Groene John,  Ong Seng,  Feinstein Kate,  Slater Bethany,  Zaritzky Mario

Final Pr. ID: Poster #: EDU-017

Purpose:
A new minimally invasive procedure, the use of magnets (Flourish™) for the treatment of esophageal atresia will be described. The invention’s background, patient selection criteria, procedure details and complications are the subject of this exhibit.

Background:
Esophageal atresia is a rare congenital defect where the proximal esophagus does not connect to the distal esophagus. Classically, this defect has been treated by surgery to reconnect the ends and reestablish esophageal continuity, however a small subset may be treated with a magnetic catheter-based system. The primary goal of this procedure is to form an anastomosis while avoiding a major thoracic surgery and its complications.
The Flourish™ device uses bullet-shaped rare earth magnets which are inserted into the upper esophagus and lower esophagus. Included in these magnets is the rare earth element neodymium, which along with iron and boron create an alloy with a strength of up to 1.2 Tesla.
When the magnets are placed in close proximity at the ends of the esophageal pouches, they will attract over several days, eventually connecting the ends of the esophagus and causing an anastomosis via pressure necrosis.

Criteria:
Selection is based on absence of tracheoesophageal fistula, esophageal gap shorter than 4 cm and a mature gastrostomy tract.

Procedure:
Under fluoroscopy, the gastric catheter is advanced superiorly through the gastrostomy to the most superior end of the distal esophageal pouch. The oral catheter is then advanced in order to bring the magnets to closest proximity. Daily radiographs are obtained to evaluate magnet positions.

Complications/outcomes:
Thirteen patients that have undergone placement of the magnetic catheter-based system at six institutions. Twelve patients had an average time to achieve anastomosis of six days and progressed to full oral feeds. The most common complication was magnetic anastomosis stenosis requiring dilatation. Currently, Flourish is approved as a Humanitarian Device Exemption (HDE).
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Authors:  Groene John , Ong Seng , Feinstein Kate , Slater Bethany , Zaritzky Mario

Keywords:  Esophageal Atresia, Atresia, Flourish

Youssfi Mostafa

Final Pr. ID: Poster #: CR-062

Esophageal radiolucent foreign bodies can be overlooked in infants since the symptoms are usually nonspecific. Chest X-Rays are often the initial diagnostic tool. The lateral view is key since it may reveal anterior bowing and/or focal narrowing of the intra-thoracic trachea which should alert the radiologist to the possibility of radiolucent esophageal foreign body and the need for an Esophagram. We present two cases that illustrate the importance of this radiographic finding. Read More

Authors:  Youssfi Mostafa

Keywords:  Esophageal, Radiolucent, Foreign Body

Michishita Yukiko,  Miyazaki Osamu,  Imai Ayako,  Okamato Reiko,  Tsutsumi Yoshiyuki,  Miyasaka Mikiko,  Sago Haruhiko,  Kanamori Yutaka,  Nosaka Shunsuke

Final Pr. ID: Poster #: SCI-004

Esophageal atresia (EA) is a relatively rare congenital anomaly. Esophageal pouch (EP) is the only direct sign of EA on fetal MRI, but is not always seen. Distended hypopharynx (DHP) has been reported as a useful prenatal sign of EA, but as EP and DHP are both subjective assessments, the prenatal diagnosis of EA is challenging. The aim of this study was to evaluate whether quantitative measurement of distended pharynx is useful in the diagnosis of EA. Read More

Authors:  Michishita Yukiko , Miyazaki Osamu , Imai Ayako , Okamato Reiko , Tsutsumi Yoshiyuki , Miyasaka Mikiko , Sago Haruhiko , Kanamori Yutaka , Nosaka Shunsuke

Keywords:  Esophageal Atresia, fetal MRI, Quantitative

Johansen Andrew,  Lee Jacob,  Robinson Amie,  Chan Sherwin

Final Pr. ID: Poster #: SCI-045

Foreign body (FB) ingestion can be a life threatening event for pediatric patients. The imaging for suspected FB is an esophagram. This procedure requires radiologist involvement, patient cooperation and has a higher dose of radiation than chest digital tomosynthesis (DTS). We want to describe usage of DTS in the pediatric population to aid in detection of radiolucent esophageal FB. Read More

