Dance Logan,  Patel Mittun

Final Pr. ID: Poster #: CR-012

An otherwise healthy 37 day old male presented to dermatology with a pedunculated, friable red glabellar mass. First noticed as a flat, bluish lesion at 10 days, its subsequent rapid growth led to an emergency department visit where dermatology diagnosed a hemangioma and initiated propranolol treatment. Despite this, the mass continued to grow rapidly, encroaching upon the patient’s right eye. The patient was admitted for further workup. Ultrasound findings were consistent with hemangioma while MRI findings were atypical, contributing to a decision to obtain percutaneous biopsy. Pathology was consistent with choriocarcinoma. PET/CT found FDG-avid glabellar, liver and lung lesions.

The infant's therapy and clinical course will be briefly described. Clinical photos, ultrasound, MR, and PET/CT before and after therapy will be included.

Discussion

The unusual predilection of infantile malignancies for cutaneous metastases allows their early discovery and creates vivid clinical stigmata not easily forgotten. While relatively common in infancy, such presentations are exceedingly rare in children and adults.

In a series of 208 infants with cutaneous metastases, numerous bluish skin nodules created the so-called “blueberry muffin” baby appearance in 82% of cases. The following diseases presented with cutaneous involvement (ordered most to least common): leukemia, Langerhans cell histiocytosis, neuroblastoma, rhabdoid tumor, rhabdomyosarcoma, primitive neuroectodermal tumor, choriocarcinoma, and adrenocortical carcinoma.

Etiology and epidemiology will be discussed.

Imaging findings and a companion case in which choriocarcinoma was also misdiagnosed initially as infantile hemangioma will be discussed.

Considered one of the fastest growing tumors, infantile choriocarcinoma classically presents with hepatomegaly, anemia, failure to thrive, and precocious puberty between 0 days and 5 months of life. Left untreated, the disease is usually fatal within 3 weeks of presentation. Chemotherapy and delayed surgical excision of metastases can be curative with long-term survival rates of around 80%.

Conclusion

A solitary cutaneous metastasis can be mistaken for infantile hemangioma both clinically and radiographically. Atypical MRI appearance is one important clue that can suggest an alternative diagnosis. Early diagnosis and treatment of infantile choriocarcinoma is critical for survival. PET/CT may be useful for staging and follow-up. Read More

Authors:  Dance Logan , Patel Mittun

Keywords:  choriocarcinoma, cutaneous metastases, infantile

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

Ramachandran Anupama,  Pandey R M,  Jana Manisha,  Kumar Atin,  Kandasamy Devasenathipathy,  Naranje Priyanka,  Gupta Arun,  Gulati Sheffali,  Chakrabarty Biswaroop,  Singhal Maneesh

Final Pr. ID: Paper #: 127

Brachial plexus is a relatively common site of pediatric nerve pathology. This study was aimed at evaluation of utility of MRI and USG in the localization of brachial plexus injury in infants Read More

Authors:  Ramachandran Anupama , Pandey R M , Jana Manisha , Kumar Atin , Kandasamy Devasenathipathy , Naranje Priyanka , Gupta Arun , Gulati Sheffali , Chakrabarty Biswaroop , Singhal Maneesh

Keywords:  Brachial, Plexus, Infantile

Cielma Tara,  Bandarkar Anjum,  Adeyiga Adebunmi

Final Pr. ID: Poster #: EDU-001 (R)

