choroid plexus cysts, and choroidal fissure cysts. Syndromes and conditions to be discussed include: Aicardi Syndrome (interhemispheric cysts), congenital muscular dystrophy (cerebellar cysts), congenital CMV (anterior temporal cysts), Zellweger syndrome (caudothalamic groove cysts), Glutaric Aciduria type 1 (middle cranial fossa cysts), and trisomy 18 (choroid plexus cysts). By being familiar with the pattern-based approach to characterization of the intracranial cystic lesions, radiologists can hone their differential diagnoses and differentiate benign/incidental lesions from ones that signify a broader pathology. Read More
Final Pr. ID: Poster #: CR-005
Fetal abdominopelvic cystic lesions have various etiologies but are most commonly ovarian or gastrointestinal in origin. Congenital pancreatic cysts are rare entities that typically arise from the pancreatic body and tail, more often in females. In contrast, pancreatic heterotopia or an ectopic pancreas is defined as pancreatic tissue found outside the normal region of the pancreas without a vascular or anatomic connection to the pancreas. It is most commonly associated with the gastrointestinal tract, with >90% of cases located in the stomach, duodenum, or jejunum, and has been known to form cystic structures. We describe an unusual case of a term female neonate with a prenatal diagnosis of an abdominopelvic cyst. The patient had episodes of hypoglycemia secondary to hyperinsulinism requiring a continuous glucose infusion. On surgical resection, the cyst was found to extend from the retroperitoneum towards the left colon without connection to the pancreas or gastrointestinal tract. Histopathological evaluation showed components of pancreatic heterotopia including islets of Langerhans surrounded by acinar cells and dilated pancreatic ducts. The immunostain for Chromogranin showed numerous alpha and beta cells confirming pancreatic tissue. Hypoglycemic episodes improved following cyst resection.
This is the first reported case of retroperitoneal cystic pancreatic heterotopia in a neonate in the English literature. We will present the ultrasound findings as well as surgical and histopathologic images. Read More
Final Pr. ID: Poster #: EDU-004
Cystic liver lesions in the pediatric population are relatively uncommon but encompass a wide range of pathologies. It is important for radiologists to be familiar with the differential diagnosis and imaging characteristics of each entity because prognosis and treatment vary widely. This educational exhibit will review the appearance of various cystic liver lesions in the pediatric population by ultrasound, CT, and MRI and will review clinical presentation and genetic/biologic causes. Read More
Final Pr. ID: Poster #: SCI-036
Aneurysmal bone cysts (ABCs) are expansile lytic lesions and can cause significant disability and pain most commonly seen in patients 10-30 years old. This study evaluates the technical feasibility, safety, and efficacy of percutaneous management of ABCs in pediatric and adolescent patients.
Final Pr. ID: Poster #: CR-015
Post-traumatic osseous cystic lesions are a rare complication in children. An etiology of intramedullary fat seepage thorough the damaged bone cortex and its entrapment within the subperiosteum has been proposed. These lesions run a benign course and usually resolve spontaneously. The presence of fatty marrow gives it a distinct appearance which aids in its diagnosis and differentiation from other bone lesions.
This case demonstrates a fat-fluid level within the subperiosteal cystic lesion in MRI and this is a typical feature of post-traumatic cystic lesion in a child. Recognition of this feature allows for a confident diagnosis, cutting down on unnecessary, potentially invasive investigations.
Final Pr. ID: Poster #: SCI-079
To develop reference ranges for cerebellum and posterior fossa measurements by fetal MRI and to investigate the reproducibility and diagnostic performance of quantitative MR parameters for the differentiation of fetal posterior fossa abnormalities. Read More
Final Pr. ID: Poster #: CR-016
Isolated bilateral fallopian tube cyst torsion is extremely rare in the pediatric population. We have found no published reports of this entity in a child. Early diagnosis of such cases is crucial for the possibility of fallopian tube salvage surgery and the prevention of irreversible damage. Nonspecific clinical and imaging findings in a few reported unilateral cases in children often make surgical intervention mandatory for the diagnosis.
A 10-year-old girl came to the hospital for acute lower abdominal pain. Ultrasound findings demonstrated two large para-ovarian cysts, contiguous with tortuous and dilated fallopian tubes, suggesting torsion of the tubes. A clinician ordered CT did not add any new information.
The patient underwent a diagnostic laparoscopy that confirms the USG impression of the torsion of the bilateral fallopian tubes. Surgical exploration demonstrated twisting of about 1080 degrees of the hemorrhagic and necrotic right paratubal cyst and tube. The left cyst and tube were torsed at 360 degrees. Right partial salpingectomy, left paratubal cyst aspiration, and detorsion of fallopian tubes was accomplished. The uterus and ovaries were healthy.
Isolated bilateral fallopian tube torsion is extremely rare in the pediatric population with nonspecific clinical and imaging findings. Diagnosis usually requires surgery. Our study showed a case of bilateral fallopian tube torsion that occurred about bilateral paratubal cysts. Visualization of a dilated fallopian tube in the presence of normal-sized ovaries must be concerning for fallopian tube torsion, which can be secondary to a paratubal mass or cyst. Prompt early recognition and operative management of this relatively rare entity may prevent unnecessary tubal resection and improve long term fertility. Read More
Final Pr. ID: Poster #: CR-013 (S)
Demonstrate a rare cause of respiratory distress in a full-term newborn to illustrate the importance of chest radiography (CXR) in guiding the work up. Read More
Final Pr. ID: Poster #: CR-031
We report the case of a previously unreported subserosal cyst of the urinary bladder in a male neonate. Prenatal sonography revealed a cystic structure in the fetal bladder that was presumed to be a ureterocele. Renal and bladder sonography at 11 days-of-age revealed a 9mm thin-walled simple cyst within a decompressed urinary bladder. The kidneys were sonographically normal. A VCUG performed the same day revealed an ovoid-shaped filling defect along the posterior-superior bladder wall. The bladder was otherwise normal. There was no vesicoureteral reflux, but a prostatic utricle filled with contrast. Cystoscopy performed at 3 months of age revealed single ureteral orifices bilaterally and no ureterocele. A dome-like lesion measuring approximately 1 cm in size was visualized along the posterior bladder wall. Sonography of the bladder performed earlier on the same day as cystoscopy once again revealed a thin-walled anechoic cyst within the posterior bladder wall. At 7 months of age, the infant underwent cystoscopic surgical excision of the bladder lesion as well as orchiopexy for an undescended testicle. The results of histopathologic analysis revealed a benign subserosal cyst with an epithelial lining and an entrapped duct. A review of the literature revealed only two previously reported cases of subserosal bladder cyst, both in adults. The natural history of these cysts is unknown. However, given the benign sonographic and histopathologic appearance of these lesions, we propose that these cysts can be safely followed with interval sonography. Read More
Keywords: Urinary bladder, cyst