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Society for Pediatric Radiology – Poster Archive

Showing 16 Abstracts.

Liang Teresa,  Lee Edward

Final Pr. ID: Poster #: EDU-090

Childhood interstitial (diffuse) lung disease (chILD) in infants consists of a rare and heterogeneous group of disorders previously classified with clinical, radiologic, and pathologic features. The purpose of this article is to discuss imaging techniques and provide a pattern-based approach for chILD in infants. Read More

Authors:  Liang Teresa , Lee Edward

Keywords:  childhood interstitial lung disease, Lung, Infants

Zhu Xiaowei,  Silvestro Elizabeth,  Andronikou Savvas

Final Pr. ID: Paper #: 019

Dynamic 4D CT (D4DCT) can replace bronchography in the assessment of tracheobronchomalacia (TBM) but setting up a new D4DCT service for infants with TBM poses unique challenges due to their venerability. Simulation prior to implementation is essential as D4DCT involves continuous volumetric CT scanning through the breathing cycle, potentially delivering high radiation doses. Radiation dose, gantry rotation and scan dynamics can be customized.
Our purpose is to describe the development and implementation of CT dynamic airway protocol using a 3D printed Infant Dynamic Airway Phantom (phantom) for simulation of D4DCT in tachnypnoea and collapsible airways, thereby validating image quality and estimating radiation dose prior to clinical implementation.
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Authors:  Zhu Xiaowei , Silvestro Elizabeth , Andronikou Savvas

Keywords:  dynamic airway, infant, D4DCT

Mata-mbemba Daddy,  Daneman Alan

Final Pr. ID: Poster #: EDU-021

There are a variety of masses in neonates, infants and young children that may disappear spontaneously without active intervention. However, there has been no published review of what type of masses could disappear and what the spectrum of their imaging features is. It is essential for radiologists to understand imaging features of these entities in order to provide pediatrician and pediatric surgeons with critical information that will enable them to manage these patients expectantly without surgical intervention.
The entities that will be illustrate in this review include, among others: multicystic dysplastic kidneys, suprarenal masses (including intraabdominal sequestration, neuroblastoma and adrenal hemorrhage), ovarian cyst and torsion, duplication cyst of gastrointestinal tract, cyst of liver and kidneys. We will:
1. Review the clinical and imaging features of these masses including their changes during follow-up imaging studies.
2. Emphasize the imaging features that are helpful in differentiating these entities from other entities that require active intervention
3. Describe an appropriate approach to deal with uncertain diagnoses.
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Authors:  Mata-mbemba Daddy , Daneman Alan

Keywords:  disappear mass, neonate, infant and young children

Joshi Aparna,  Grove Jason,  Ladino-torres Maria

Final Pr. ID: Poster #: EDU-005

Dynamic contrast-enhanced MR lymphangiography (DCEMRL) with intranodal injection has emerged as a useful tool in evaluating lymphatic disorders. We share our institutional experience with DCEMRL in infants through a detailed discussion of technique and series of case presentations.

Techniques for nodal access and imaging infants with DCEMRL are explained through text and step-by-step illustrations.

MR lymphangiography images of infants between 22 days and 8 weeks of age are presented with multi-modality correlation, including patients with congenital chylous ascites, non-immune fetal hydrops, and postsurgical chylothorax. Each case discussion includes a review of relevant lymphatic anatomy, explanation of the disease process, and key teaching points regarding DCEMRL in infants.
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Authors:  Joshi Aparna , Grove Jason , Ladino-torres Maria

Keywords:  Lymphangiography, Infant, MR

Green Jared,  Jaju Alok,  Richard Jamie

Final Pr. ID: Poster #: CR-047

A 17-month-old female presented with a one-month history of abnormal soft tissue protruding from the vaginal introitus.

