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

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

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