Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-030

Hypoxic Ischemic Encephalopathy (HIE) is a brain injury caused by a lack of blood and oxygen supply to the brain. HIE affects 4,000,000 term-born neonates per year worldwide, with an estimated 2 billion/year cost in the US, let alone family burdens. Therefore, reducing mortality and morbidity for HIE patients remains an important public health concern. Therapeutic hypothermia (TH) was established in 2005 as a standard therapy by cooling patients to 33-34°C in the first six postnatal hours for 72 hours. However, 35–50% of the patients still experience adverse outcomes, defined as death or cognitive Bayley Scales of Infant Development by age two years. Ongoing HIE-related trials worldwide are testing whether new therapies can supplement TH and further reduce adverse outcomes. However, therapeutic innovation is slow and inconclusive, for 1) before therapy, patients at high risk of developing adverse outcomes cannot be identified; 2) after therapy, outcomes cannot be measured until age two years. Besides, public MRI data exists for hundreds of patients with brain tumors, Alzheimer’s Disease, and other diseases, fueling AI’s success in MRI-based diagnosis and prognosis of brain tumor, Alzheimer’s Disease, and other disorders. In contrast, annotated MRIs with linked clinical and bio-marker data do not exist publicly for HIE. Our previous work has collected multi-site HIE MRI data. Therefore, to fill the gap in HIE diagnosis with MRI data, target high-risk patients, increase efficiency, evaluate therapeutic effects early, and expedite therapeutic innovations, in this work, we propose to predict 2-year neurocognitive outcomes in neonates using brain MRIs by deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Chacko Anith,  Andronikou Savvas,  Shearn Andrew,  Thai Ngoc Jade

Final Pr. ID: Paper #: 131

3D printed models from MRI scans can effectively demonstrate the surface structure of the brain. Previous workflows focus on adult brains as a basis for prints. Our database of pediatric MRI brains who had perinatal hypoxic ischemic injury and presented late for imaging, with pathology causing cortical surface irregularities and parenchymal cysts. Difficulties arise in accurate depiction of the cortex on 3D print models in these pathologic brains. We aim to demonstrate effective workflows to accurately and efficiently print 3D models of especially pathologic pediatric MRI brains. Also, to critically and empirically test and refine the various steps involved in producing 3D print models which include segmentation of the MRI volume into tissue classes, generation of a surface model from this volume, preparation and final print of a 3D model. Read More

Authors:  Chacko Anith , Andronikou Savvas , Shearn Andrew , Thai Ngoc Jade

Keywords:  3D Printing, Hypoxic Ischaemic Injury, 3D Models

Henry M Katherine,  White Ammie,  Servaes Sabah,  Wood Joanne

Final Pr. ID: Poster #: EDU-031

Infants are at risk for fatal physical abuse yet may present to care multiple times with inflicted trauma before abuse is diagnosed and the infant is protected. Prompt identification of at-risk infants is essential to protection from ongoing abuse. Sentinel injuries are unexplained minor injuries in young infants that are appreciable on physical exam. Examples of sentinel injuries include bruising, subconjunctival hemorrhages, and intra-oral trauma. These injuries can be a subtle external sign of concurrent clinically occult internal injuries (e.g., skeletal, abdominal, intracranial injuries) in a well-appearing infant or may be an early warning that foretells more significant trauma in the future. Identification and evaluation of these infants with appropriate imaging has been highlighted as one approach to ensure that abuse is promptly detected, injuries are addressed, and the infant is protected.

In this multidisciplinary educational presentation made in collaboration with child abuse pediatricians and pediatric radiologists, we will: (1) review different types of sentinel injuries; (2) discuss current evidence and guidance for performance of imaging (skeletal survey, abdominal CT, neuroimaging with MRI or CT) when a sentinel injury is identified; (3) discuss the interpretation and significance of imaging findings; (4) provide imaging examples of these injuries; and (5) discuss gaps in the literature while highlighting opportunities for collaboration between child abuse pediatricians and pediatric radiologists to improve the care of these infants.

