Germaine Colton,  Richards Allyson,  Tocchio Shannon

Final Pr. ID: Poster #: CR-035

Congenital insensitivity to pain (CIP) is a rare genetic condition in which patients are born with the absence of nociception at birth. These patients do not feel painful or noxious stimuli including pain from infection, inflammation or heat. The inability to feel and respond to painful stimuli leads to repeated injuries and infections, as well as poor wound healing. Children born with CIP are often misdiagnosed as being victims of abuse due to the nature and repetitiveness of their injuries. While rare, it is essential to understand the distinguishing features of CIP and how it differs from non-accidental trauma (NAT). In this case presentation, we provide an overview of the types of fractures and injuries common in patients with CIP, review characteristic imaging findings of CIP and discuss pitfalls specific to radiology.

CONTENT ORGANIZATION:
1) Overview and epidemiology of CIP.
2) Imaging findings characteristic of CIP.
3) Other clinical findings and injuries specific for CIP.
4) Differentiating CIP from NAT.
5) Review follow-up imaging considerations and discuss a radiologist’s role in managing a patient with CIP.

SUMMARY:
1) The major teaching points of this case presentation include:
2) Understanding the clinical presentation and distinguishing imaging findings common in CIP.
3) Recognizing CIP and differentiating it from other types of accidental vs non-accidental trauma is an essential component in patients receiving appropriate care.
4) Providing the correct recommendations for imaging follow-up helps provide improved care to patients with CIP. Read More

Authors:  Germaine Colton , Richards Allyson , Tocchio Shannon

Keywords:  Genetics, Non-Accidental Trauma, Infection

Mccauley Robert,  Pierre Kevin,  Yekeler Ensar,  Sharma Priya,  Rodero Cardoso Mariana

Final Pr. ID: Poster #: CR-027

Sparganosis is a rare parasitic infection caused by the plerocercoid larvae of Spirometra spp. That is seldom encountered in humans. Clinical presentations are often nonspecific, and imaging findings can mimic other soft tissue lesions and lead to misdiagnosis. We present a case of a 14-year-old female with an abdominal wall lesion initially suspected to be cutaneous endometriosis, which was later diagnosed as sparganosis.

Case Presentation:
A 14-year-old female presented with a progressively enlarging, tender subcutaneous mass located superior and left of the umbilicus. The lesion was associated with intermittent pain, particularly exacerbated during menstruation, which raised clinical suspicion for cutaneous endometriosis. Abdominal MRI revealed a 2.5 cm subcutaneous mass with heterogeneous signal intensity on both T1- and T2-weighted images. Areas of hyperintensity suggested hemorrhagic components, which can be seen with endometriotic implants.

The patient underwent surgical excision of the mass. Intraoperatively, a well-defined subcutaneous lesion was removed without complications. Histopathological examination unexpectedly revealed a cestode consistent with Spirometra spp. (sparganosis), along with mixed inflammation, granulation tissue formation, and focal necrosis. The cystic structure corresponded to the parasite's infection site. Postoperative management included prescribing albendazole therapy following stool sample collection to rule out residual parasitic infection.

Discussion:

Sparganosis is an uncommon parasitic infection in humans that is typically acquired through ingestion of contaminated water or undercooked meat from intermediate hosts. It often presents as a slowly growing subcutaneous mass, which can be mistaken for other soft tissue lesions such as lipomas, cysts, or, as in this case, endometriosis. Imaging findings are nonspecific; MRI may show cystic or solid masses with variable enhancement patterns. In this patient, MRI findings closely resembled cutaneous endometriosis due to the presence of hemorrhagic components within the lesion.

Definitive diagnosis of sparganosis is usually established postoperatively via histopathological identification of the parasite. This case demonstrates the importance of considering parasitic infections in the differential diagnosis of subcutaneous masses. Read More

Authors:  Mccauley Robert , Pierre Kevin , Yekeler Ensar , Sharma Priya , Rodero Cardoso Mariana

Keywords:  MRI, Infection, Pediatric Radiology

Rozovsky Katya,  Higgins Rick,  Moffatt Hayley,  Wrogemann Jens,  Al-somali Faisal,  Miller Elka,  Alqublan Lina,  Bunge Martin

