Della Grotta Lynn,  Koberlein George

Final Pr. ID: Poster #: EDU-027

Cystic pelvic masses can represent a diagnostic challenge with its broad spectrum of differentials ranging from benign to malignant. Ultrasound is often the preliminary evaluation with MRI a next step when more information is needed. Proper diagnosis provides guidance to the clinical team with management ranging from watchful waiting to surgery. This poster will use a case-based approach to review the variety of cystic pelvic masses in pediatric patients, discuss salient imaging features, an approach to imaging workup, and treatment and prognosis. Read More

Authors:  Della Grotta Lynn , Koberlein George

Keywords:  Pelvic, Cystic Mass, Pediatric

Coleman Jay,  Collard Michael,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-087

Molecular biology has come to the forefront of modern oncology. Knowledge of specific genetic mutations within tumors drives prognostic information and can guide therapy. Keeping up with new terminology in oncology can be difficult for pediatric radiologists who often host oncology conferences and present regularly at grand rounds. The purpose of this educational exhibit is to describe DICER1 syndrome and discuss its implications for pediatric radiology. Read More

Authors:  Coleman Jay , Collard Michael , Pfeifer Cory

Keywords:  cystic nephroma, DICER1, pleuropulmonary blastoma

Infante Ignacio,  Amoretti Natalia,  Roa Cintia,  Rizzi Ana,  Lipsich Jose

Final Pr. ID: Poster #: CR-004 (S)

Liver tumors account for 1-4% of all pediatrics malignancies. Most primary liver tumours in children are malignant, but one-third are benign. Mesenchymal hamartoma of the liver, though rare is the second most frequent benign liver mass in children. Generally occurs in children less than 2 years of age with a male preponderance (male: female, 2:1). We report a case of mesenchymal hamartoma of the liver in an 11 month-old female presented at the emergency department with abdominal distension of two months of evolution associated with intermittent vomiting, diarrhea and chronic malnutrition. Abnormal labs included elevated alpha-fetoprotein levels (15006 ng/ml) and non detectable beta Human Chorionic Gonadotrophin. The liver function was normal. Imaging demonstrated an abnormal abdominal X-ray, with soft tissues mass enlargement and displacement of bowel. An ultrasound revealed a mixed mass (cystic-solid) liver in segment VII. On colour-Doppler flow imaging, there was evidence of increased vascularity. Contrast-enhanced CT scan of the abdomen in arterial and venous phases showed a large cystic mass in the left lobe of the liver, with peripheral solid tissue, very vascularized in both vascular secuences. Percutaneous biopsy was done and pathology confirmed mesenchymal hamartoma. The patient underwent left hepatectomy. The patient evolved successfully. Read More

Authors:  Infante Ignacio , Amoretti Natalia , Roa Cintia , Rizzi Ana , Lipsich Jose

Keywords:  Cystic Mass, tumor, Imaging

Markovitz Michael,  Hemmrich Megan,  Francis Christopher

Final Pr. ID: Poster #: CR-017

Cystic teratoma and lymphatic malformation (LM) are two generally benign differential considerations for congenital masses which demonstrate overlapping clinical and imaging findings. It is important to distinguish between these etiologies as cystic teratomas may require surgical excision whereas lymphatic malformations may be treated with minimally invasive sclerotherapy. We present two contrasting cases: a cervical neck teratoma mimicking a LM and an abdominal LM resembling a cystic teratoma.

Case 1: A 9-month-old female presented with a right craniofacial neck mass discovered on prenatal screening. Postnatal ultrasound demonstrated a complex multiloculated cystic lesion with peripheral vascularity. MRI confirmed a predominantly cystic, mixed soft tissue and cystic right anterolateral neck mass, most consistent with mixed type lymphatic malformation. Despite two rounds of percutaneous sclerotherapy with doxycycline, the lesion continued to enlarge on repeat MRI, crossing the midline and causing mass effect on the trachea with associated airway compromise. Respiratory distress was exacerbated by COVID-19 infection requiring intubation and eventual tracheostomy. She was started on sirolimus and underwent a third sclerotherapy treatment with doxycycline and STS without improvement. Surgical debulking was performed with pathology returning as mature multicystic teratoma composed of endodermal, neuroglial and mesodermal elements with minimal fat.