Following completion of this educational module, our goals are that the participant will better understand the clinical context of sentinel injuries and have a baseline knowledge to make an appropriate imaging plan for these infants. Read More

Authors:  Henry M Katherine , White Ammie , Servaes Sabah , Wood Joanne

Keywords:  Child Abuse, Sentinel Injuries, Skeletal Survey

Venkatakrishna Shyam Sunder,  Chacko Anith,  Schoeman Sean,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-029

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

Authors:  Venkatakrishna Shyam Sunder , Chacko Anith , Schoeman Sean , Andronikou Savvas

Keywords:  Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

Awdeh Haitham,  Bosserman Andrew,  Tran Michael,  Bawa Pritish,  Kumaravel Manickam

Final Pr. ID: Poster #: SCI-029

To validate the necessity of an MRI when there is high clinical concern of epiphyseal injury with normal radiographic findings Read More

Authors:  Awdeh Haitham , Bosserman Andrew , Tran Michael , Bawa Pritish , Kumaravel Manickam

Keywords:  Salter Harris, Physis injury, Physis

Verma Nupur,  Patel Pratik,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-108

Accidents remain a top cause of morbidity and mortality in pediatric patient. Assessment for blunt trauma to the abdomen is difficult in the trauma patient and findings of bowel injury can be subtly or confounded by visceral injuries. The most specific finding of free air in blunt hollow visceral organ is often minimally present, or entirely unseen. The pediatric radiologist must be familiarity with the more often seen and less specific secondary signs on CT, including free fluid, bowel wall thickening, and mesenteric contusion injury. We present, by case example, bowel injuries in the traumatic pediatric patient and their management and outcomes, while addressing common pearls and pitfalls. As many of these patients do well with non-operative treatment the radiologist must also be familiar with findings that would allow such option, to appropriately advice referring providers and manage potential re-image of the pediatric patient. Read More

Authors:  Verma Nupur , Patel Pratik , Rajderkar Dhanashree

Keywords:  Trauma, Pediatrics, Dose Reduction in CT, Abdominal Injury

Manral Kalpana,  Durand Rachelle,  Pandya Nirav,  Kornblith Aaron,  Cort Kayla,  Courtier Jesse

Final Pr. ID: Poster #: EDU-064

According to the current statistics, approximately 1 million children aged 6-14 participated in 11-payer football, more popular as youth football, in the 2021-2022 school year (3). A trend to earlier participation in specialized sports activities in pediatric patients has been observed. Contact sports such as basketball, football, and soccer comprise a considerable proportion of all played sports and are associated with the highest number of injuries, both acute and chronic in nature(9).
Lower extremities are the most common site of injury in pediatric football players, followed by upper extremity. Fractures and sprains/strains are the most common injury patterns (1, 9, 10). With the increasing number of young football athletes, there is a greater need to explore football-associated injuries, which can have a considerable physical, emotional, and psychosocial impact on a young individual.
This educational exhibit aims to explore the most common American football-related pediatric extremity injuries and their imaging characteristics using various modalities and briefly discuss the treatment options for the pediatric population. Read More

Authors:  Manral Kalpana , Durand Rachelle , Pandya Nirav , Kornblith Aaron , Cort Kayla , Courtier Jesse

Keywords:  American football, Pediatric, Extremity injuries

Alturkistani Tahani,  Goldwasser Bernard,  Blumfield Einat,  Liszewski Mark,  Taragin Benjamin

Final Pr. ID: Poster #: EDU-032

1) To understand penetrating injury in pediatric patients and how the child’s body habitus is more susceptible to multi organ injury than that of adult.
2) To explain the role of computed tomography (CT) in a pediatric penetrating trauma triage algorithm.
3) To discuss optimization of CT protocols in pediatric trauma patients based on the mechanism of injury with attention to radiation dose reduction.
4) To review the imaging findings in penetrating injuries to the chest, abdomen and pelvis. Read More

Authors:  Alturkistani Tahani , Goldwasser Bernard , Blumfield Einat , Liszewski Mark , Taragin Benjamin

