Aquino Michael,  Koberlein George

Final Pr. ID: Poster #: EDU-098

Access to timely and accurate interpretation of imaging studies is critical to ensure quality care. This has driven demand for 24/7 radiology coverage. Examples of coverage models and solutions to logistical and financial challenges of providing around-the-clock real-time radiology services can be helpful as more children's hospitals move toward meeting this demand. The purpose of this exhibit is to describe the practice model used to provide after-hours pediatric radiology coverage at Cincinnati Children's Hospital Medical Center. Read More

Authors:  Aquino Michael , Koberlein George

Keywords:  Quality, Emergency, Trauma

Nguyen Derek,  Dunn Emily

Final Pr. ID: Poster #: SCI-014

Children and young adults can present with breast complaints in the emergency setting and ultrasound is typically the initial imaging modality of choice for work-up. While many sonographic findings are benign, there are rare presentations of indeterminate and suspicious masses. In these cases, radiologists and clinicians involved in these patient's care may be unfamiliar with the diagnosis and management of lesions that warrant follow-up with dedicated breast imagers. This study is designed to analyze the common characteristics of pediatric breast complaints from the emergency department and if follow-up care was recommended and pursued. Read More

Authors:  Nguyen Derek , Dunn Emily

Keywords:  Emergency, Breast, Ultrasound

Uricchio Joseph,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-023

In this educational exhibit we will present a series of gastrointestinal (GI) emergencies encountered in the neonatal period. We will focus on typical presentations but will also include atypical cases and discuss multi-modality approach to imaging these patients.
Read More

Authors:  Uricchio Joseph , Sharma Priya , Rajderkar Dhanashree

Keywords:  NICU, Emergency, Gastrointestinal

Gleason Miranda,  Moredock Elisabeth,  Parish David,  Pfeifer Cory

Final Pr. ID: Poster #: SCI-021

The practice of performing dedicated breast ultrasounds in the pediatric emergency department varies according to institution. In the adult population, breast ultrasounds are commonly interpreted by dedicated breast imagers and/or radiologists appropriately qualified to interpret mammograms. Children's hospitals with dedicated pediatric radiology faculty are less likely to have such individuals on staff. This paper examines the practice of breast ultrasounds ordered in the emergency department throughout a large children's health system. Read More

Authors:  Gleason Miranda , Moredock Elisabeth , Parish David , Pfeifer Cory

Keywords:  Breast Abscess, Breast Ultrasound, Emergency Radiology

Thomas Karen,  Marin Jennifer,  Mills Angela,  Boutis Kathy

Final Pr. ID: Poster #: SCI-037

Awareness of the need for benefit:risk assessment prior to imaging studies has increased dramatically over the past decade, but the impact of this on the disclosure practice of Emergency Department (ED) Physicians is not known. Our aim was to assess ED physician practice and attitudes towards CT radiation risk disclosure for stable patients. Read More

Authors:  Thomas Karen , Marin Jennifer , Mills Angela , Boutis Kathy

Keywords:  Radiation, CT, Emergency, consent, disclosure

Nicholas Jennifer,  Marrocco Michael,  Shelton Peter,  Killeen Amy,  Don Steven

Final Pr. ID: Poster #: SCI-031

A button battery lodged in the esophagus is a medical emergency. This study evaluated how accurately button batteries can be distinguished from other ingested foreign bodies on radiographs and how this influences clinical management. Read More

Authors:  Nicholas Jennifer , Marrocco Michael , Shelton Peter , Killeen Amy , Don Steven

Keywords:  Button Battery, Emergency, Education

Nguyen Derek,  Dunn Emily

Final Pr. ID: Poster #: EDU-063

Children and young adults occasionally present with breast complaints in the emergency setting, typically with palpable abnormalities or pain. Ultrasound is the imaging of modality of choice in this setting due to its wide availability, resolution for superficial soft tissue structures, and lack of ionizing radiation. In this presentation, we review breast lesions seen in children and young adults undergoing sonographic evaluation in the emergency department at a tertiary pediatric hospital with the final diagnosis. The aim of this exhibit is to review pediatric breast anatomy and depict representative ultrasound imaging features of normal variants, benign lesions, and findings which should raise suspicion for malignancy. Cases will include but not limited to: premature glandular tissue, ductal ectasia, breast edema, breast cellulitis, breast abscess, periductal mastitis, complicated cyst, intraductal papilloma, fibroadenoma, phyllodes tumor, and breast cancer. Read More

