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

Gazzi Lynn

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

Intestinal malrotation is a defect that occurs in the 10th week of gestation. During this stage the intestines normally migrate back into the abdominal wall following a brief period where they are temporarily located in the base of the umbilical cord. As the intestines returns to the abdomen it makes two rotations and becomes fixed into its normal position. The small bowel is located in the center of the abdomen and the large intestine drapes around the top and sides of the small intestine. When rotation is incomplete and intestinal fixation does not occur, this creates a defect known as malrotation. Malrotation occurs in one of every 500 births in the United States. Up to 40 percent of patients with this show signs of the disease within the first week of life. By one month of age 50-60 percent are diagnosed. 75 to 90 percent are diagnosed by age 1. The remaining cases are diagnosed into adulthood. Some symptoms of malrotation include vomiting and bilious emesis, fussiness, crying in pain, a swollen abdomen that’s tender to the touch, fever, diarrhea and bloody stool or none at all. If malrotation is not treated, it can lead or turn into a midgut vovulus. This is when the gut twists counterclockwise around the superior mesenteric artery and vein causing a narrowing. This may cause abdominal distention and pain or acute bowel necrosis. It can also be life threatening or lead to a lifelong dependence on total parenteral nutrition, so surgical correction is the dependent treatment. When medical history and physical examination indicate a suspicion of malrotation and vovulus, patients must undergo blood tests and diagnostic imaging studies to evaluate the position of the intestine to determine if there is blockage or twisting. The imaging modality of choice remains the upper GI study. This is a fluoroscopic study using barium contrast to look at the upper and middle sections of the gastrointestinal tract. A radiologist’s knowledge of normal anatomy is important in performing and interpreting the upper GI series. From a technical standpoint common pitfalls during this test that can lead to a misdiagnosis would be imaging quality. Improper patient positioning, nonsufficient images taken and the wrong amount of contrast administered during the most crucial part of the study can lead to false findings. The purpose of this abstract is to present case studies and imaging which mimic intestinal rotation but are a normal variant vs. actual cases of malrotation Read More

Authors:  Gazzi Lynn

Keywords:  malrotation, midgut vovulus, image findings