Keywords:  Trauma, Cross-sectional, penetrating trauma, Penetrating injuries, GunShot wounds

Cort Kayla,  Piskunowicz Maciej,  Hwang Misun

Final Pr. ID: Poster #: EDU-008

Contrast-enhanced ultrasound (CEUS) for the evaluation of the neonatal brain provides additional diagnostic information when compared to conventional gray scale ultrasound through the detection of perfusion abnormalities associated with injury. When compared to cross-sectional imaging, CEUS has many advantages given its relative low cost and ability to be performed at the bedside, without the need for sedation or exposure to ionizing radiation. Diagnostic information is yielded through the qualitative evaluation of parenchymal enhancement patterns as well as quantification of microbubble perfusion kinetics from which time intensity curves are derived and additional perfusion parameters can be extrapolated. Given the 2-dimensional nature of the modality, a strategically designed scanning protocol is necessary to obtain the aforementioned quantitative values. The purpose of this exhibit is to demonstrate the current understanding of brain CEUS and educate on the brain CEUS protocol used for the diagnosis of neonatal brain pathology. Read More

Authors:  Cort Kayla , Piskunowicz Maciej , Hwang Misun

Keywords:  hypoxic ischemic injury

Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Mian Ali,  Vedajallam Schadie,  Thai Ngoc Jade

Final Pr. ID: Poster #: EDU-048

The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries, is difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, as compared to adults. Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic ischaemic injury can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions, although this can often be subtle.

In contrast, in the chronic stage of evolution of partial prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a large medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region.

To achieve this, we have selected cases diagnosed on imaging as having sustained a pattern of term, partial-prolonged hypoxic-ischaemic injury affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these we have identified those patients demonstrating injury along the entire watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration.

Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates, which also has implications for potential compensation in litigation. The set of images presented in this pictorial review provides a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum. Read More

Authors:  Chacko Anith , Andronikou Savvas , Goncalves Fabricio , Mian Ali , Vedajallam Schadie , Thai Ngoc Jade

Keywords:  Cortical Ischemic Patterns, Watershed Zone, Hypoxic Ischemic Injury

Artunduaga Maddy,  Rao Devika,  Friedman Jonathan,  Kwon Jeannie,  Pfeifer Cory

Final Pr. ID: Paper #: 003 (S)

E-cigarette/vaping-associated lung injury (EVALI) has been recently reported in the radiology literature and has become an urgent public health matter as stated by the Center for Disease Control and Prevention. As of October 22, 2019, there have been 1,604 cases in the United States territory with 34 confirmed deaths. Patients <20 years represent 36% of EVALI cases. Moreover, the use of vaping among adolescents and teenagers has progressively increased in recent years. Although the exact cause and mechanism of injury remain a subject of investigation, clinical suspicion along with imaging findings and in some cases, bronchoscopic results, remain the mainstay in the diagnosis of EVALI, after excluding infection. Reported imaging patterns of EVALI include hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, diffuse alveolar damage, lipoid pneumonia, and giant cell interstitial pneumonia. We describe computed tomography (CT) findings of EVALI patients from our institution Read More

Authors:  Artunduaga Maddy , Rao Devika , Friedman Jonathan , Kwon Jeannie , Pfeifer Cory

Keywords:  Vaping, Vaping-associated lung injury, E-cigarette-associated lung injury

Steinberg Julie,  Kristeva Mariya,  Barhaghi Krystle,  Tao Ting

Final Pr. ID: Poster #: CR-014

The case report will present imaging findings from two companion cases of adolescent athletes presenting with palpable thigh masses. Patient A underwent ultrasound and MR and was diagnosed with a degloving injury of the rectus femoris. Patient B also presented with a thigh mass, and following MR underwent attempted aspiration and biopsy. The patient was then diagnosed with inflammatory myositis based on pathology from the biopsy and subsequently evaluated by rheumatology. Following review of the imaging by pediatric radiologists, a degloving injury was then diagnosed and the patient was referred to orthopedics for further management. The exhibit will review the imaging features of this uncommon injury as well as review the complex anatomy of the rectus femoris muscle.
A degloving injury represents an injury to the rectus femoris in which the inner bipennate portion of the indirect myotendinous complex is separated from the surrounding outer unipennate portion of the muscle, which results in separation and retraction of the inner muscle belly from the outer muscle belly. It differs from typical injury to the indirect myotendinous junction in in which there is no dissociation of the inner and outer components of the muscle. Awareness of this injury will help avoid misdiagnosis of soft tissue mass and unnecessary interventions. Images included in the case report will include ultrasound and two MRs. Read More