Authors:  Nguyen Derek , Dunn Emily

Keywords:  Emergency, Breast, Ultrasound

Albers Brittany,  Yang Yiting,  Parikh Ashishkumar,  Shah Chetan

Final Pr. ID: Poster #: SCI-015

Head CT is often performed in the emergency setting to evaluate for new neurologic symptoms. CT is limited in evaluation of acute stroke, brainstem and posterior fossa lesions, demyelinating disease, and diffuse axonal injury. Unremarkable head CT may be falsely reassuring and can delay treatment. Limited sequence MR (LSMR) is a new approach for evaluating a patient with neurologic symptoms. In order for LSMR to be feasible, it must be accurate, efficient, and cost-effective. Read More

Authors:  Albers Brittany , Yang Yiting , Parikh Ashishkumar , Shah Chetan

Keywords:  Emergency, CT, MR

Rajderkar Dhanashree,  Sharma Priya,  Verma Nupur

Final Pr. ID: Poster #: EDU-133

GI Emergencies and congenital malformation in the neonate are variable in their presentation and can be seen from the hypo-pharynx to the anus. The pediatric radiologist often plays a key role in diagnosis and planning of early surgical management. Read More

Authors:  Rajderkar Dhanashree , Sharma Priya , Verma Nupur

Keywords:  Congenital, GI malformations, Newborn bowel obstruction, New born GI emergencies, GI congenital emergencies

Kim Joseph,  Shukla Neal,  Hammer Matthew,  Lozano Richard,  Hajibeygi Ramtin,  Tu Long

Final Pr. ID: Poster #: CR-049

A 16-year-old boy was transferred to our institution after experiencing a week of worsening numbness and weakness in his left lower extremity. Initially diagnosed with sciatica at an outside facility, he was treated with steroids. However, as his symptoms progressed, including difficulties with bowel movements, he returned for further evaluation.

Outside MRI studies of the lumbar spine and brain revealed hyperintensities and enhancement at T11-T12, raising concerns for transverse myelitis. Subsequent MRI of the cervical and thoracic spine and brain demonstrated extensive T2-weighted cord edema extending from C7 to the conus medullaris, along with a long segment of intramedullary hemorrhage, most pronounced from T8-T9. The differential diagnosis based on these findings included long-segment transverse myelitis complicated by cord hemorrhage or an intramedullary neoplasm, such as ependymoma or astrocytoma.

Comprehensive laboratory testing, including serologic and cerebrospinal fluid studies, ruled out infectious, autoimmune, metabolic, and demyelinating causes. Given the presence of intramedullary hemorrhage, a vascular etiology, such as an arteriovenous shunt, was considered; however, a diagnostic spinal angiogram showed no evidence of an aneurysm or vascular malformation.
Multi-specialty conferences involving radiology, infectious diseases, rheumatology, neuroimmunology, and neurosurgery were conducted, but no consensus was reached regarding the underlying etiology of the lesions. Ultimately, the patient was treated empirically for transverse myelitis with steroids, intravenous immunoglobulin (IVIG), and plasmapheresis.

Hemorrhagic transverse myelitis can result from a variety of etiologies, including infectious, neoplastic, demyelinating, vascular, autoimmune, and idiopathic factors. Key MRI sequences for evaluation include T2-weighted and post-contrast images, which are essential for assessing spinal cord edema, inflammation, and hemorrhagic changes. Additionally, gradient echo (GRE) sequences are vital for detecting subtle blood products, as blood degradation products display greater hypointensity and blooming on GRE images compared to T2-weighted images. By understanding this rare condition and its potential underlying causes, radiologists can play a crucial role in guiding clinical teams toward accurate diagnosis and timely management of patients with hemorrhagic transverse myelitis. Read More

Authors:  Kim Joseph , Shukla Neal , Hammer Matthew , Lozano Richard , Hajibeygi Ramtin , Tu Long