Final Pr. ID: Poster #: EDU-053

Blastomycosis is a rare granulomatous fungal infection, endemic to Canada and Midwest of the North America. The clinical features of blastomycosis are extremely variable, since the disease may involve any organ or system. Pediatric blastomycosis is uncommon, and the diagnosis is often delayed, which results in severe and disseminated disease by the time of diagnosis. Imaging studies plays an important role in the diagnosis and management of pediatric patients with blastomycosis.
The purpose of our educational exhibit is to describe the imaging features of pulmonary and extrapulmonary blastomycosis in the pediatric population. Read More

Authors:  Rozovsky Katya , Higgins Rick , Moffatt Hayley , Wrogemann Jens , Al-somali Faisal , Miller Elka , Alqublan Lina , Bunge Martin

Keywords:  blastomycosis, multi system manifestation, rare granulomatous fungal infection

Grimm Elizabeth,  Law Emily,  Luo Yu

Final Pr. ID: Poster #: EDU-015

Arthritis in pediatric patients presents a range of diagnostic challenges, including conditions such as septic arthritis, inflammatory arthritis, idiopathic chondrolysis, toxic synovitis, Lyme arthritis, and hemophilic arthritis. These conditions often share overlapping clinical and imaging features, complicating accurate diagnosis. However, key differences in clinical presentation and imaging findings can aid in differentiation. For instance, both septic arthritis and inflammatory arthritis may present with joint pain, swelling, and limited range of motion, with ultrasound commonly revealing joint effusion. Septic arthritis is typically characterized by an acute onset, high fever, elevated white blood cell (WBC) count, and significantly increased inflammatory markers. MRI findings often include complex joint effusions, synovial thickening, and periarticular bone marrow edema, with advanced cases showing periarticular myositis or pyomyositis and osteomyelitis involvement. In contrast, inflammatory arthritis usually presents with gradual onset, low-grade fever, and minimal WBC elevation, with MRI findings of symmetric or asymmetric synovial thickening, synovial enhancement, pannus formation, and mild to none surrounding muscular or bony involvement.
This educational exhibit aims to review the epidemiology of pediatric arthritis, including septic arthritis, inflammatory arthritis, idiopathic chondrolysis, toxic synovitis, Lyme arthritis, and hemophilic arthritis. It will discuss appropriate imaging protocols and highlight key clinical and imaging features that distinguish each arthritis, enhancing diagnostic accuracy and optimizing patient management. Read More

Authors:  Grimm Elizabeth , Law Emily , Luo Yu

Keywords:  Septic Arthritis, MR, Infection

Yousef Ayat,  Gerrie Samantha,  Alharbi Khalid,  Saint-martin Christine

Final Pr. ID: Poster #: EDU-076

The clinical presentation of neonatal CNS infections is often non-specific, requiring neuroimaging to narrow the differential diagnoses for prompt treatment and improved outcomes. Congenital infections include TORCH infections (Toxoplasmosis, Others (HIV, parvovirus, syphilis, and others), Rubella, Cytomegalovirus, Herpes simplex). Perinatal and postnatal CNS infections are related to other less common pathogens such as E. coli, Enterobacter, Candida, Parechovirus, and COVID-19 infections.

The imaging pattern of neonatal CNS infections varies depending on the patient’s age and stage of development at the time of exposure. The presentations of neonatal CNS infections include meningitis, encephalitis, leukoencephalopathy and vasculitis with and without complications.

Imaging aids in narrowing the differential diagnosis in complex cases and allows for the recognition of complications. We describe the imaging findings of neonatal CNS infections, ranging from common TORCH infections to rare pathogens.

We provide an educational case-based review of the imaging findings of various neonatal CNS infections while discussing their complications such as arterial stroke, venous thrombosis, hydrocephalus, abscess, and subdural empyema. We will explain the various imaging modalities used in the approach to neonatal infection while highlighting the precautions and need for administering IV contrast.

We aim to establish a systematic approach to the imaging workup of neonatal CNS infections to narrow the correct diagnosis, thereby expediting appropriate subspecialty referral and treatment. Read More

Authors:  Yousef Ayat , Gerrie Samantha , Alharbi Khalid , Saint-martin Christine

Keywords:  CNS Infection, Neonatal, Education

Thomas Aby,  Steiner Michael,  Teague Clint

Final Pr. ID: Poster #: EDU-032

Congenital infections or in utero infections results from a wide variety of pathogens. The most common ones are referred by the mnemonic TORCH infections. The manifestations of congenital infections are diverse, ranging from asymptomatic cases to severe, life-threatening conditions. Common presentations include neurological abnormalities, hearing and vision impairments, developmental delays, and growth problems.