Authors:  Steinberg Julie , Kristeva Mariya , Barhaghi Krystle , Tao Ting

Keywords:  myotendinous injury, rectus femoris, musculoskeletal

Santos Laura,  Kammen Bamidele,  Sabharwal Sanjeev,  Kvist Ola,  Hitt Dave,  Jambawalikar Sachin,  Jaramillo Diego

Final Pr. ID: Poster #: SCI-019

Diffusion tensor imaging (DTI) is a technique in which diffusion of water molecules is restricted by cellular membranes. In the physis and adjacent metaphysis, the physeal metaphyseal complex (PMC), the columns of cartilage and newly formed bone restrict the diffusion of water to primarily the longitudinal direction. DTI indirectly measures physeal activity by revealing tissue microarchitecture of the PMC and by measuring the Brownian motion of water along the columns of bone and cartilage, which can be imaged and quantified as tractography. Having conducted DTI-MRI on over 900 knees, our research group has established that DTI can distinguish between a normal and a dysfunctional physis.
A physeal bar or partial physeal arrest is the consequence of injury to an open physis, resulting in a perpendicular bony bridge through the physis which can lead to limb shortening or angular deformity. This poster presents our initial experience in performing DTI on the growth plate in 7 patients (5 females, 2 males) with MR-confirmed physeal bars to characterize tractography patterns associated with bony bridges and compare the tracotgraphy and diffusion metrics of the injured versus the healthy contralateral physis. Read More

Authors:  Santos Laura , Kammen Bamidele , Sabharwal Sanjeev , Kvist Ola , Hitt Dave , Jambawalikar Sachin , Jaramillo Diego

Keywords:  diffusion tensor imaging, physeal bar, physeal injury

Chopra Mark,  Barrett Hannah,  Hutchinson J.,  Kiho Liina,  Arthurs Owen

Final Pr. ID: Poster #: CR-013

Ductus Arteriosus calcification is a relatively common, typically unreported feature on plain film radiography. The more recent literature quotes a prevalence on unenhanced CT of between 37-61% of children and a peak at the age of 6-10 years. Adult studies have shown that calcification of the ligamentum arteriosum can occur alone or be associated with atherosclerotic and/or granulomatous calcification. We report two cases in whom they were identified as incidental findings on forensic post mortem CT, for whom we obtained histological confirmation.

Case 1: An 8 month old child who died in non-suspicious circumstances had incidental ductal arteriosus calcification reported on post mortem CT, following unremarkable skeletal survey. Intimal mural calcification was reported on histology at autopsy.

Case 2: A 19 month old child who died of aspiration underwent full skeletal survey and PMCT as part of the pre-autopsy imaging assessment. The skeletal survey revealed incidental ductus arteriosus calcification, initially reported as PDA clip, with correlation at CT. Intimal and medial mural calcification was reported on histology at autopsy.

These cases showed that ductal calcification was intimal and medial in nature. This is consistent with the current literature regarding mural calcification rather than thrombus regression calcification. Read More

Authors:  Chopra Mark , Barrett Hannah , Hutchinson J. , Kiho Liina , Arthurs Owen

Keywords:  Ductus arteriosus calcification, Post mortem, Non-accidental injury

Hutchinson Marcy,  Kozak Brandi,  Ho-fung Victor,  Chauvin Nancy

Final Pr. ID: Poster #: EDU-015 (T)

Background:
Sonographic techniques are simple and safe. The utility and clinical value of dynamic sonographic evaluation of the glenohumeral joint in infants with brachial plexus injury (BPBI) has been described since the late 1990's. However, this technique remains an underutilized tool in most imaging practices. Brachial plexus injury during the birthing process can lead to glenoid dysplasia, posterior shoulder subluxation and significant morbidity if left untreated. Imaging evaluation of the degree of deformity is paramount to guide clinical treatment and the follow-up of complicated cases. Imaging techniques include MRI, CT and US. Shoulder ultrasound provides a dynamic, noninvasive method of evaluation. It has also been our experience that this imaging technique can be mastered by the Sonographer and supported with accurate interpretation by the Radiologist.