The patient’s past medical history was significant for hemi-hypertrophy of the left lower extremity. Physical examination demonstrated normal external genitalia, with pink solid tissue protruding from the vagina posterior aspect, and mild associated white fluid discharge. Laboratory analysis revelaed a normal CBC, serum HCG and AFP.

An ultrasound examination of the pelvis demonstrated a heterogeneous echogenicity soft tissue mass with scant internal vascularity centered in the vagina and cervix, measuring approximately 4.0 x 2.3 x 2.5 cm.

The patient’s clinical and imaging findings were most concerning for malignancy, namely vaginal rhabdomyosarcoma, so consultation was requested from Pediatric Surgery and Oncology. As a result of these consultations, the patient was scheduled for vaginoscopy with biopsy under general anesthesia, as well as surgical port placement due to the high suspicion for malignancy. Also to be performed under the same anesthetic was a CT examination of the chest and MR examination of the pelvis.

Vaginoscopy revealed a “pebbly appearance” of the vaginal walls, which also reportedly “felt thickened” on digital exam. Multiple surgical biopsy specimens were obtained from the visibly abnormal areas.

MR examination immediately post biopsy showed circumferential mural thickening of the cervix and vagina, with a more prominent area of soft tissue thickening at the level of the vaginal introitus. The areas of mural thickening appeared T1 and T2 signal isointense with mild post-contrast enhancement and no evidence of abnormal restricted diffusion. No focal mass was identified. CT examination of the chest was normal.

Histopathologic analysis revealed a benign lesion composed of a relatively small number of spindle cells embedded in a loose fibrous stroma. No significant numbers of mitoses or atypia were observed, including in the lining squamous epithelium. These features were most consistent with a fibroepithelial stromal polyp.

In light of the pathology findings, the port implant was removed, and the patient has since undergone surveillance vaginoscopy examinations.

This case illustrates MRI findings of a rare benign condition which may mimic vaginal rhabdomyosarcoma on the basis of clinical and ultrasound findings. MRI demonstrating an absence of aggressive features may help to suggest this rare differential consideration.
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Authors:  Green Jared , Jaju Alok , Richard Jamie

Keywords:  Vaginal, Infant, Mass

Yadav Vikas,  Ealai Parthasarathy

Final Pr. ID: Poster #: EDU-083

To delineate the spectrum of intra cranial imaging findings in infants with late hemorrhagic disease of newborn (late HDN) Read More

Authors:  Yadav Vikas , Ealai Parthasarathy

Keywords:  Hemorrhagic disease, neonate, Infant, Intracranial bleed, Vitamin K

Murcia Diana,  Myers Ross,  Estroff Judy,  Callahan Michael

Final Pr. ID: Paper #: 125

Identify the most common diagnoses of superficial head and neck lesions in children under 4 years of age, and correlate imaging and pathologic findings. Read More

Authors:  Murcia Diana , Myers Ross , Estroff Judy , Callahan Michael

Keywords:  infant, Tumor, Ultrasound

Boucher Marc-antoine,  Lippé Sarah,  El-jalbout Ramy,  Dupont Caroline,  Knoth Inga Sophia,  Damphousse Amelie,  Kadoury Samuel

Final Pr. ID: Poster #: SCI-005

In neonates, ultrasound is the initial neuroimaging modality used to detect and follow intracranial pathologies, since MRI is challenging due to immobilization, costs and sedation issues. Ultrasound is typically acquired in 2D and interpretations are performed slice by slice. However, recent reports suggest a longitudinal follow-up of structure volumes and shapes may be relevant for investigation of neurodevelopmental disorders. The objective of this study is to test the diagnostic efficiency of the 3D ultrasound technology to measure total brain volume as well as lateral ventricular volume compared to volumetric measurements obtained from MRI. Read More

Authors:  Boucher Marc-antoine , Lippé Sarah , El-jalbout Ramy , Dupont Caroline , Knoth Inga Sophia , Damphousse Amelie , Kadoury Samuel