This review aims to discuss the radiological manifestations of the TORCH infections with emphasis on the resurgence of syphilis as a significant concern within the realm of congenital infections. And in by doing so, underscore the critical role of radiology in facilitating early detection and enabling timely intervention. Read More

Authors:  Thomas Aby , Steiner Michael , Teague Clint

Keywords:  TORCH, Syphilis, congenital infection

Szymanski Kathryn,  Pfeifer Cory,  Friedman Neil,  Kuwabara Michael

Final Pr. ID: Poster #: CR-033

Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the left frontoparietal lobe. Rapid progression was seen on further imaging over the length of the patient’s hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired from tonsillar herniation 22 days after the onset of initial symptoms and 4 days after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Balamuthia mandrillaris can cause a lethal brain infection. Because of the fatal nature of this infection, we propose 1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and 2) the threshold to treat empirically should be low due to the fatal nature of the infection. Read More

Authors:  Szymanski Kathryn , Pfeifer Cory , Friedman Neil , Kuwabara Michael

Keywords:  amoeba, Balamuthia mandrillaris, brain infection

Smith (garcia) Jacquelyn,  Meyers Mariana,  Mirsky David

Final Pr. ID: Poster #: EDU-028

Central nervous system (CNS) infections acquired in-utero are a significant cause of fetal and neonatal morbidity and mortality. Early detection is crucial for timely therapy, prognostication, and peripartum planning. Fetal imaging plays an important role in diagnosing CNS infection and determining the extent of involvement. It has been of particular diagnostic importance with the current outbreak of Zika virus, a neurotropic virus that can result in severe CNS anomalies. An imaging review of commonly encountered congenital infections, including Zika virus, will be presented, with an emphasis on fetal magnetic resonance imaging (MRI). Read More

Authors:  Smith (garcia) Jacquelyn , Meyers Mariana , Mirsky David

Keywords:  Fetal MRI, CNS Infection, Zika Virus

Chen Danling,  Kuehne Alexander,  Hwang James,  Tu Long,  Ehrlich Lauren,  Lisse Sean

Final Pr. ID: Poster #: CR-048

Grisel syndrome is a rare, acquired, non-traumatic rotatory subluxation of the atlantoaxial joint that typically occurs in the childhood period. It arises from cervical ligamentous laxity and instability following an infectious or inflammatory process in the head and neck, such as from an upper respiratory tract infection or from otolaryngolic surgery. The proposed pathophysiology of the disorder is infective septic emboli spreading from the posterosuperior pharynx to the upper cervical region via the pharyngovertebral vein, which connects the posterior nasopharyngeal veins with the periodontoid plexus. Patients present with neck pain, stiffness, and torticollis. Four types of atlantoaxial subluxation have been described using the Fielding classification system: type 1: rotation of the atlas on the axis without anterior displacement; type 2: atlantoaxial subluxation with 3-5 mm anterior displacement; type 3: atlantoaxial subluxation with greater than 5 mm anterior displacement; and type 4: atlantoaxial subluxation with posterior displacement. Permanent deformation and severe neurologic sequelae may result in the absence of timely intervention.
A 11-year-old male patient presented to the hospital with a two-week-history of severe postoperative neck pain, stiffness, headache, jaw pain, trismus, and anorexia after undergoing elective outpatient adenotonsillectomy. Contrast-enhanced CT imaging of the neck demonstrated a 4.0 cm rim-enhancing collection in the right C1-C2 prevertebral space extending into the right atlantoccipitalatlantooccipital and atlantoaxial joints consistent with prevertebral abscess formation. Additional imaging findings included atlantoaxial rotation and anterior subluxation of C1 on C2 up to 9 mm. MR of the cervical spine demonstrated evidence of prevertebral space infection, osteomyelitis of C1 and the C2 odontoid process, and rotatory and anterior atlantoaxial subluxation. Findings met criteria for Fielding type III rotatory atlantoaxial dislocation and Grisel’s syndrome. While the patient initially received conservative treatment with an extended intravenous antibiotics course of intravenous antibiotics and application of a hard collar, follow-up imaging demonstrated worsening infection, increased atlantoaxial subluxation, and central canal stenosis at C1-C2. He consequently underwent neurosurgical decompression and occipital-cervical fusion with full recovery of neurologic function. Read More

Authors:  Chen Danling , Kuehne Alexander , Hwang James , Tu Long , Ehrlich Lauren , Lisse Sean

Keywords:  Infection, Cervical Spine, Atlantodental

Matos Rojas Irma,  Lazarte Claudia,  Katekaru Tokeshi Doris,  Ugas Carlos,  Valdez Quintana Melissa,  Casamayor Alvina

Final Pr. ID: Poster #: EDU-13 (R)

Significant progress in improving outcome for patients with oncohematological diseases are attributed to intensive chemotherapy, bone marrow transplantation, platelet transfusions, development of new imaging techniques, new antimicrobials and others. All these advances increase the survival of these patients which in turn increases the frequent of risk of infections that are substantial cause of morbidity and mortality in these patients.
The purpose of this exhibit is to show the spectrum of infections in these patients; describe the imaging finding according to the etiology and associated factors.

