Joshi Aparna,  Saleem Sheena

Final Pr. ID: Poster #: EDU-091

Epidural hematomas are typically seen after accidental head trauma in children, though they can also be seen in abusive head trauma. Most often they are arterial but venous hematomas can occur in posterior fossa and vertex locations.

This educational exhibit will review the pathophysiology and common imaging features on CT and MR of intracranial and intraspinal epidural hematomas. Illustrative examples of unusual types of epidural hematomas such as retroclival epidural hematoma and epidural hematoma crossing calvarial sutures will be included. Read More

Authors:  Joshi Aparna , Saleem Sheena

Keywords:  Epidural hematoma

Moore Ryan,  Basta Amaya,  Schmitz Kelli,  Hopkins Katharine,  Vajtai Petra

Final Pr. ID: Poster #: EDU-101

Renal trauma is not uncommon in the pediatric population and can be seen in a wide variety of settings, from minor sports-related injuries to serious motor vehicle accidents. The imaging appearance is as varied as the etiology of injuries, ranging from minor parenchymal defects to avulsion of the vascular pedicle. Our educational poster aims at exploring a variety of injuries of the kidney in children, including chronic subcapsular hematoma, different severities of laceration, renal rupture without and with urine extravasation, injuries to the ureter, trauma involving kidneys with congenital anomalies, and trauma in an undiagnosed Wilms' tumor. Because renal trauma can present with many different faces, we aim to highlight essential diagnostic pearls as well as some unusual factors which may predispose the kidney to injury. Read More

Authors:  Moore Ryan , Basta Amaya , Schmitz Kelli , Hopkins Katharine , Vajtai Petra

Keywords:  renal, trauma, injury, hematoma, laceration

Wachs Jonah,  Desai Sudhen,  Garica Angela,  Greer Jade,  Nissim Lavi

Final Pr. ID: Poster #: EDU-014

A 33-day old infant was presented to the hospital after difficulty breathing and breastfeeding. The patient had a history of hyperbilirubinemia with acute hypoxic respiratory failure, felt secondary to a mediastinal mass, severe metabollic lactic acidosis, anemia, and acute severe coagulopathy.

This patient was denied vitamin K prophylaxis at birth at discretion of the parents. Vitamin K deficency subsequently caused coagulopathy and jaundiced skin, which associate with Vitamin K Deficiency Bleeding.

Presented is a case of thymic hemorrhage in a neonate demonstrating as a mimic lesion on imaging. Further invasive work-up to distinguish etiology of mass was not required demonstrating biopsy or surgery is not always necesary for diagnostic purposes. The identified symptoms represent the potential sequelae of thymic hemorrhage. Read More

Authors:  Wachs Jonah , Desai Sudhen , Garica Angela , Greer Jade , Nissim Lavi

Keywords:  mediastinal mass, thymoma, hematoma

Bandarkar Anjum,  Cielma Tara,  Holley Danyelle,  Adeyiga Adebunmi

Final Pr. ID: Poster #: EDU-042

Background: Hemophilia is a rare X-linked recessive bleeding disorder characterized by the absence of one of the coagulation factors including factor VIII in hemophilia A and factor IX in hemophilia B. Amongst the complications, muscle hemorrhage is the second most common type of hemorrhage in hemophilia, second only to hemarthrosis. Bleeding may be precipitated by trauma or fractures or may be spontaneous. Hemorrhage into the large muscle groups of the upper and lower extremities, can cause tissue compartment syndrome, nerve compression, and potential tissue death. A child with hemophilia and muscle hemorrhage may present with focal swelling, pain, or refusal to use the affected body part. Early recognition and treatment of muscle hemorrhages can prevent compartment syndrome and longterm complications, reduce pain, and allow a quick return to normal function and activity.
Aims:
1. To describe utility of rapid ultrasound in detecting muscle hemorrhages in children with hemophilia.

2. To illustrate sonographic appearances of muscle hemorrhages in various locations in the body. Read More

Authors:  Bandarkar Anjum , Cielma Tara , Holley Danyelle , Adeyiga Adebunmi

Keywords:  Hemophilia, Muscle hemorrhage, Hematoma

Handa Atsuhiko,  Becker Robert,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-085

Retroclival hematomas most often occur in pediatric patients following high speed motor vehicle accidents. Hematomas may involve the epidural, subdural, or subarachnoid spaces. Of these hematoma patterns, retroclival epidural hematomas are often associated with ligamentous injury to the tectorial membrane, transverse ligament, or alar ligament resulting in instability. Children’s relatively large head size in proportion to their bodies, less muscular support and more superior fulcrum point of cranial vertebrae (C2-C3 in young children) relative to adults predispose pediatric patients to ligamentous injury. Retroclival subdural hematomas are the most often to be associated with non-accidental brain injuries. Therefore, when young non-ambulatory children present without significant trauma, it is not only imperative to recognize the radiographic findings of retroclival subdural hematomas, but to be cognizant of its association with child abuse.
Radiological evaluation should include reconstructed sagittal CT images in soft tissue window as well as bone window. Special attention should be paid to the soft tissue window since hematomas often show low or intermediate attenuation on CT and can be easily missed on bone window. If only CT of the head is performed, extension to the craniocervical junction should be included. MRI, especially T2 weighted thin cut images are best suited for evaluation of ligamentous injury. STIR sequence can also provide ligamentous details as well as bone marrow edema. Read More

Authors:  Handa Atsuhiko , Becker Robert , Sato Yutaka , Sato T Shawn

Keywords:  Retroclival hematoma, ligamentous injury, abusive injury

Cielma Tara,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-006 (R)

Background:
Lumbar puncture (LP) is used during the initial work-up of a febrile infant for diagnosis of central nervous system (CNS) abnormalities such as neoplasm, and infectious processes. In children, the L3-L4 and L4-L5 intervertebral space can be used to access the subarachnoid space. Collection of cerebral spinal fluid (CSF) is then tested for any markers of infection. At times, a lumbar puncture may fail and create a leak of CSF and hematoma within the meningeal space.

Purpose:
Through this case series, we will describe normal sonographic anatomy of the spinal canal and effective techniques to best demonstrate epidural hematoma post lumbar puncture. Retrospective review of ultrasound B-mode and cine loop images was performed with respect to the three cases. Typical imaging features include heterogenously echogenic material within the dorsal and ventral epidural space that may move with real-time patient motion. Additionally, the collection of material may compress the thecal sac, obliterating flow of CSF.
High frequency linear sonography of the spinal canal and epidural space after unsuccessful lumbar puncture in experienced hands can adequately demonstrate anatomic detail of the spine and meningeal spaces and identify the epidural hematoma. Ultrasound allows expedited diagnosis of traumatic epidural hematoma after failed lumbar puncture and facilitates ultrasound-guided CSF collection. Read More

Authors:  Cielma Tara , Bandarkar Anjum

Keywords:  Spine Ultrasound, Epidural Hematoma, Lumbar Puncture