Keywords:  Spinal Cord, MRI, Emergency/Acute

Jordan Kathryn,  Killerby Marie,  Patel Arjun,  Cassella Katharyn,  Greene Elton,  Johnstone Lindsey,  Leschied Jessica

Final Pr. ID: Poster #: EDU-014

The majority of children’s hospitals reside in urban settings, and the most common animal related injuries seen in these areas are induced by cats or dogs. However, urban medical centers serve patients from large surrounding rural areas where a more diverse array of animal or agriculture related injuries can occur. Although an altercation with an angry horse, pig, or cow could result in severe trauma in adults, animal related injuries pose an even greater danger to children given their smaller stature and growing bodies. The natural curiosity of children also increases the risk of severe injury when living or playing around industrial agricultural equipment. Even partaking in outdoor sports or leisure activities confers risk for exposure to a variety of injury mechanisms. Depending on the specifics of the surrounding ecosystem, radiologists may also care for patients exposed to envenomation from snakes, scorpions, spiders, and various other insects, resulting in local or systemic complications. When incorporating a mechanism of injury, radiologists may anticipate complications of exposure to these animals or insects and can recommend further imaging evaluation. For example, in addition to characterizing imaging findings, such as local necrosis, from a brown recluse bite injury in a patient transferred from an outlying hospital, the radiologist would anticipate the urgency with which to assess for more systemic complications such as angioedema, rhabdomyolysis, or internal hemorrhage due to disseminated intravascular coagulopathy. To best serve our patients, pediatric radiologists should exhibit familiarity with possible mechanisms of injury related to wildlife, their various imaging manifestations, and potential complications in order to help guide clinicians in managing these potentially devastating injuries. This educational exhibit aims to demonstrate key findings of such pediatric injuries through a series of cases. Read More

Authors:  Jordan Kathryn , Killerby Marie , Patel Arjun , Cassella Katharyn , Greene Elton , Johnstone Lindsey , Leschied Jessica

Keywords:  Pediatric Trauma, Image Findings, Emergency/Acute

Dougherty Ryne,  Alves Timothy

Final Pr. ID: Poster #: EDU-022

Abdominal pain is common presentation to the pediatric emergency department, and appendicitis remains the most common pediatric surgical emergency. While the imaging workup of pediatric appendicitis typically begins with ultrasound, MRI is increasingly being used for problem-solving and to further evaluate equivocal ultrasound results. With increased utilization, more and more mimics of appendicitis are being encountered on MRI. The purpose of this educational exhibit is to familiarize the practicing pediatric radiologist with these mimics through a case-based review in order to improve diagnostic accuracy and patient care. Read More

Authors:  Dougherty Ryne , Alves Timothy

Keywords:  Appendicitis, Emergency, MRI

Sharma Priya,  Rajderkar Dhanashree,  Schaiberger Gregory,  Batmunh Bayar,  Slater Roberta,  Mancuso Anthony

Final Pr. ID: Paper #: 173

The purpose of this study is to identify how well radiology residents are able to diagnose gastrointestinal emergencies on ultrasound using a simulated emergency radiology call shift. Read More

Authors:  Sharma Priya , Rajderkar Dhanashree , Schaiberger Gregory , Batmunh Bayar , Slater Roberta , Mancuso Anthony

Keywords:  simulation, gastrointestinal, emergency

Prasad Shashank,  Goodyear Abbey,  Mcfarland Joseph,  Munjal Havisha,  Phiip Sijo,  Ngoc Giang Thanh,  Kwon Jeannie

Final Pr. ID: Poster #: EDU-019

1. Review the advantages and approach to using ultrasound for the evaluation of emergent pediatric-specific abdominal conditions.
2. Discuss specific examples and demonstrate ultrasound findings for common and rare pediatric abdominal emergencies and correlation with other modalities. Read More

Authors:  Prasad Shashank , Goodyear Abbey , Mcfarland Joseph , Munjal Havisha , Phiip Sijo , Ngoc Giang Thanh , Kwon Jeannie

Keywords:  Abdominal, Ultrasound, Emergencies

Schaiberger Gregory,  Sharma Priya,  Batmunh Bayar,  Rajderkar Dhanashree,  Slater Roberta,  Mancuso Anthony

