Montgomery Stormy,  Kodger Nicole,  Johnson Melissa,  Harris Kelly,  Tutman Jeffrey

Final Pr. ID: Poster #: EDU-020

Interrogation of the renal vasculature in the pediatric patient is challenging, requiring meticulous sonographic technique and attention to detail. Ultrasound, and Doppler sonography in particular, plays a key role in evaluation of suspected renal vascular abnormalities given its portability, availability, and lack of ionizing radiation. Attempts must be made to optimize the performance of this technically challenging examination. Additionally, the radiologist must be familiar with the frequently subtle findings in these examinations.

The purpose of this exhibit is the educate the audience on the proper performance and interpretation of renal Doppler ultrasound. We will first review the normal vascular anatomy of the kidney and normal arterial and venous waveforms. Sonographic technique will be reviewed, including tips and tricks for optimizing image acquisition and including a review of appropriate technique for color and spectral Doppler interrogation. A case-based pictorial review will then follow, including the following diagnoses:

1. Renal artery thrombosis
2. Renal vein thrombosis
3. Renal artery stenosis, including discussion of congenital vs. acquired causes and associated syndromes
4. Manifestations of systemic processes in the renal vasculature (including patent ductus arteriosis, aortic coarctation, and LVAD)
5. Spectrum of abnormal vascular findings in renal transplants
6. Pseudoaneurysm and AV fistula
7. Nutcracker syndrome Read More

Authors:  Montgomery Stormy , Kodger Nicole , Johnson Melissa , Harris Kelly , Tutman Jeffrey

Keywords:  Renal, Doppler, Ultrasound

Ruiz Martha,  Bhargava Ravi,  Marfil Braulio,  Hawkes Michael,  Shapiro James

Final Pr. ID: Poster #: SCI-008

Doppler ultrasound (DUS) is routinely used to assess graft status after liver transplantation (LT). Although early post-surgical assessment is encouraged, the exact prognostic value of DUS parameters is unknown.

The purpose of this study was to determine the prognostic value of DUS parameters obtained in the immediate postoperative period. Read More

Authors:  Ruiz Martha , Bhargava Ravi , Marfil Braulio , Hawkes Michael , Shapiro James

Keywords:  Doppler, Liver transplant, Prognosis

Khaw Kristina,  Sridharan Anush,  Poznick Laura,  Kilbaugh Todd,  Hwang Misun

Final Pr. ID: Paper #: 130

The purpose of this experiment was to evaluate the correlation between the doppler and intracranial pressure (ICP) and mean arterial pressure (MAP) in a pediatric porcine model of asphyxia-associated cardiac arrest. Read More

Authors:  Khaw Kristina , Sridharan Anush , Poznick Laura , Kilbaugh Todd , Hwang Misun

Keywords:  Doppler, Intracranial Pressure

Shore Matthew,  Riedesel Erica

Final Pr. ID: Poster #: EDU-128

Hepatic sinusoidal obstruction syndrome (SOS) - previously termed hepatic veno-occlusive disease (VOD) - is a serious cause of acute liver failure in patients undergoing hematopoietic cell transplantation (HCT).

Hepatic SOS results from injury to the hepatic venous endothelium during intensive myelopablative chemotherapy or radiation therapy prior to HCT. Endothelial injury eventually leads to fibrous obliteration of the terminal hepatic venules with sinusoidal obstruction, hepatocyte necrosis, and hemorrhage, typically seen in the first 3-6 weeks post-transplant.

Early identification of this disease process is critical given high incidence of multi-organ failure and significant morbidity and mortality. Ultrasound is extremely valuable in accurate early diagnosis as imaging findings often precede clinical signs of disease. Spectrum of findings on gray-scale ultrasound includes hepatomegaly, heterogeneous hepatic parenchymal echotexture, ascites, and gallbladder wall thickening. Findings on Doppler ultrasound - increased mean hepatic artery resistive index (RI) and decreased or reversed portal venous flow - are highly sensitivie for hepatic SOS.

