Lulkin Solange,  Sancho Cano Julieta,  Lipsich Jose

Final Pr. ID: Poster #: SCI-002 (S)

The lower GI study with water soluble contrast, is used to evaluate the remnant colon. The population to study includes patient with anorectal malformation, stenosis due to necrotizing enterocolitis, bowel resections or to plan the ostomy closure.
There are scarce adverse effects reported in the literature.

Case: We present a 7-month-old boy with operated cardiopathy and the prior story of necrotizing enterocolitis with bowel perforation a few days after the birth, with surgical intervention resolution. By the time of the study, our patient had ileostomy and colostomy in plan of reconnection, for that reason, the GI study was planned.
The patient was lying down face up in the table. Plane X Ray of the abdomen was taken as a first move of the examination (normal air distribution, no abnormal radiopacities). Then a probe with a balloon was introduced in to the distal ostomy and the balloon was inflated with 5 ml of air to prevent the loose of the probe. A syringe of 20 ml was connected, and the solution was injected (1/3 ml Triyosom GI* and 2/3 ml water) with a moderated hydrostatic pressure. During the injection fluoroscopy was given and images of the distal colon were seen. No fistulas or loose of contrast was evidenced, neither contrast out of anus was seen, as a result of stenosis in that point. We emptied the distal colon by taking out the contrast.
3 hours after the practice the patient started vomiting, abdominal distention and signs of sepsis. He was admitted at the emergency. Finally, he died 6 hours after the GI study had been performed. Analytic results of the blood: 2/2 positive to Gram Negative. Autopsy informed: no GI signs of bacterial translocation.

*Meglumina diatrizoato-diatrizoico acido.
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Authors:  Lulkin Solange , Sancho Cano Julieta , Lipsich Jose

Keywords:  Lower GI study, children, Adverse Effects

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

Gupta Amit,  Naranje Priyanka,  Kandasamy Devasenathipathy,  Jana Manisha

Final Pr. ID: Poster #: CR-008

Introduction
Hepatic visceral larva migrans (VLM) is an increasingly recognized parasitic manifestation wherein migratory nematode larvae get lodged in hepatic parenchyma leading to inflammatory granuloma or abscess formation. In this report, we describe a case of VLM presenting with upper gastrointestinal (GI) bleed secondary to a rare complication, a hepatic artery pseudoaneurysm. On literature search, only one such case is reported.
Case Report
A 13-year-old girl presented with abdominal pain and progressively increasing jaundice for the last 2 weeks. The patient had multiple episodes of hematemesis and melaena requiring 2 units of blood transfusion during this time. Ultrasound (USG) abdomen showed multiple ill-defined hyperechoic lesions in the right lobe of liver with presence of anechoic cystic areas within. A dual phase Computed Tomography (CT) scan of the abdomen revealed multiple confluent and discrete hypodense lesions in the right lobe of liver more apparent on portal venous phase, along with presence of a 1.5 cm pseudoaneurysm arising from posterior branch of right hepatic artery. A differential diagnosis of pyogenic liver abscesses, hepatic VLM, disseminated tuberculosis and immunodeficiency with invasive fungal infection was kept along with hepatic artery pseudoaneurysm leading to hemobilia. Lab investigations revealed peripheral eosinophilia (54%) and raised serum IgE (1600 IU/mL). Hydatid serology was negative. Based on these findings, a diagnosis of hepatic VLM was made and the patient was started on Albendazole (400 mg BD). The patient underwent Digital Subtraction Angiography and managed with successful embolization of the pseudoaneurysm using microcoils. There was significant improvement in jaundice and no recurrence of hematemesis over the next ten days along with rapid drop in peripheral eosinophilia. The patient subsequently remained asymptomatic over a follow-up period of 18 months. The inflammation caused by cytotoxic eosinophil-derived proteins associated with helminthic parasites may lead to vascular complications.
Conclusion
Hepatic VLM can be rarely associated with hepatic artery pseudoaneurysm presenting in the form of acute upper GI bleed in the background of progressive abdominal symptoms secondary to hepatic lesions. Prompt diagnosis and management with percutaneous angio-embolization for the aneurysm and anti-helminthic therapy for the underlying parasitic infestation is of paramount importance for a good clinical outcome. Read More

Authors:  Gupta Amit , Naranje Priyanka , Kandasamy Devasenathipathy , Jana Manisha