Case 2: A 13-year-old male with no significant past medical history presented with three weeks of right-sided abdominal pain and constipation. CT showed a right abdominal multiseptated cystic lesion. MRI confirmed a 27 cm multicystic abdominal mass with small soft tissue component and calcification with mass effect on the small bowel and right ureter causing partial small bowel obstruction and hydronephrosis, most consistent with a large cystic teratoma. However, following surgical excision pathology demonstrated a multicystic mass containing vascular structures with lymphocytic aggregates and nodules consistent with LM.

Expanding on these cases, this exhibit will also review the clinical presentations and management of cystic teratoma and LM with an emphasis on imaging workup and radiology-pathology correlation. It is important for radiologists and their interdisciplinary colleagues to be cognizant of the overlapping features of these conditions to avoid errors in diagnosis and management as their treatments differ. Read More

Authors:  Markovitz Michael , Hemmrich Megan , Francis Christopher

Keywords:  Lymphatic Malformation, Teratoma, Cystic

Hwang Sook Min,  Yoo So-young,  Kim Ji Hye,  Jeon Tae Yeon

Final Pr. ID: Poster #: SCI-016

Neuroblastoma (NB) is the most common malignancy in neonate and infancy, and, furthermore, growing use of prenatal US has led to increased detection of congenital NB. This study aims to evaluate imaging assessment and clinical features of congenital NB with a special focus on cystic NB. Read More

Authors:  Hwang Sook Min , Yoo So-young , Kim Ji Hye , Jeon Tae Yeon

Keywords:  Congenital neuroblastoma, cystic type, good prognosis, prenatal detection, excellent prognosis

Tijerin Bueno Marta,  De La Puente Gregorio Alejandro,  Martinez-rios Claudia,  Malkin David,  Greer Mary-louise

Final Pr. ID: Poster #: SCI-045

To determine the spectrum of abnormalities associated with DICER1 syndrome.
To review imaging studies performed in oncologic staging and surveillance.
To delineate the screening protocol used in those with positive genetic testing. Read More

Authors:  Tijerin Bueno Marta , De La Puente Gregorio Alejandro , Martinez-rios Claudia , Malkin David , Greer Mary-louise

Keywords:  DICER1, Pleuropulmonary blastoma, pineoblastoma, cystic nephroma

Bezzant Braydan,  Guo Grace,  Roberie Dustin

Final Pr. ID: Poster #: CR-048

Down syndrome, typically caused by Trisomy 21, is the most common chromosomal abnormality resulting in intellectual disability affecting 1 in 600-800 pregnancies worldwide. Respiratory problems are the leading cause of hospitalizations and excess mortality in DS, accounting for 42% of admissions through age 2 years. Respiratory issues include pulmonary vascular disease, recurrent respiratory infection, sleep-disordered breathing, airway abnormalities, or subpleural cysts. Abnormalities like craniofacial anomalies, developmental delay, chronic aspiration, and hypotonia contribute to the severity of respiratory issues. Independent of congenital heart defect status, the lungs of DS children have widened alveolar ducts, and fewer and enlarged alveoli. These alveolar changes along with connective tissue abnormalities are believed to contribute to the development of subpleural cysts found in up to 20-36% of DS children. The clinical significance of these cysts is variable. It is important for radiologists to be familiar with subpleural cysts associated with DS as it may prevent misdiagnosis with other serious conditions. Additionally, subpleural cysts may increase the risk for pneumothorax or parenchymal damage during mechanical ventilation or surgery. Generally, subpleural cysts are poorly seen on radiographs and have been primarily identified using CT. We present a 5 year old male with DS, born at 36 weeks gestation, who presented to the emergency room with cough, rhinorrhea, and fever. He had no history of respiratory issues and received routine vaccinations. Chest radiograph revealed bilateral apical predominant subpleural cystic lucencies, perihilar fullness, and peribronchial cuffing. He was diagnosed with acute upper respiratory infection and discharged home with symptomatic management and outpatient follow-up. Sedated CT of the chest two weeks later had findings of diffuse bilateral subpleural and perilymphatic cysts, small subpleural calcifications, and mild scattered interlobular septal thickening. Since he did not have respiratory issues at baseline or after his illness, there was less concern for progressive disease requiring intervention and he was managed with conservative monitoring. Our case highlights the importance of recognizing pulmonary manifestations frequently associated with DS to improve disease recognition and prevention of complications. Read More

