Guirguis Albair,  Lampl Brooke,  Park Ellen,  Mamoun Ihsan

Final Pr. ID: Poster #: EDU-028

Background: Esophageal disorders are relatively common in pediatric age group, clinically presenting with dysphagia, odynophagia, chest pain, cough, and aspiration. Etiologies may include infections and motility disorders, congenital disorders, and some traumatic (post foreign body or caustic ingestion)??? causes. Overlap exists in the appearance of esophageal pathology by fluoroscopy and cross-sectional evaluation. Recognition of the imaging features and how to differentiate various pathologies assist in diagnosis and further management.

Purpose: To review the esophageal disorders that can manifest in children with specific attention to the imaging features of different pathologies.

Educational goal: To recognize and describe the different pathologies and to emphasize the key imaging features encountered in esophageal disorders.

Technique and modalities of Imaging: Plain radiographs may be helpful in the newborn in the diagnosis of esophageal atresia, however esophagram is considered the primary tool for evaluation as it demonstrates both the anatomy and function of the esophagus. Cross sectional imaging such as CT and MRI may follow esophagram for further assessment of the extent of the diseases in some cases such as the wall involvement, extra-luminal extension, and extrinsic lesions.

Examples of cases (please refer to images)

Lymphoma involving the esophagus.
Ulcerating mass and irregular wall thickening of the lower esophagus.

Esophageal leimyomatosis (Alport syndrome).
Diffuse esophageal wall thickening and dilatation.

Congenital Esophageal stenosis.
Long segment of irregular concentric narrowing with mild proximal dilatation.

Listed below are some of the esophageal disorders included in the poster:
Congenital stenosis.
Achalasia.
Esophageal web.
Traumatic stricture (battery ingestion).
Esophageal perforation (post TOF repair).
Diffuse Esophageal Spasm.
Eosinophilic Esophagitis.
Tertiary contractions.
Hiatal hernia.



Conclusion: Imaging is one of the main tools in the work up for esophageal disorders, allowing for appropriate management and treatment. Several cases will be presented, including clinical information, illustrated images and descriptions of the imaging findings. These cases will cover different pathologies, as a quick comprehensive review for esophageal disorders. Read More

Authors:  Guirguis Albair , Lampl Brooke , Park Ellen , Mamoun Ihsan

Keywords:  Esophagus, Esophagram, Dysphagia

Damer Alameen,  Damer Reham,  Davila Jorge

Final Pr. ID: Poster #: EDU-026

Videofluoroscopic swallowing studies (VFSS) are used to assess dysphagia in the pediatric population in conjunction with the Penetration-Aspiration Scale (PAS), which describes the degree of airway invasion during swallowing. However, guidelines regarding indications and follow-up are varied and vague, and often lead to over-referral, over and undertreatment, and follow-up that does not always benefit patients (i.e inadequate interventions in the interim to yield improvement). The aim of our work is to present clear guidelines for VFSS indications and follow-up to reduce unnecessary referrals, and promote clinically significant follow-up management. Read More

Authors:  Damer Alameen , Damer Reham , Davila Jorge

Keywords:  Dysphagia, Videofluoroscopy, Penetration-Aspiration

Koutrouveli Eleni,  Zamparas Athanasios,  Sfakiotaki Rodanthi,  Sofokleous Valentinos,  Antoniou Maria,  Fezoulidi Georgia,  Vekrakou Artemis,  Vakaki Marina

Final Pr. ID: Poster #: CR-003

Lingual tonsils are part of the Waldeyer ring, located at the base of the tongue in continuity with the palatine tonsils. Situated at the common entry of the respiratory and the digestive system, they play a pivotal role in initiating and maintaining immune response. Lingual tonsil hypertrophy (LTH) is rare in children with no comorbidities. However, an accumulating body of evidence suggests that LTH is associated with obesity and Down Syndrome, particularly in cases where palatine tonsillectomy and adenoidectomy have been performed. Recent research has indicated positive correlation between LTH and obstructive sleep apnea, which constitutes a significant cause of morbidity in children. Therefore, prompt diagnosis is critical, as a timely tonsillectomy can easily resolve this life-threatening condition. Although the role of CT and MRI in identifying LTH has been discussed in literature, there remains limited evidence concerning ultrasound’s value in its accurate diagnosis, while avoiding radiation exposure.
The following case highlights ultrasound’s reliable evaluation of the lingual tonsil and its potential position as a screening method for patients with obstructive sleep apnea.
We present a case of a 14-year-old boy with Down syndrome, who had undergone a previous palatine tonsillectomy. The patient presented with dysphagia and sleep apnea. Upon direct laryngoscopy performed by an experienced otolaryngologist, a suspicion arose of a mass adherent to the anterior surface of the epiglottis. As a result, he was referred to our radiological department for further evaluation, and an ultrasound examination was performed.
Ultrasound revealed an ovoid-shaped, well-defined mass located at the base of the tongue. The mass demonstrated a hypoechoic echogenicity, with a striated appearance consisting of alternating linear hyperechoic and hypoechoic bands. These sonographic characteristics were compatible with palatine tonsils. No residual palatine tonsillar tissue was recognized upon meticulous examination.
A dynamic, real-time examination followed, with the patient instructed to take deep breaths. The movement of the mass within the retroglossal space was observed, proving its role in obstructive apnea. Correlating the ultrasound findings with the patient’s medical history, a diagnosis of enlarged lingual tonsil was made, also demonstrated on CT and confirmed by post-surgical pathology. Read More

Authors:  Koutrouveli Eleni , Zamparas Athanasios , Sfakiotaki Rodanthi , Sofokleous Valentinos , Antoniou Maria , Fezoulidi Georgia , Vekrakou Artemis , Vakaki Marina

Keywords:  Dysphagia, Down's Syndrome, Adolescent