Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Final Pr. ID: Poster #: EDU-065

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

Authors:  Gual Fabiana , Lima Natalia , Matsuoka Marcia , Sameshima Yoshino

Keywords:  vascular anomalies, hemangioma, vascular malformations

El-ali Alexander,  Vaughan Kevin,  Brown Amanda,  Davis Amy,  Grunwaldt Lorelei,  Sabri Yilmaz

Final Pr. ID: Poster #: CR-009

The aim of this report is to document the clinical presentation, multimodality imaging features, and management of patients with diffuse intra-abdominal Infantile Hemangioma (IH) and Kaposiform Hemangioendothelioma (KHE). Read More

Authors:  El-ali Alexander , Vaughan Kevin , Brown Amanda , Davis Amy , Grunwaldt Lorelei , Sabri Yilmaz

Keywords:  Infantile Hemangioma, Kaposiform Hemangioendothelioma, Radiologic Pathologic Correlation

Choi Young-youn

Final Pr. ID: Poster #: CR-009

Hemangioma occurs mainly in soft tissue but rarely be shown in bone. It is benign vascular bone tumors that account for 1% of all primary bone tumors. It is also called hamartoma because it is proliferating tumor originated from bone tissue. Most prevalent sites of intraosseous hemangioma are vertebrae and skull. Within the calvarium, the parietal bone is most commonly involved followed by the frontal bone. Within the facial skeleton, the mandible, maxilla, and nasal bones are involved. Hemangioma of the maxilla is very rare in newborn period. We experienced a neonatal case of intraosseous hemangioma of the right maxilla treated with embolization in an early infant period.
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Authors:  Choi Young-youn

Keywords:  intraosseous hemangioma, maxilla, embolization, newborn

Tan Timothy Shao Ern,  Teo Eu Leong Harvey James

Final Pr. ID: Poster #: EDU-060

Vascular anomalies are commonly encountered in paediatrics, often presenting as clinically palpable superficial lesions, and may be associated with an underlying syndrome or congenital disease. According to the ISSVA classification, vascular anomalies are broadly categorized into proliferating vascular tumours and vascular malformations. Vascular tumours may be benign (infantile and congenital haemangiomas), locally aggressive (kaposiform hemangioendothelioma) and malignant (angiosarcoma). Vascular malformations are further subdivided into high-flow (e.g. arterio-venous malformations or fistulas), low-flow (capillary, venous and lymphatic malformations) and complex combined malformations.

Ultrasound is usually the first-line imaging modality of choice to evaluate these lesions, particularly in children, due to its advantages such as excellent superficial spatial resolution, lack of ionizing radiation, negating any need for sedation, wide availability, low-cost and ability to assess vascularity and flow dynamics. Moreover, ultrasound is also useful in detecting complications, guiding further work-up and can be used for routine follow-up after treatment. Transducer selection is typically determined by lesion size and depth. However, mixed complex vascular malformations and deep extensive lesions, particularly those located in poorly accessible regions (e.g. near bony or air-filled structures) may not be well delineated on ultrasound and further evaluation with cross-sectional imaging, usually magnetic resonance imaging/angiography, would be warranted.

The goals of this educational exhibit are to review and familiarize radiologists with the ISSVA classification as well as clinical and imaging features of commonly encountered soft tissue vascular anomalies occurring in children, with emphasis on the utility of ultrasound as a useful diagnostic tool. Sonographic and clinical features of the above mentioned conditions will be illustrated and reviewed. Read More

Authors:  Tan Timothy Shao Ern , Teo Eu Leong Harvey James

Keywords:  Vascular Anomalies, Hemangioma, Ultrasound

Harrison Andrew,  Browne Lorna

Final Pr. ID: Poster #: EDU-093

Vascular tumors are commonly encountered in infants and children, the vast majority being infantile hemangiomas with less frequent congenital hemangiomas. Less commonly encountered vascular tumors are challenging due to their rarity. However, these often have distinguishing clinical, imaging, and histologic features which enable diagnosis and dictate management.

The objective of this electronic exhibit is to present the clinical and imaging findings of vascular tumors encountered in a large children’s hospital over a 10-year period. These will be grouped according to the ISSVA benign, locally-aggressive, and malignant classification of vascular tumors.

We will include unusual presentations of infantile and congenital hemangiomas, as well as the clinical features and imaging appearances of the less commonly encountered vascular tumors (tufted angioma, spindle cell hemangioma, pyogenic granuloma, epithelioid hemangioma, kaposiform hemangioendothelioma, and angiosarcoma). Treatment options and prognosis will also be discussed. Read More

Authors:  Harrison Andrew , Browne Lorna

Keywords:  angiosarcoma, hemangioma, ISSVA

Rossel Natalia,  Pérez-marrero Lizbet,  Whittle Carolina,  Aris Ricardo,  Fuentealba Isabel

Final Pr. ID: Poster #: SCI-025

Soft tissue hemangiomas (STH) are the most common benign vascular tumors in childhood. Its diagnosis is mainly clinical. In some cases, imaging is required, US Doppler choice of preference. Less frequently, it can be complemented with complex studies such as diagnostic angiography, MRI and biopsy, or ultrasonographic follow-up.
This study aims to investigate the characteristics of STH that required imaging follow-up, complex studies or biopsies. Read More