Purpose:
Describe the imaging features of glenohumeral joint dysplasia due to BPBI with emphasis on ultrasound technique.
Review step-by-step dynamic sonographic evaluation of the glenohumeral joint in BPBI with emphasis on correct positioning of the patient to ensure consistency and reproducible quality imaging.
Improve both confidence and independent evaluation of patients through this presentation by the sonographer. Read More

Authors:  Hutchinson Marcy , Kozak Brandi , Ho-fung Victor , Chauvin Nancy

Keywords:  glenohumeral, brachial plexus birth injury (BPBI)

Heitzmann Mark,  Shalaby-rana Eglal,  Deye Katherine

Final Pr. ID: Poster #: SCI-077

Abdominal injuries account for a relatively small percentage of non-accidental trauma. Previous estimates range from 0.5% to 11%. Despite this, abdominal injuries are the second leading cause of death in non-accidental trauma after head injury. Our objective is to assess the prevalence of abdominal injuries in the setting of suspected non-accidental trauma within a large urban children's medical center. Read More

Authors:  Heitzmann Mark , Shalaby-rana Eglal , Deye Katherine

Keywords:  non-accidental trauma, abdominal injuries

Thakrar Pooja,  Boyd Kevin,  Wideburg Eric,  Kumbhar Sachin

Final Pr. ID: Poster #: EDU-072

The incidence of e-cigarette, or vaping, product use associated lung injury (EVALI) has been increasing since the summer of 2019. At least seven distinct patterns of lung injury have been described with this emerging disease (1). A recent report from the United States Centers for Disease Control and Prevention indicates that approximately 15% of patients diagnosed with EVALI have been in the pediatric age group (2). Because of the potential legal and social repercussions of vaping and cannabis use, pediatric patients may be disinclined to admit to use of electronic cigarettes. As such, recognition of the potential imaging patterns of this disease may allow the pediatric radiologist to raise the possibility of EVALI to facilitate timely diagnosis and appropriate management of the disease.

This educational exhibit will review the imaging findings seen in the various patterns of lung injury identified with this increasingly common lung disease. We will also discuss the indications for obtaining imaging studies in patients with suspected EVALI. In addition, we will describe the potential clinical presentations in these patients.

References:
1. Henry TS, Kligerman SJ, Raptis CA, et al. (2019) Imaging findings of vaping-associated lung injury. AJR 1-8. 10.2214/AJR.19.22251
2. Centers for Disease Control and Prevention. (2019) Severe pulmonary disease associated with electronic cigarette product use—interim guidance. https://www.cdc.gov/mmwr/volumes/68/wr/mm6836e2.htm Read More

