Kim Taehoo,  Faingold Ricardo,  Daneman Alan

Final Pr. ID: Poster #: CR-009

A preterm male infant born at 28+2 weeks from twin pregnancy was admitted to Neonatal Intensive Care Unit post urgent cesarean section for placental abruption. Postnatal echocardiogram confirmed multiple cardiac abnormalities including double outlet right ventricle with D-transposition of great arteries, requiring an arterial switch operation. His hospital course was complicated by seizure with previous documentation of left grade 1 germinal matrix hemorrhage and multifocal thromboembolic stroke on brain MRI. At 2 months of life, he required a chest tube insertion during which he had a cardiac arrest requiring venoarterial extracorporeal membrane oxygenation (ECMO).

Head US at 2 hours post-cannulation showed new bilateral symmetrical linear hyperechoic abnormalities in the periventricular supratentorial regions predominantly in the watershed areas, extending peripherally reaching the cortices. Similar new hyperechoic linear foci were seen in the right thalamus. While the clinical diagnosis at this time included watershed infarcts, the pattern of hyperechogenicity with dirty shadowing suggested air emboli, less likely hemorrhage or calcifications.

Follow-up head US at 5 hours post-cannulation was arranged which showed near-complete resolution of the previously seen bilateral parenchymal hyperechoic abnormalities. Thus, we concluded resolving cerebral intravascular air emboli secondary to recent ECMO cannulation, rather than watershed infarcts. No evidence of new evolving infarct nor intracranial hemorrhage was noted.

The patient unfortunately sustained a fulminant septic shock and end-organ injuries despite maximum medical therapies. His family elected to withdraw all life-sustaining therapies the day after his head US.

Systemic air embolism is a rare but potentially fatal complication of ECMO. Rapid recognition is important for reducing morbidity and mortality. Head ultrasound is usually the first brain imaging study performed in neonates for screening. Bilateral periventricular increased echogenicity can be seen in a wide range of different pathologies, including but not limited to periventricular leukomalacia, infarcts, hemorrhages and neonatal encephalitis. This case report highlights important sonographic features distinguishing intracranial air embolism from other confounding diagnosis. Read More

Authors:  Kim Taehoo , Faingold Ricardo , Daneman Alan

Keywords:  Brain Ultrasound, Neonatal, ECMO

Karl Barbara,  Sammet Christina,  Popescu Andrada,  Rigsby Cynthia

Final Pr. ID: Poster #: EDU-07 (R)

The goal of this education exhibit is to develop an imaging strategy to safely image the patient on extracorporeal membrane oxygenation (ECMO) within the CT department focusing on scan protocols, define table movement required for high pitch table movement, communication and necessary emergency supplies. Read More

Authors:  Karl Barbara , Sammet Christina , Popescu Andrada , Rigsby Cynthia

Keywords:  ecmo, pitch, CT, extracorporeal membrane oxygenation

Thompson Adrienne,  Al-aklabi Mohammed,  Cave Dominic,  Noga Michelle

Final Pr. ID: Poster #: EDU-064

BACKGROUND & OBJECTIVE: Extracorporeal Membrane Oxygenation (ECMO) is being used increasingly across the world as a short-term life support for infants, children, and adults. As of 2014, over 4500 patients at over 200 centers world-wide were being treated with ECMO annually. The applications of ECMO range from patients with acute cardiac or pulmonary failure, to patients who are immediately post-op from lung or heart transplant/surgery. In reading the daily batch of ICU radiographs, the pediatric radiologist will often see ECMO cannulae amongst the tubes and lines. Many radiologists can acknowledge the presence of cannulae, but are often unfamiliar with the radiographic details of cannulae position and complications. Our goal is to educate pediatric radiologists on ExtraCorporeal Membrane Oxygenation (ECMO) and the normal/abnormal appearance of radiographs of patients on ECMO.
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Authors:  Thompson Adrienne , Al-aklabi Mohammed , Cave Dominic , Noga Michelle

Keywords:  ECMO, Life support, Extracorporeal Membrane Oxygenation

Hull Nathan,  Robb Tiffany,  Young Phillip

Final Pr. ID: Poster #: EDU-039

This poster will review the complexities and challenges of performing CTA on pediatric patients on ECMO and provide practical suggestions for performing these exams. Read More

Authors:  Hull Nathan , Robb Tiffany , Young Phillip

Keywords:  ECMO, CT Angiography, Pediatric