Keywords:  Infants brain, 3D Ultrasound, MRI

Muthiyal Sreekumar,  Kini Viswanatha,  Koshy Sheeja

Final Pr. ID: Poster #: CR-005

Inflammatory myofibroblastic tumour is a rare quasineoplastic lesion in the gatrointensitnal tract ; often present with variable and nonspecific imaging features, which may mimic other more common lesions, including malignancy. Occurrence in early infancy involving mesentery has been only sparsely reported in literature. We present such a paradigm in a 4 months old infant with clinical, radiological and histopathological features and corroborative overview of literature.
On Ultrasound abdomen, a mass lesion measuring about 6x4cm with irregular lobulated margin in the left lumbar–iliac fossa regions , involving the mesenteric planes and contigous descending colonic wall, having heterogeneous echotexture was seen . No calcification or cystic component was evident . Left kidney and spleen were seen separately . On Doppler it showed a few areas of vascularity.
On MRI ,It measured about 6.1x5.1x5.2 cm in CC, TR and AP dimensions with lobulated margins, involving the mesentery. It was heterogeously hypo intense on T1 W images and hyper intense on T2W images. On DW sequences, a few areas of restricted diffusion , predominantly along the periphery of the lesion, while the central areas showed minimal/non-restriction ; which also reflected in ADC map. On post contrast, the lesion showed moderate heterogeneous enhancement corresponding to the areas of restricted diffusion and dominant non enhancing components, suggesting areas of necrosis. Apart from contiguous colonic wall involvement , no other evidence of loco regional infiltration or metastasis was seen. Based on these, a diagnosis of Inflammatory myofibroblastic tumor was made.with differential diagnosis of non Hodgkin's lymphoma
The patient subsequently underwent laparotomy. On Histopathology, it showed myofibroblastic spindle cells and inflammatory infiltrates of lymphocytes with no evidence of nuclear pleomorphism or atypical mitosis ; suggesting the diagnosis of inflammatory myofibroblastic tumour ; which matched the MRI diagnosis.
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Authors:  Muthiyal Sreekumar , Kini Viswanatha , Koshy Sheeja

Keywords:  Inflammatory myofibroblastic tumour, mesentery, infant

Sheikh Zishan,  Kumbla Surekha,  Bracken Jenny

Final Pr. ID: Poster #: EDU-060

Neck lesions are a common clinical scenario encountered in children. They can present as neck lumps or be discovered incidentally on medical imaging performed for other indications. While most paediatric neck lesions are benign, they can be a source of morbidity to patients and cause considerable anxiety to their care givers. Neck lesions in infants are made additionally more challenging as this area can be difficult to assess clinically. A clinically evident or suspected neck mass has, as a result, become a common indication for medical imaging in this age group. Being aware of the spectrum of neck lesions seen in infants and their respective imaging manifestations helps direct management appropriately in these cases.

A review of neck lesions seen in infants seen at a tertiary paediatric centre over the last two decades is presented with correlation of imaging findings across multiople modalities with the final diagnosis. Our aim is to provide an overview of both common and rare neck lesions seen in this age group by using broad categories of congenital, inflammatory and aggressive/malignant lesions. As well as showcasing cases with classic imaging findings we will include some cases where features overlapped between different varieties of neck lesions to illustrate pitfalls in imaging neck lesions in infants.
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Authors:  Sheikh Zishan , Kumbla Surekha , Bracken Jenny

Keywords:  infant, neck, lesion

Le Judy

Final Pr. ID: Poster #: EDU-05 (R)

The goal of this study is to educate Radiographers on varies specialty surfaces that are often under critical care patients and how they affect image quality on portable x-rays. By understanding which items cause image artifacts, radiographers can reduce the amount of repeated images and thus, decrease dose to patients. Read More