In this education exhibit we will review the epidemiology and pathophysiology of hepatic sinusoidal obstruction syndreom (SOS) and discuss imaging findings that aid in accurate diagnosis. Special attention will be given to Doppler ultrasound findings and additional diagnostic information provided by B-flow Doppler ultrasound. Read More

Authors:  Shore Matthew , Riedesel Erica

Keywords:  Hepatic Sinusoidal Obstruction Syndrome, Doppler Ultrasound, B-flow Ultrasound, Educational Exhibit

Pelizzari Mario,  Garcia Barale Dolores,  Cohen Canals Ayelen

Final Pr. ID: Poster #: EDU-059

Hidradenitis suppurativa (HS) is a chronic autoinflammatory follicular skin disease characterized by nodules, abscesses, fistulas, and scarring in areas where apocrine glands are found, such as the axillary, inguinal, and anogenital regions. While this condition is commonly associated with adults, it can occasionally affect children, mainly during puberty. Pediatric hidradenitis suppurativa poses unique challenges in terms of diagnosis, management, and the quality of life of affected young individuals.
In this context, ultrasound emerges as a crucial diagnostic and monitoring tool. Ultrasound allows for a detailed assessment of skin lesions, identifying specific features of HS. This imaging technique not only aids in confirming the diagnosis but also guides the choice of appropriate treatments and monitors the response over time. Ultrasound provides a non-invasive, non-radiating alternative to more invasive procedures, which is particularly valuable in pediatric patients.
This work focuses on exploring key aspects of hidradenitis suppurativa in pediatric patients, with a particular emphasis on the pivotal role of ultrasound in the diagnosis and monitoring of this condition. Through this review, we aim to enhance the understanding of hidradenitis suppurativa in the pediatric setting. Read More

Authors:  Pelizzari Mario , Garcia Barale Dolores , Cohen Canals Ayelen

Keywords:  Hidradenitis suppurativa, Doppler, Ultrasonography

Infante Juan

Final Pr. ID: Poster #: EDU-026

Renal dysfunction in a transplant kidney is a common clinical problem which is usually attributed to either rejection or arterial stenosis. While the overall incidence of transplant renal artery stenosis is low, the question of stenosis remains after Doppler examinations although abnormal Doppler ultrasounds are often later proven to be false positives. In the author's experience, these false positive cases are almost always associated with high correction angles (at or near 60 degrees). Conversely, repeating a positive Doppler study by maneuvering the transducer to produce a lower correction angle often resolves the apparently elevated velocity.

A contributing factor to the usage of high correction angles is the actual angle of takeoff of the transplant renal artery relative to the external iliac artery. This can make performing the study with a low correction angle a physically challenging task for the sonographer. Nevertheless, proper effort when scanning these cases is indicated to save the patients from unnecessary follow-up studies and possibly unnecessary invasive procedures.


This educational exhibit aims to address the following learning points:

1) The basis for avoiding high correction angles can be traced to back to basic trigonometric principles which we must keep in mind during image acquisition and interpretation
2) The mechanism for false positive Doppler studies in post-transplant renal artery stenosis is often an unnecessarily high Doppler correction angle
3) Repeating a positive Doppler study with the aim of minimizing the correction angle through optimal probe placement can help avoid unnecessary further testing including possibly invasive procedures
4) The angle of takeoff and variable trajectories of transplant renal arteries can pose difficult physical and cognitive problems for the ultrasound operator Read More

Authors:  Infante Juan

Keywords:  renal artery stenosis, renal transplant, Doppler

Yin Chen,  Pfeifer Cory,  Clarke Rebekah

Final Pr. ID: Poster #: EDU-074

There are 2 types of transcranial Doppler ultrasound. In the non-imaging technique, vessels are identified and interrogated based on sound, waveform, and sample depth, often using a transorbital window. The imaging technique involves the use of color Doppler to visualize the vessels themselves, commonly via a transtemporal window. Non-imaging transcranial doppler has long been used as diagnostic tool to assess for intracranial vasospasm in critically ill adults. Imaging transcranial Doppler is a common tool used in the surveillance of children with sickle cell anemia to evaluate for risk of stroke. This presentation describes the use of the imaging transcranial Doppler technique to monitor the intracranial circulation in critically ill children in neurocritical care setting. Read More