Authors:  Bezzant Braydan , Guo Grace , Roberie Dustin

Keywords:  Cystic Lung Disease

Shewarega Annabella,  Lin Tony,  Christison-lagay Emily,  Stitelman David,  Hittelman Adam,  Morotti Raffaella,  Silva Cicero,  Rowe Erin

Final Pr. ID: Poster #: CR-018

Multicystic renal tumors (MCRTs) in children encompass a rare and diverse group of neoplastic entities, including cystic nephroma (CN), cystic partially differentiated nephroblastoma (CPDN), and cystic Wilms' tumor (CWT). CPDN occupies an intermediate status between the benign CN and the malignant CWT. Despite marked histological differences, distinguishing these tumors clinically is a complex undertaking.
A 33-month-old male child presented with abdominal pain and recurrent episodes of screaming and knee-drawn postures during sleep. The patient had a recent history of mild gastroenteritis, but no recent travel or sick contacts. Physical examination revealed a palpable abdominal mass. Abdominal ultrasound detected a distinct multicystic lesion in the upper left quadrant, separated from the spleen. While gastric involvement was considered, the lesion appeared isolated from the gastric bubble and fixed. Potential diagnoses included a unique gastric bezoar, vascular mass lesions, and an exophytic renal lesion. MRI revealed a large, multiloculated cystic lesion with septations, primarily contained within the renal boundaries, but protruding medially. Noticeable enlargement of adjacent retroperitoneal lymph nodes prompted consideration of an MCRT, including CWT. An atypical multicystic dysplastic kidney was also considered. The patient underwent surgical resection followed by histopathological analysis, which confirmed the diagnosis of CN.
While radiological imaging aids in diagnosing MCRT, distinguishing between CN, CPDN, and CWT often necessitates histopathological analysis. Vascular invasion can point to a diagnosis of CWT. The presence of solid elements is less helpful, as discerning whether these are part of the tumor or part of the native kidney can be difficult. The accuracy of the diagnosis plays a crucial role in determining the necessity for chemotherapy and/or radiation therapy. This case report highlights the diagnostic complexities associated with MCRTs in pediatric patients and underscores the significance of a multidisciplinary approach that incorporates clinical, radiological, and histopathological evaluations to provide the best possible care for these young patients. Read More

Authors:  Shewarega Annabella , Lin Tony , Christison-lagay Emily , Stitelman David , Hittelman Adam , Morotti Raffaella , Silva Cicero , Rowe Erin

Keywords:  Cystic Nephroma, Abdominal, Tumor

Supakul Nucharin,  Wanner Matthew,  Marine Megan,  Karmazyn Boaz

Final Pr. ID: Poster #: EDU-032

To summarize our experience in diagnosis neonatal bowel obstruction in cystic fibrosis (CF) patient using contrast enema study. This pictorial review will illustrate and discuss several aspects of imaging findings in non-complicated and complicated meconium ileus as well as the mimicker.

Key imaging findings, pearls and pitfalls in diagnosis and guided treatment will be made, emphasizing what radiologists need to know. Correlation with intraoperative findings and follow-up images will also be provided. Read More

Authors:  Supakul Nucharin , Wanner Matthew , Marine Megan , Karmazyn Boaz

Keywords:  microcolon, cystic fibrosis, delayed pass meconium

Mcbee Morgan,  Towbin Alexander,  Dillman Jonathan,  Trout Andrew

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

Authors:  Mcbee Morgan , Towbin Alexander , Dillman Jonathan , Trout Andrew

Keywords:  hepatic cyst, Cystic mass, Fluid lesion