There are a number of factors that need to be considered in order to interpret abnormalities seen on radiology as the type of hematological disease, stage of the hematological disease, treatment phase, profile of immunodeficiency, treatment for infection received, patient history and clinical signs. For example, according to type of immunosuppression there are different spectrum of infections but leukemia affect all types of immunosuppression that include neutropenia, T cell defect and B cell defect. Read More

Authors:  Matos Rojas Irma , Lazarte Claudia , Katekaru Tokeshi Doris , Ugas Carlos , Valdez Quintana Melissa , Casamayor Alvina

Keywords:  infections, Hematologic malignancy, Pediatric, diagnostic accuracy, aplastic anemia

Misiura Anne,  Urbine Jaqueline,  Mallon Mea,  Malik Archana,  Kazmi Faaiza,  Poletto Erica

Final Pr. ID: Poster #: EDU-082

Hypoxic-ischemic encephalopathy is a potentially devastating neurological diagnosis for which prompt recognition is crucial for patient management. The appearance of HIE on imaging depends on the duration and severity of the hypoperfusion injury, which can range from global to subtle. As such, the differential diagnosis is wide, including infectious, metabolic, and congenital dysmyelination causes. It is also critical for the pediatric radiologist to be aware of possible confounding cases when presented with imaging features seen in HIE which would significantly change management. Read More

Authors:  Misiura Anne , Urbine Jaqueline , Mallon Mea , Malik Archana , Kazmi Faaiza , Poletto Erica

Keywords:  Hypoxic, Infection, Encephalopathy

Zember Jonathan,  Turkbey Evrim,  Bulas Dorothy,  Bost James,  Liang Jason,  Rubenstein Kevin,  Gould Nicholas,  Montealegre Sanchez Gina,  Barron Karyl,  Debiasi Roberta,  Delaney Meghan,  Arrigoni Lauren,  Wessel David,  Notarangelo Luigi

Final Pr. ID: Poster #: SCI-042

The radiologic findings of SARS-CoV-2 infection have been well described in the literature over the past several years. Although the myriads of acute disease processes have also been extensively documented, the long-term complications of SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C) are unknown, including conditions carrying potentially significant morbidity, such as pediatric post-acute sequelae of COVID-19 (PASC). This study establishes a prospective, longitudinal cohort of SARS-CoV-2 infected individuals versus uninfected controls to characterize long-term outcomes following pediatric SARS-CoV-2 infection, including cardiopulmonary imaging evaluation with chest radiography (CXR) or chest computed tomography (CT). This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), NIH. Read More

Authors:  Zember Jonathan , Turkbey Evrim , Bulas Dorothy , Bost James , Liang Jason , Rubenstein Kevin , Gould Nicholas , Montealegre Sanchez Gina , Barron Karyl , Debiasi Roberta , Delaney Meghan , Arrigoni Lauren , Wessel David , Notarangelo Luigi

Keywords:  Chest Computed Tomography (CT), Chest, Infection

Gnannt Ralph,  Patel Premal,  Amaral Joao,  Parra Dimitri,  Connolly Bairbre

Final Pr. ID: Poster #: SCI-009

Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to explore the outcome (patency, success and infection) of PICC repairs in children and to compare those risks to that of PICC exchange. Read More

Authors:  Gnannt Ralph , Patel Premal , Amaral Joao , Parra Dimitri , Connolly Bairbre

Keywords:  PICC, repair, infection

Nowariak Meagan,  Kruc Rebecca,  Ames Jeff,  Murati Michael,  Hoggard Eric,  Dietz Kelly

Final Pr. ID: Poster #: SCI-023

The purpose of our study is to determine the significance of bladder debris seen incidentally by ultrasound in pediatric patients undergoing outpatient non-emergent ultrasounds. Read More

Authors:  Nowariak Meagan , Kruc Rebecca , Ames Jeff , Murati Michael , Hoggard Eric , Dietz Kelly

Keywords:  Ultrasound, Bladder, Infection

Shah Isha,  Joshi Priscilla

Final Pr. ID: Poster #: EDU-082

The dengue virus, an RNA virus from the Flaviviridae family, is typically considered non-neurotropic. Dengue encephalitis is caused by four strains DENV1 to DENV4. While the dengue virus generally does not affect the nervous system, DENV2 and DENV3 can be neurotropic. Symptoms of dengue encephalitis include headaches, seizures, and changes in consciousness.