Final Pr. ID: Poster #: SCI-015

The Wisdom in Diagnostic Imaging SIMulation (WIDI SIM) is a strategically designed computer aided simulation of an emergency imaging experience, which rigorously tests residents’ readiness to diagnose various Radiology emergencies. It has proven to be a reliable means for assessing resident preparedness to competently and independently cover radiology call. The residents are provided with a total of 65 cases of varying difficulty, including normal studies. The residents respond using free text which is then scored by faculty members utilizing a robust grading rubric. The identification of pertinent GU emergencies by the “on-call” resident is of the utmost importance as it the resident who must then notify the clinicians of this concern and so that emergent treatment can be expedited. Read More

Authors:  Schaiberger Gregory , Sharma Priya , Batmunh Bayar , Rajderkar Dhanashree , Slater Roberta , Mancuso Anthony

Keywords:  WIDI, GU, Emergencies

Sato T Shawn,  Lai Lillian,  Sato Yutaka

Final Pr. ID: Poster #: EDU-051

Review the unique features of pediatric oncologic emergencies using case review of neurological, spinal, thoracic and abdominal pathologies, covering complications due to the malignancy or its treatment. Read More

Authors:  Sato T Shawn , Lai Lillian , Sato Yutaka

Keywords:  Pediatric, Oncologic, Tumor, Emergency, Radiology

Handa Atsuhiko,  Nozaki Taiki

Final Pr. ID: Poster #: EDU-084

Children with cancer are at increased risk of life-threatening emergencies, either from cancer itself or related to cancer treatment. These conditions need to be assessed and treated as early as possible to minimize their morbidity and mortality. Cardiothoracic emergencies encompass a variety of pathologies, including (1) pericardial effusions and cardiac tamponade, (2) massive hemoptysis, (3) superior vena cava syndrome, (4) pulmonary embolism, and (5) pneumonia. Abdominal emergencies include (6) bowel obstruction, (7) intussusception, (8) perforation and tumor rupture, (9) intestinal graft-versus-host disease, (10) acute pancreatitis, (11) neutropenic colitis, and (12) obstructive uropathy. Radiological imaging plays a vital role in the diagnosis of these emergencies. Although imaging features have been described in most of these conditions, recent advancement in clinical pediatrics is fast-paced. In this educational exhibit, we aim to review the clinical and imaging features of pediatric oncologic emergencies including a review of the recently published literature. Key radiological images are presented to highlight the radiological approach to the diagnosis. Pediatricians, pediatric surgeons, and pediatric radiologists need to work together to arrive at the correct diagnosis and to ensure prompt and appropriate treatment strategies. Read More

Authors:  Handa Atsuhiko , Nozaki Taiki

Keywords:  pediatric oncologic emergency

Saulsberry-abate Anjelica,  Davis James,  Hryhorczuk Anastasia

Final Pr. ID: Poster #: EDU-058

Review the clinical presentation, imaging findings, and management of emergencies in children with sickle cell disease (SCD), with attention to the critical role of imaging when differentiating between potential diagnoses and directing appropriate care. This exhibit will explore the multimodality emergency imaging of children with:
I. Acute vasoocclusive pain crisis
II. Dactylitis
III. Infection/sepsis
IV. Acute chest syndrome
V. Stroke
VI. Splenic sequestration
VII. Gallbladder disease
VIII. Renal nephropathy and infarcts
We will emphasize the central role of imaging in identifying acute and life-threatening complications in children with sickle cell disease, as well as the value of radiology in uncovering other pathologic processes that should be considered when children with SCD present to the emergency department. Read More

Authors:  Saulsberry-abate Anjelica , Davis James , Hryhorczuk Anastasia

Keywords:  Sickle Cell, Emergency, Hematology

Zucker Evan,  Shailam Randheer,  Gee Michael,  Victoria Teresa

Final Pr. ID: Poster #: SCI-010

When evaluating a child with a potential septic hip, prompt diagnosis is important to prevent potential complications such as chondrolysis and avascular necrosis. The diagnosis often requires emergent aspiration of fluid from the hip by a skilled practitioner, traditionally a pediatric radiologist. However, the workforce of pediatric radiologists is dwindling, with retiring physicians being difficult to replace, leading to an overstretched workforce, many of whom may lack interventional skills. Lack of workforce may lead to the restructuring of medical tasks, including hip aspirations. The purpose of this study was to gauge the current participation rate of pediatric radiologists versus other specialties in performing emergency hip aspirations. Read More