Authors:  Thakrar Pooja , Boyd Kevin , Wideburg Eric , Kumbhar Sachin

Keywords:  EVALI, vaping-associated lung injury, adolescent

Wolf Joel,  Remon Juan,  Myers Eliza,  Blumfield Einat

Final Pr. ID: Poster #: EDU-034

Iatrogenic upper gastrointestinal (GI) injuries are rare occurrences with predisposition in premature births, low birth weight, multiple attempts at OGT placement. Medical literature on the topic consists of case reports and mostly has been from the perspective of management with very limited literature on diagnostic evaluation. As the clinical presentation of such iatrogenic injuries is nonspecific, the radiographic appearance may be the only clue for diagnosis and the typical findings should be recognized and diagnosed by radiologists and neonatologists. The purpose of this presentation is to describe the radiographic findings and a diagnostic approach to guide the radiologist. A retrospective case-review was performed from 2009-2017, of neonates with upper GI injuries associated with naso/orogastric tube placement or with pharyngeal auctioning at birth ( a single case). Seven cases were found comprising of five females and two males. Six of seven neonates were premature with gestational ages ranging from 24 weeks and 2 days to 28 weeks, and birth weights spanning 515-1085 grams. The 38 week neonate weiged 3500 grams. We report three types of injury: 1) posterior pharyngeal rupture, 2) non-complicated esophageal rupture with formation of a false lumen, 3) complicated esophageal rupture with penetration into the right pleural space. Management has evolved over time from a primarily surgically oriented approach to a more conservative approach involving TPN and antibiotics. Read More

Authors:  Wolf Joel , Remon Juan , Myers Eliza , Blumfield Einat

Keywords:  iatrogenic injury, neonatal upper gi rupture

Paddock Michael,  Offiah Amaka,  Sprigg Alan

Final Pr. ID: Poster #: EDU-004

Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns that are highly suspicious of II and common differential diagnoses with which radiologists should be familiar. Read More

Authors:  Paddock Michael , Offiah Amaka , Sprigg Alan

Keywords:  Inflicted injury, Non-accidental injury, Physical abuse, Skeletal survey, Child abuse

Hook Marcus,  Barrera Ambika,  Biko David,  Dennis Rebecca,  Rapp Jordan

Final Pr. ID: Paper #: 029

Vaping associated pulmonary injury (VAPI) has recently received national attention as an epidemic resulting in cases of significant morbidity and mortality from electronic cigarette use. The purpose is to present the clinical and imaging findings in adolescents with pulmonary symptoms from suspected VAPI. Read More

Authors:  Hook Marcus , Barrera Ambika , Biko David , Dennis Rebecca , Rapp Jordan

Keywords:  Vaping, Lung injury, Pneumonia

Dunn Emily,  Bokhari Danial,  Machnitz Judit,  Facciola James,  Lu Monica,  Aoyama Brianna,  Sadreameli S. Christy,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-073

‘E-cigarettes,’ also known as ‘vapes’, are handheld battery-powered devices which heat and deliver aerosolized liquid (usually containing nicotine) to the respiratory tract via inhalation. E-cigarettes are the most commonly used tobacco product amongst youth in the U.S. today. Over 1 in 4 U.S. teens report vaping in the past 30 days. Pod-based forms, such as JUUL, are especially popular with teens. These and other devices are also popular among adults.
The contents of commercially available solutions, or e-liquids, are poorly regulated. Aerosol generated by the devices may contain varying levels of nicotine, flavorings (which are often toxic), heavy metals, ultrafine particles, volatile organic compounds, and other unknown materials. Moreover, users may add substances of their choice to the liquid, including marijuana or other THC-containing products. Short and long-term health effects associated with vaping are incompletely understood, likely in part due to heterogeneity of products, variable consumption amongst users, and the relatively recent introduction and popularization of these devices.
Awareness of negative health effects associated with vaping is increasing. Exposure to highly addictive nicotine has effects on the developing brain, leading to ADHD-like symptoms and often lifelong addiction. Teen e-cigarette use has been associated with an increased risk of future conventional cigarette smoking. Over 1000 cases of acute vaping-associated lung injury in the U.S. have been reported to the CDC as of October, 1, 2019. There is increased recognition of lung injury with early studies identifying a number of imaging patterns of pulmonary disease in adults, including hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, and others.
Radiologists should maintain a high index of suspicion for vaping-associated lung injury in the assessment of patients with respiratory distress and possible exposure. Recognition of imaging features of vaping-associated lung injury is especially important in children and young adults, who may not endorse a history of exposure. Identification of clinical and radiologic features associated with e-cigarette use can drive screening and cessation efforts.
In this presentation, we present cases which highlight radiographic and CT imaging features of acute lung disease associated with e-cigarette use in children and young adults. Read More