Authors:  Rossel Natalia , Pérez-marrero Lizbet , Whittle Carolina , Aris Ricardo , Fuentealba Isabel

Keywords:  Soft Tissue Hemangioma, Infantile hemangioma, Congenital hemangioma

Saini Rimpi,  Wermers Joshua,  Larson Shelby,  Mitchell Grace,  Patel Amy

Final Pr. ID: Poster #: EDU-093

With an incidence of 3.25%, breast masses in the pediatric population are a relatively rare phenomenon. Despite this, breast masses are a substantial source of anxiety and concern for parents and patients alike, largely due to the increased awareness of breast cancer in the adult population. Fortunately, the vast majority of masses are benign, and pediatric breast malignancies constitute less than 1% of all pediatric malignancies. Moreover, malignancy tends to be secondary to metastatic disease from lymphoma, leukemia, or rhabdomyosarcoma, as primary breast carcinoma is exceedingly rare. Although initial sonographic characteristics of breast masses may be nonspecific, recommendation for further evaluation with biopsy and/or excision of the mass is usually not recommended due to the rarity of malignancy, and avoidance of disrupting immature breast parenchymal tissue. In adults, the Breast Imaging-Reporting and Data System classification is quite accurate for dictating management recommendations. However, this system grossly over-emphasizes the risk of malignancy in pediatric patients, as imaging findings are usually discordant with histology. Currently, there are no standardized guidelines for management recommendations of pediatric breast masses, and short-term follow-up ultrasound is usually recommended to evaluate for malignant potential. The purpose of this educational exhibit is to compare the sonographic abnormalities of breast pathologies arising from normal breast development, including but not limited to gynecomastia, mastitis, and abscesses, from those arising from neoplastic processes including fibroadenomas, hemangiomas, arterio-venous malformations, and phyllodes tumors. In addition, the current literature on management recommendations, including indications for MRI and biopsy/excision of breast masses, will be reviewed. Finally, this exhibit will discuss the important role pediatric radiologists play in understanding the epidemiology and natural history of breast pathologies, enabling accurate characterization of masses and appropriate treatment recommendations to further guide patient management. Read More

Authors:  Saini Rimpi , Wermers Joshua , Larson Shelby , Mitchell Grace , Patel Amy

Keywords:  Breast, Ultrasound, hemangioma

Guillen Gutierrez Cinthia,  Rodriguez Garza Claudia,  De Luna Vega Raul,  Hernández Grimaldo Edgar,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-010 (S)

Vascular abnormalities are commonly observed in pediatric patients, with an estimated prevalence of at least 4.5%.
The current classification scheme for vascular anomalies was developed in 2014 by ISSVA (International Society for the Study of Vascular Abnormalities) and is based on the work of Mulliken and Glowacki of 1982.
This classification emphasizes the fundamental difference between vascular tumors and vascular malformations.
The diagnosis of vascular abnormalities is based on clinical history and physical examination.
US: Screening, proper characterization
TC: It allows assessing the extent of the lesion and the relationship with adjacent structures
MRI: It's the ideal imaging study and reflects its histological composition.

The most commons anomalies are:
Hemangiomas:
The most frequent vascular tumors are lobed and highly vascular lesions.
They have significant enhancement to the administration of contrast medium, but only moderate T2 hyperintensity that reflects their highly cellular nature.

Venous Malformation:
Malformed venous channels with slow blood flow with thrombosis and flebolite formation
Important, often heterogeneous and peripheral enhancement with central progression.
Hyperintense T2 signal reflects low cellularity

Lymphatic malformations:
Dilated lymphatic channels and cysts. They can be macro or microcystic
Macrocystic variants appear as cysts with a very bright T2 signal and minimal enhancement (if any), bleeding is a common complication with liquid-liquid level formation.

Arteriovenous Malformations:
The main finding is empty flow due to high flow, which infiltrate the tissues without evidence of a free mass.
There may be a mild enhancement and T2 hyperintensity that reflects tissue edema

Treatment:
In most cases, conservative treatment is recommended, but when a patient suffers from clinical complications sclerotherapy of the nidus becomes mandatory.
A multidisciplinary approach is needed.

Sclerosing agents
Alcohol 98%: Strong endothelial damage, high response rate, less expensive, easy to obtain. Painful during the procedure, high complication rate, penetrative effect on the deep vascular layer
Ethanolamine oleate: Excellent thrombogenic effect, chemical damage to the vascular wall, less toxic effect than absolute ethanol. It can induce acute renal failure due to hemolytic effect, less endothelial damage than absolute ethanol.
Polidocanol: Overhydration of endothelial cells, almost painless procedure. May induce reversible cardiac arrest Read More

Authors:  Guillen Gutierrez Cinthia , Rodriguez Garza Claudia , De Luna Vega Raul , Hernández Grimaldo Edgar , Elizondo Riojas Guillermo

Keywords:  Hemangioma, Lymphatic Malformation, Venous Malformation