Authors:  Zucker Evan , Shailam Randheer , Gee Michael , Victoria Teresa

Keywords:  Workload, Hip, Emergencies

Fitzpatrick Laura,  Allain Dominic,  Schmit Pierre

Final Pr. ID: Poster #: SCI-024

Accurate placement of lines and tubes is essential in pre-hospital emergent care of pediatric patients, to ensure that lifesaving measuring can be initiated in an effective and timely manner. Malpositioned pediatric tubes can lead to failed resuscitation efforts. The purpose of this study is to determine the prevalence of misplaced endotracheal tubes (ETT), nasogastric tubes (NGT) and intraosseous trocars (IOT) in the pediatric acute care setting using post-mortem imaging. Read More

Authors:  Fitzpatrick Laura , Allain Dominic , Schmit Pierre

Keywords:  Emergency, Radiology, Quality

Mceniery Jane

Final Pr. ID: Poster #: EDU-027

Trampoline-related injuries in children are a common cause for presentation to the Emergency Department, and their incidence is increasing. Injuries to the lower limb are the most common. Transverse fractures of the proximal tibial metaphysis are a well-described classic fracture. These fractures may be subtle, only diagnosed at the time of follow up x rays. When reviewed at Radiology Quality Assurance meetings, these missed fractures were perceptible on the original imaging. We sought to examine the characteristics of fractures that were missed, and elucidate measures that could improve diagnostic accuracy. Read More

Authors:  Mceniery Jane

Keywords:  Trauma, Trampoline, Fracture, Quality Assurance, Emergency

Oliver Brianna

Final Pr. ID: Poster #: EDU-036

Pelvic and scrotal pain are common emergent presenting symptoms in the pediatric population, and these patients are commonly imaged to evaluated for gonadal torsion. In this educational exhibit we will review the entire spectrum of gonadal and paragonadal torsions in the pediatric population, focusing on clinical presentations, key imaging findings, possible pitfalls in diagnosis, and next steps in management. It is essential for the pediatric radiologist to be familiar with this range of pathology in order to render an accurate and timely diagnosis, particularly given that some (but not all) of these diagnoses require emergent surgery. Read More

Authors:  Oliver Brianna

Keywords:  Torsion, Emergencies, Pelvic

Krauss Jillian,  Cole Tiffany,  Wyers Mary

Final Pr. ID: Poster #: EDU-045

Torsion and volvulus can affect a variety of organ systems throughout the body, ranging from pathology involving the gastrointestinal tract to the reproductive organs and even the lymphatic system. Torsion and volvulus, regardless of the affected organ, often presents acutely, prompting pediatric patients to seek urgent clinical evaluation either through their pediatrician or the Emergency Department. Accurate and timely diagnosis of these conditions and prompt surgical intervention is critical for both preserving organ viability and preventing patient morbidity and mortality. In these patients, there is a high reliance on imaging for confirmation of the diagnosis.

The purpose of this educational exhibit will be to discuss commonly encountered types of torsion and volvulus in pediatric patients in the emergent setting, with a focus on the imaging features and important clinical and radiologic associations in these conditions. The exhibit will highlight pathologies including midgut volvulus, gastric volvulus, sigmoid volvulus, splenic torsion, testicular torsion, and ovarian torsion, among others, in a case-based format. It is important that the radiologist be able to quickly and reliably diagnosis these potentially life-threatening conditions, as well as recognize any other potential conditions the patient may be at risk for.

This educational exhibit is designed to improve reader comfort and awareness with respect to these various conditions. In addition to reviewing the traditional imaging approach in diagnosing these pathologies, the exhibit will also address some emerging methods in detection of volvulus and torsion, including ultrasound for diagnosis of malrotation with midgut volvulus and rapid MRI for the diagnosis of ovarian torsion. Read More

Authors:  Krauss Jillian , Cole Tiffany , Wyers Mary

Keywords:  Volvulus, Emergency/Acute, Ovarian Torsion