Authors:  Yin Chen , Pfeifer Cory , Clarke Rebekah

Keywords:  Imaging Transcranial Doppler, Pediatric, Neurocritical Care Unit

Collard Michael,  Kwon Jeannie,  Mangona Kate Louise,  Pfeiffer Cory

Final Pr. ID: Poster #: EDU-068

Head ultrasound has long been utilized in the first few months of life to screen neonates for hemorrhage, assess midline anatomy, characterize extra-axial fluid collections, elucidate causes for suspected ventriculomegaly, and serially evaluate parenchymal echotexture without exposing the child to ionizing radiation or the expense of MRI. Less commonly utilized in a routine fashion is Doppler interrogation of the midline vasculature as part of the inpatient routine head ultrasound protocol. This exhibit will educate the reader on how and when transfontanelle Doppler can be utilized and the benefits it can provide. Read More

Authors:  Collard Michael , Kwon Jeannie , Mangona Kate Louise , Pfeiffer Cory

Keywords:  Doppler, Cranial, Neonatal

Stanescu Luana,  Kamps Shawn,  Dick Andre,  Phillips Grace

Final Pr. ID: Poster #: EDU-022

Liver transplantation is a potentially life-saving procedure for children with liver failure. Pediatric liver transplant recipients are at greater risk for complications such as vascular thrombosis than adults. In addition, children more commonly receive reduced size grafts, which alter the normal liver anatomy. While the postoperative assessment of pediatric liver transplants with sonography has been well studied, less exists in the radiology literature regarding intraoperative Doppler sonography of the graft prior to abdominal closure. We illustrate the intra- and post-operative ultrasound findings in pediatric liver transplants, with an emphasis on normal features, common pitfalls, and frequently encountered vascular complications. Read More

Authors:  Stanescu Luana , Kamps Shawn , Dick Andre , Phillips Grace

Keywords:  Liver Transplantation, Intra-operative, Doppler

Holm Tara,  Murati Michael,  Hoggard Eric,  Dietz Kelly

Final Pr. ID: Poster #: SCI-014

Total pancreatectomy and islet autotransplantation (TPIAT) has become an increasingly utilized option for pain management in pediatric patients with chronic and hereditary pancreatitis. Doppler ultrasound of the liver is routinely used to evaluate patency of the portal vein and assess portal vein and hepatic artery velocities after this procedure. However, to the best of our knowledge no study has established the expected Doppler findings on pediatric patients after TPIAT. This study is intended to establish normal values for velocities in the hepatic artery and portal vein in pediatric patients after TPIAT, and to determine the rate of hepatic vascular complications in these patients. Read More

Authors:  Holm Tara , Murati Michael , Hoggard Eric , Dietz Kelly

Keywords:  Islet Autotransplantation, pancreatitis, Doppler

Acosta-izquierdo Laura,  Dien-esquivel Maria,  Miller Elka,  Ferretti Emanuela,  Martinez-rios Claudia

Final Pr. ID: Poster #: EDU-016 (S)

Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. These infants are prone to multiple complications. Frequent complications affect the brain. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the brain during the first weeks of life. An appropriate ultrasound technique includes assessment of the brain in gray scale, color and spectral Doppler. Doppler US should be interpreted in correlation with the neonate’s clinical and systemic hemodynamic state, postnatal age, blood gas concentrations, respiratory or cardiovascular complications, amongst others. Prior literature focuses on the sonographic characteristics of premature, near term and term infants. However, Doppler US characterization of the intracranial vessels of ELGA infants is lacking. The purpose of this exhibit is to describe the resistive index (RI) and peak systolic velocities (PSV) of the anterior cerebral artery and the PSV of the superior sagittal sinus of a cohort of ELGA infants, and to assess their correlation with complications encountered in these infants. Read More