Authors:  Le Judy

Keywords:  portable imaging, infant, image quality

Fenlon Edward,  Degnan Andrew,  Maddocks Alexis,  Chen Susie,  Jaramillo Diego

Final Pr. ID: Poster #: EDU-062

Proximal humeral epiphyseal fracture-separation is a rare fracture pattern in infants often associated with birth-related or non-accidental trauma, representing a Salter-Harris type I or type II fracture. Lack of a proximal humeral epiphyseal ossification center in most newborns or only subtle displacement of a small epiphyseal ossification center in older infants, makes this injury difficult to diagnose on plain radiographs, potentially leading to delayed diagnosis or misdiagnosis. Ultrasound and MRI are therefore useful imaging modalities in indeterminate cases.

Clinical findings of infant proximal humeral epiphyseal fracture-separation such as shoulder swelling, tenderness, and decreased active motion, overlap with more common entities including clavicular fracture, brachial plexus injury and osteomyelitis. Radiographs are often the first diagnostic study ordered to evaluate these symptoms but are insensitive due to minimal ossification of the proximal humeral epiphysis. Radiographs may be normal or show subtle displacement of the epiphyseal ossification center, apparent joint space widening, small metaphyseal fracture fragments or displacement of the proximal humeral metaphysis in relation to the scapula. These findings can be misdiagnosed as shoulder dislocation or pseudosubluxation due to a joint effusion. Careful review of the medical record may elucidate a history of difficult delivery with shoulder dystocia or suspected shoulder trauma.

Ultrasound and MRI are useful in indeterminate cases due to their ability to resolve the cartilaginous physis and proximal humeral epiphysis, and to resolve their relationship to the humeral shaft and cartilaginous labrum. Ultrasound has higher anatomic resolution and offers the flexibility to quickly image the asymptomatic contralateral shoulder and image in planes that best show the relationship between the non-ossified epiphysis and the humeral shaft. Doppler ultrasound demonstrates epiphyseal perfusion without the need for contrast administration, and serial ultrasound imaging can be used to evaluate healing and remodeling. MRI is more useful in evaluating cases where osteomyelitis and/or septic arthritis are being considered, or in cases of an inconclusive history suspicious for non-accidental trauma to evaluate for additional osseous and soft tissue injuries.

Several examples of typical proximal humeral epiphyseal fracture-separations in infants will be presented and the relevant imaging findings discussed.
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Authors:  Fenlon Edward , Degnan Andrew , Maddocks Alexis , Chen Susie , Jaramillo Diego

Keywords:  Fracture, Infant, Trauma

Dabadie Alexia,  Lee Anna,  Bray Heather

Final Pr. ID: Poster #: EDU-070

The purpose of this educational exhibit is to review the patterns of clinical presentation of common and uncommon renal tumors of infancy and to illustrate their imaging and pathologic features. Read More

Authors:  Dabadie Alexia , Lee Anna , Bray Heather

Keywords:  Radiology-pathology correlation, Renal tumors, Infants

You Sun Kyoung,  Lee So Mi,  Cho Hyun-hae

Final Pr. ID: Poster #: SCI-027

To assess the relationship between radiographic findings and biochemical markers, such as serum alkaline phosphatase (ALP), used for screening of metabolic bone disease (MBD) in preterm infants. Read More

Authors:  You Sun Kyoung , Lee So Mi , Cho Hyun-hae

Keywords:  Preterm infant, Metabolic bone disease, Wrist, Alkaline phosphatase, Phosphorus

Gebarski Kathleen,  Gebarski Stephen

Final Pr. ID: Poster #: EDU-065

Sonography of the posterior fossa in infants can be challenging and difficult to interpret. Use of posterior fontanelle, mastoid and squamous temporal bone acoustic windows has improved the visualization of the posterior fossa in infants. We provide a 10 year experience of posterior fossa sonography to improve familiarity with a wide variety of diseases of the posterior fossa. Read More

Authors:  Gebarski Kathleen , Gebarski Stephen

Keywords:  posterior fossa, sonography, infants