Authors:  Johansen Andrew , Lee Jacob , Robinson Amie , Chan Sherwin

Keywords:  Digital Chest Tomosynthesis, Esophageal Foreign Body, Esophagram

Ledbetter Karyn,  Chernoguz Artur,  Shaaban Aimen,  Kraus Steven

Final Pr. ID: Poster #: CR-004

An 11-day-old male presented with recurrent choking episodes. Chest radiograph demonstrated partial opacification of the right hemithorax with associated air- bronchograms. Due to concern for tracheoesophageal fistula, a single-contrast barium esophagram was performed and demonstrated an anomalous bronchus arising from the distal esophagus. Subsequent CT of the chest showed an esophageal bronchus arising from the gastroesophageal junction with branches extending to the right lower and right upper lobes. No additional intrathoracic anomaly was identified. The patient was then treated with right upper lobectomy, right lower lobe apical segmentectomy and resection of the esophageal bronchus.

The esophageal bronchus is a rare communicating bronchopulmonary foregut malformation in which a bronchus arises from the esophagus. This anomalous bronchus may supply an entire lung or a single lobe. Although the lung parenchyma associated with the aberrant bronchus is classically supplied by the pulmonary circulation (thereby distinguishing it from a sequestration), additional anomalies are often seen. A few of the more frequently observed associated anomalies include pulmonary artery anomalies, esophageal atresia, duodenal atresia and tracheoesophageal fistula.

Diagnosing an esophageal bronchus begins with chest radiography, which will demonstrate a pattern of airspace disease that resembles a lobar pneumonia. This pattern of opacification is atypical in the neonatal setting, where the vast majority of pulmonary diseases, including pneumonia and aspiration, typically manifest as diffuse and bilateral processes. As patients with an esophageal bronchus also present with feeding difficulties, obtaining an esophagram is the next step in making the diagnosis. The esophagram will demonstrate filling of an abnormal structure that is often seen to be directed cranially and, with continued opacification, may be observed as a branching structure overlying opacified lung. Finally, cross-sectional imaging can be obtained to delineate the vasculature associated with the esophageal bronchus and to assess for additional anomalies.

The most common treatment of an esophageal bronchus is lobectomy. However, when the associated lung parenchyma is normal, performing an anastomosis between the esophageal bronchus and the tracheobronchial tree has been reported. On the contrary, pneumonectomy may be required in cases where anomalous vascularity precludes lobectomy. Read More

Authors:  Ledbetter Karyn , Chernoguz Artur , Shaaban Aimen , Kraus Steven

Keywords:  Esophageal, Congenital

Defendi Larissa,  Sameshima Yoshino,  Yamanari Maurício,  Neto Miguel José,  Queiroz Marcos

Final Pr. ID: Poster #: EDU-022

Although clinical history seems the most important diagnostic information in gastroesophageal reflux (GER), it is less reliable in pediatric practice, mainly under 2 years old. Diagnostic tests are needed to document the presence of GER and exclude associated conditions. Gastroesophageal ultrasonography (US) is a widely available, noninvasive and sensitive method that provides morphological and functional information in GER diagnosis.

The purpose of this exhibit is:
1. To highlight the main points in the pathophysiology of GER in children;
2. To review the ultrasonographic technique employed in the evaluation of reflux episodes and in the assessment of gastroesophageal junction morphology;
3. To discuss current state of the literature concerning US and pediatric GER.

Ultrasonography cases from our Radiology Department will be employed to illustrate the following topics:
- Clarifying GER and GER disease (GERD) concepts;
- Pathophysiology of GER in children;
- Clinical presentation of GER according to age;
- Diagnostic approaches to pediatric GER;
- The role of US in the management of children with suspected GER;
- The US technique in GER evaluation;
- Understanding the normal gastroesophageal morphology on US;
- Recognizing reflux episodes in US;
- Sonographic assessment of abdominal esophageal length and His angle;
- Literature divergences and recommendations regarding each step of the technique. Read More

Authors:  Defendi Larissa , Sameshima Yoshino , Yamanari Maurício , Neto Miguel José , Queiroz Marcos

Keywords:  Esophageal, Ultrasound