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants in which the circular muscle layer of pylorus becomes thickened, leading to narrowing and elongation of the pyloric channel. The pyloric mucosa becomes redundant and appears hypertrophic. On ultrasound, the thickened pylorus is often seen adjacent to the gallbladder and anteromedial to the right kidney. Infants with IHPS are asymptomatic at birth but, in the first few weeks of life, develop nonbilious forceful vomiting described as “projectile emesis” and present with partial gastric outlet obstruction. Surgical pyloromyotomy is curative.
Standard sonographic criteria include measurement of pyloric muscle >3 mm and elongation of pyloric canal >14 mm. Normal pyloric muscle thickness measures <2 mm. When pyloric muscle thickness measures between 2-3 mm, the exam is called as equivocal or borderline. Factors leading to equivocal exam may include incorrect technique that involves over measuring the pyloric muscle thickness, obliquely oriented section of pylorus and transient pylorospasm.
Purpose: The goals of this exhibit are-
1. To review the sonographic anatomy of normal and abnormal pylorus.
2. To illustrate our technical approach to diagnose IHPS with specific attention on how to accurately measure the muscle thickness and channel length.
3. To describe tips and tricks to minimize equivocal exams. Read More

Authors:  Cielma Tara , Bandarkar Anjum , Adeyiga Adebunmi

Keywords:  Infantile hypertrophic pyloric stenosis, ultrasound, muscularis externa

Evens Ashley,  Gonzalez-gomez Ignacio,  Neville Kucera Jennifer

Final Pr. ID: Poster #: CR-002

Infantile myofibromatosis is a rare condition consisting of benign fibrous tumors typically deposited in the skin, soft tissues, muscles, bones, and visceral organs. The entity can be solitary or multicentric. Although controversial, outcomes are generally worse in cases with visceral organ involvement. The prognosis is generally favorable in cases that lack visceral organ involvement, with a majority of cases showing spontaneous regression.

The imaging findings of infantile myofibromatosis will be illustrated using both prenatal and postnatal imaging including ultrasound, MRI, radiography, CT, and bone scintigraphy. We also present gross specimen and pathology images.

Our case involves a 33 week 4 day gestational age male fetus that initially revealed dilated loops of bowel on ultrasound. Fetal MRI was performed at 34 weeks and 4 days, which demonstrated the dilated loop was colon in the region of the hepatic flexure. Additionally, multiple solid-appearing lung masses were noted, which had not been visualized on ultrasound. Because of concern for a possible metastatic process, the entire fetus was thoroughly imaged, but no primary source was found. The differential diagnosis that was given on the fetal MRI included metastatic disease from the mother or fetus, infantile myofibromatosis, or infectious etiology.

The mother underwent induction of labor at 35 weeks 4 days, and the baby was born via uncomplicated vaginal delivery. To exclude transplacental metastases, the mother underwent dermatologic skin check, mammography, colonoscopy, and head CT, all of which were negative.

Postnatal radiographs of the baby revealed a focally dilated loop of bowel, and the patient underwent exploratory laparotomy. In the OR, nodules were noted on the small bowel serosa resulting in a bowel obstruction. Chest radiograph and CT also confirmed the presence of multiple solid lung masses. Bone scintigraphy was negative. Pathology from one of the bowel nodules revealed infantile myofibroma. Our patient has not undergone any therapeutic treatment, and follow up imaging has demonstrated continued spontaneous regression of the lung masses.

Although infantile myofibromatosis is a rare entity, it is important to include in the differential diagnosis in a fetus with multiple solid-appearing lung masses. Throughout the clinical course of these patients, imaging plays an imperative role in the assessment of these lesions.
Read More

Authors:  Evens Ashley , Gonzalez-gomez Ignacio , Neville Kucera Jennifer

Keywords:  infantile myofibromatosis

Stanescu A. Luana,  Otjen Jeffrey,  Parisi Marguerite

Final Pr. ID: Poster #: SCI-075

Purpose
Ovarian torsion is rare in neonates and infants. Clinical diagnosis is challenging in the setting of lack of specific symptoms and the limitations in assessing pain in infants. Torsed ovaries in this patient population are also a diagnostic dilemma on imaging. In this study we reviewed the spectrum of imaging findings with pathologic correlation in a large series of patients. Read More

Authors:  Stanescu A. Luana , Otjen Jeffrey , Parisi Marguerite

Keywords:  Neonatal, infantile, Ovarian Torsion

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