In dengue encephalitis, areas most commonly affected are the basal ganglia, thalamus, brainstem, cerebellum, cortical white matter, periventricular white matter, and cortical gray matter. On T2-weighted and FLAIR sequences, these areas appear hyperintense, while on T1-weighted images, the lesions may be iso- or hypointense. Micro-hemorrhages show as blooming on susceptibility-weighted MRI. MRI is essential for the initial assessment of suspected dengue encephalitis and for patients with dengue fever experiencing worsening neurological symptoms.

Our presentation highlights the need to understand the relevant imaging findings and possible causes of neurological issues in dengue-infected patients, as this is crucial for accurate diagnosis and effective treatment, leading to better outcomes. Read More

Authors:  Shah Isha , Joshi Priscilla

Keywords:  Neuroradiology, Infection, Pediatric Imaging

Alian Ali,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-095

In 2017, children under the age of 15 accounted for only 10% of the 10 million Mycobacterium tuberculosis (TB) infections estimated by the World Health Organization. Child carriers of TB pose health risks to their adult caregivers, and children can exhibit greater susceptibility to significant health risks from the infection. Nontuberculous mycobacterial (NTM) infection presents disparate health risks and can generate imaging specific findings. This presentation addresses radiologic manifestations of mycobacterial disease as a means to educate pediatric radiologists given the medical significance of mycobacterial infection. Read More

Authors:  Alian Ali , Pfeifer Cory

Keywords:  tuberculosis, infection, multi-system

Kuehne Alexander,  Chen Danling,  Hwang James,  Tu Long,  Ehrlich Lauren,  Lisse Sean

Final Pr. ID: Poster #: CR-055

Parechovirus infection is a recognized cause of childhood meningoencephalitis with distinctive neuroimaging findings. Human parechovirus (HPeV) is a single-RNA virus from the Picornaviridae viral family transmitted through respiratory or gastrointestinal contact. While the clinical presentation of parechovirus infection usually manifests as mild, self-limiting symptoms, in rare cases, the virus may infect the central nervous system and result in seizures, encephalopathy, and permanent neurologic disability. Pediatric patients younger than two years of age are at greatest risk for central nervous system (CNS) infection. CNS viral infection may be confirmed by lumbar puncture. Typical imaging features of parechovirus encephalitis on brain MR imaging include a diffuse pattern of restricted diffusion involving the subcortical and deep periventricular white matter, predominantly within the frontoparietal region, with additional involvement of the corpus callosum and the bilateral thalami. The differential diagnosis of similar radiologic presentations includes other causes of viral encephalitides (such as rotavirus, chikingunya, and HSV), hypoxic-ischemic encephalopathy, leukodystrophy, and rare genetic metabolic disorders.
A two-week-old male patient without significant past medical history presented to the pediatrician with irritability and increased work of breathing. Within a day, the patient developed worsening tachypnea, increased grunting, pallor, lethargy, and exanthem of the chest and neck. The patient presented to the hospital and was intubated for respiratory distress. Continuous electroencephalography recorded during inpatient admission was notable for abnormal ictal burden consistent with status epilepticus. Brain MR imaging was obtained, and demonstrated the characteristic imaging findings of parechovirus infection of diffuse abnormal restricted diffusion throughout the bilateral subcortical and periventricular white matter, corpus callosum, and thalami, with sparing of the cortex. HPeV RNA was positive in PCR assays of cerebrospinal fluid, serum, and stool. Patient received 2 doses of intravenous immunoglobulin. Unfortunately, there is no current further treatment for parechovirus infection and our patient ended up succumbing to the disease. We hope that this case presentation highlights the unique imaging feature characteristics of parechovirus and can help include this rare infection on the differential for pediatric radiologists moving forward. Read More

Authors:  Kuehne Alexander , Chen Danling , Hwang James , Tu Long , Ehrlich Lauren , Lisse Sean

Keywords:  Meningitis, Infection, Neuroradiology