Keywords:  Visceral larva migrans, Pseudoaneurysm, GI bleed

Wolf Joel,  Remon Juan,  Myers Eliza,  Blumfield Einat

Final Pr. ID: Poster #: EDU-034

Iatrogenic upper gastrointestinal (GI) injuries are rare occurrences with predisposition in premature births, low birth weight, multiple attempts at OGT placement. Medical literature on the topic consists of case reports and mostly has been from the perspective of management with very limited literature on diagnostic evaluation. As the clinical presentation of such iatrogenic injuries is nonspecific, the radiographic appearance may be the only clue for diagnosis and the typical findings should be recognized and diagnosed by radiologists and neonatologists. The purpose of this presentation is to describe the radiographic findings and a diagnostic approach to guide the radiologist. A retrospective case-review was performed from 2009-2017, of neonates with upper GI injuries associated with naso/orogastric tube placement or with pharyngeal auctioning at birth ( a single case). Seven cases were found comprising of five females and two males. Six of seven neonates were premature with gestational ages ranging from 24 weeks and 2 days to 28 weeks, and birth weights spanning 515-1085 grams. The 38 week neonate weiged 3500 grams. We report three types of injury: 1) posterior pharyngeal rupture, 2) non-complicated esophageal rupture with formation of a false lumen, 3) complicated esophageal rupture with penetration into the right pleural space. Management has evolved over time from a primarily surgically oriented approach to a more conservative approach involving TPN and antibiotics. Read More

Authors:  Wolf Joel , Remon Juan , Myers Eliza , Blumfield Einat

Keywords:  iatrogenic injury, neonatal upper gi rupture

Abdullah Selwan,  Shet Narendra,  Watkins Runa,  Kim Jane

Final Pr. ID: Poster #: SCI-024

Many institutions include a scout radiograph in the protocol for pediatric upper gastrointestinal (UGI) fluoroscopic studies. Recently, it has been shown that the scout radiograph does not add to the interpretation of VCUG examinations. Given that the scout radiograph is a significant portion of the total radiation exposure of the study, we sought to determine if the scout radiograph contributes to the interpretation of the outpatient pediatric UGI study. Read More

Authors:  Abdullah Selwan , Shet Narendra , Watkins Runa , Kim Jane

Keywords:  Scout radiograph, Upper GI Series, Radiation Exposure

Smitthimedhin Anilawan,  Suarez Angela,  Webb Ryan,  Otero Hansel

Final Pr. ID: Poster #: EDU-029

The diagnosis of malrotation is heavily reliant on imaging. Upper GI series remain the gold standard with the normal position of the duodenojejunal junction lateral to the left-sided pedicles of the vertebral body, at the level of the duodenal bulb on frontal views and posterior (retroperitoneal) on lateral views. However, a variety of conditions might influence the position of the duodenojejunal junction, potentially leading to a misdiagnosis of malrotation. Such conditions include gastric over distension, splenomegaly, renal or retroperitoneal tumors, liver transplant, small bowel obstruction, the presence of properly or malpositioned enteric tubes and scoliosis. All of these may cause the duodenojejunal junction to be displaced. We present a series of cases highlighting conditions that mimic malrotation to increase the practicing radiologist awareness and help minimize interpretation errors. Read More

Authors:  Smitthimedhin Anilawan , Suarez Angela , Webb Ryan , Otero Hansel

Keywords:  malrotation, Upper GI study, mimickers

Lewis Paul,  Bandarkar Anjum,  Bulas Dorothy,  Kane Timothy

Final Pr. ID: Poster #: EDU-142

Background: Median Arcuate Ligament Syndrome (MALS) has a long and controversial past. Currently a diagnosis of exclusion, MALS is considered in patients suffering from functional abdominal pain who have typically had extensive prior workups. More common in slender, young women, MALS patients classically present with postprandial epigastric pain, nausea, weight loss, and occasional diarrhea. Since it was first described in 1963, debate has continued as to the pathophysiology of the disease with authors disagreeing whether symptoms are due to mesenteric ischemia and vascular steal phenomenon or compression of the celiac plexus and resulting neuropathy. The association with Postural Orthostatic Tachycardia Syndrome (POTS) in the pediatric population adds further speculation to the exact etiology.
Surgical treatment for MALS is becoming more common, particularly in the pediatric population. Recent technical advances in ultrasound and cross sectional imaging have led to an increased role of diagnostic radiologists in the diagnosis of MALS. Imaging provides an objective measurement in a sea of subjective complaints, with the results often dictating whether surgery is even considered. Read More

Authors:  Lewis Paul , Bandarkar Anjum , Bulas Dorothy , Kane Timothy

Keywords:  MALS, GI, Vascular

Berger Jonathan,  Thomas Anna,  Teague Clint

Final Pr. ID: Poster #: CR-052

* To present a rare case of rectosigmoid venous malformation in a 15-year old male patient without Klippel Trenaunay Syndrome.
* To review common syndromic and nonsyndromic causes of pediatric lower gastrointestinal bleeding with presentation of relevant imaging.
* To discuss the classic imaging features and various treatment options for colorectal venous malformations. Read More

Authors:  Berger Jonathan , Thomas Anna , Teague Clint

Keywords:  lower gastrointestinal bleeding, vascular malformations of the lower GI tract