Authors:  Acosta-izquierdo Laura , Dien-esquivel Maria , Miller Elka , Ferretti Emanuela , Martinez-rios Claudia

Keywords:  Brain Doppler, Resistive index, Prematurity

Patel Falguni

Final Pr. ID: Poster #: CR-002 (R)

To demonstrate the finding of a Femoral artery Pseudoaneurysm on a Left Lower extremity venous and arterial doppler ultrasound and under Interventional Radiology sonographically guided compression of the neck of the Pseudoaneurysm and guided injection of thrombin into the Pseudoaneurysm resulted in successful thrombosis of a Pseudoaneurysm. Follow up ultrasounds to document resolving of a Left Femoral artery Pseudoaneurysm in an infant. Read More

Authors:  Patel Falguni

Keywords:  Doppler Lower extremity Ultrasound, Pseudoaneurysm, Interventional procedure.

Kozak Brandi

Final Pr. ID: Poster #: EDU-018 (T)

Transcranial Doppler examinations are crucial in the care and treatment of patients in the Sickle cell population. The earlier we are able to obtain diagnostic studies on these patients the more effective treatment is and can reduce the risk of the patient suffering from a life altering stroke. Read More

Authors:  Kozak Brandi

Keywords:  Transcranial Doppler, TCD, Sickle Cell

Cielma Tara,  Bandarkar Anjum,  Demshur Lesley,  Bulas Dorothy

Final Pr. ID: Poster #: EDU-002 (T)

Background: Duplex sonography is a critical portion of intracranial hemodynamics evaluation. Serial Doppler examination allows real-time assessment of disease progression or improvement.

The goals of this exhibit are:
1. Describe the technical approach of performing neonatal/infant transcranial Doppler ultrasound.
2. Review tips, and up to date technology that assist in optimizing studies.
3. Discuss changes in flow patterns with various pathologies, providing examples of clinical indications.
4. Review future potential techniques and applications. Read More

Authors:  Cielma Tara , Bandarkar Anjum , Demshur Lesley , Bulas Dorothy

Keywords:  Neurosonography, Cerebral Doppler, Hypoxic Ischemic Encephalopathy

Bandarkar Anjum,  Otero Hansel

Final Pr. ID: Poster #: SCI-076

The Median Arcuate Ligament Syndrome (MALS) is a diagnosis of exclusion. It is a condition characterized by abdominal pain due to compression of celiac artery by the median arcuate ligament.
1. The purpose of this study is to review a single institutional experience in screening and diagnosing MALS in the pediatric population with emphasis on the diagnostic accuracy of ultrasound (US) Doppler against additional imaging and follow up.
2. We also describe our technical approach of performing Doppler US in suspected MALS and various diagnostic criteria. Read More

Authors:  Bandarkar Anjum , Otero Hansel

Keywords:  Median Arcuate ligament syndrome, Doppler Ultrasound, Postural Orthostatic tachycardia syndrome

Pelizzari Mario,  Montalvetti Pablo,  Joulia Vulekovich Lara,  Musso Marcos

Final Pr. ID: Poster #: EDU-058

OBJECTIVES
The objective of this study is to describe and classify the different types of aplasia cutis using dermatological Doppler ultrasound, in an imaging diagnostics service. To demonstrate the ultrasound signs and different presentations of the pathology.

ABSTRACT
Aplasia cutis is a congenital anomaly characterized by the focal absence of one or more layers of the skin and, at times, underlying tissues such as bone or dura mater. It has an incidence of 3 in every 10,000 live births, and its etiology is unknown.
Its most frequent location is the scalp, although it can affect other parts of the body and be multifocal. Ultrasound and Doppler examination, using high-frequency probes, objectively assess the anatomical involvement and potential complications.

CONCLUSION
Given the clinical suspicion of aplasia cutis, ultrasound and Doppler imaging are valuable for diagnosis and monitoring complications. Read More

Authors:  Pelizzari Mario , Montalvetti Pablo , Joulia Vulekovich Lara , Musso Marcos

Keywords:  aplasia cutis, Doppler, Ultrasonography