Authors:  Dunn Emily , Bokhari Danial , Machnitz Judit , Facciola James , Lu Monica , Aoyama Brianna , Sadreameli S. Christy , Tekes-brady Aylin

Keywords:  e-cigarette, vaping, lung injury

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

Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-027

Hypoxic ischemic encephalopathy (HIE) is a brain injury that occurs in 1 ∼ 5/1000 term-born neonates. HIE lesion detection is a crucial step in clinical care of HIE. It could lead to a more accurate estimation of prognosis, a better understanding of neurological symptoms, and a timely prediction of response to therapy in this population. In addition, the rise of Artificial Intelligence (AI) brings hope to objectively and accurately finding HIE lesions. With public MRI data for brain tumors, Alzheimer’s Disease, and other diseases, AI has achieved significant success in MRI-based diagnosis and prognosis of these diseases. To facilitate the early prognosis and diagnosis of HIE, in this work, we focus on HIE lesion detection with MRI data using deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Mizrahi Daniel,  Averill Lauren,  Blumer Steven,  Meyers Arthur

Final Pr. ID: Poster #: CR-008

This is a case report of a 15-year-old boy with chronic intermittent left shoulder pain due to an undiagnosed lesser tuberosity avulsion fracture, an associated biceps pulley injury and intra-articular dislocation of the long head of the biceps tendon. Also presented is a companion case of a 13-year-old boy with an acute lesser tuberosity avulsion with an intact biceps pulley. Avulsion fractures of the lesser tuberosity are rare injuries which can be difficult to diagnose clinically and on radiographs. Even more rare are reported cases of biceps pulley injuries in children and adolescents with lesser tuberosity avulsions. Utilizing the imaging from these two cases we review lesser tuberosity avulsions in children and also review the complex anatomy of the biceps pulley, which due to its close association with the lesser tuberosity, may be involved in these injuries. These cases emphasize the importance of MR in the diagnosis and treatment planning of lesser tuberosity avulsions. Read More

Authors:  Mizrahi Daniel , Averill Lauren , Blumer Steven , Meyers Arthur

Keywords:  Lesser tuberosity avulsion, biceps tendon dislocation, biceps pulley injury

Varada Sowmya,  Wong Tony,  Jaramillo Diego

Final Pr. ID: Paper #: 062

Prior to maturity, a secondary physis surrounding the patella defines an area of potential weakness. We seek to understand how age, sex, and physeal status affect the prevalence and degree of patellar osteochondral injury and medial patellofemoral ligament (MPFL) injury after acute patellar dislocation. Read More

Authors:  Varada Sowmya , Wong Tony , Jaramillo Diego

Keywords:  patella, osteochondral injury, MRI

Epps Caleb,  Smith Benjamin

Final Pr. ID: Poster #: CR-008

A 13-year-old male presented to the emergency department with acute penile shaft swelling and pain after falling in the shower onto a partially erect penis. Initial ultrasound of the penis demonstrated a hypoechoic collection within the right ventrolateral midshaft, adjacent to an apparent focal discontinuity of the tunica albuginea. Additionally, a normal appearing urethra was identified. The patient was emergently brought to the operating room where a correlating tunica albuginea defect was not identified (via artificial erection with saline injection into the right corpora cavernosa), suggesting the absence of a penile fracture. Follow-up penile MRI revealed a urethral duplication, with injury to the ventral aspect of the dorsal urethra and an adjacent complex fluid collection. This represented a peri-urethral hematoma/urinoma. The ventral urethra was intact and unremarkable, accounting for the normal urethra visualized sonographically.

Urethral duplication is a rare congenital anomaly characterized by two urethras with variation in their location and courses. Type IIA 2 (Effman classification; seen in this patient) is the most complex form where there is proximal fusion of the two urethras prior to bladder insertion. Clinical manifestations vary but include penile deformation, urinary incontinence, and urinary tract infections. Traumatic urethral injury seen in patients with duplication is rare with no case reports found on literature review. Moreover, penile fracture mimics are not common as a clinical scenario and sonographic findings are relatively specific. The presented case demonstrates a rare scenario that may serve as a penile fracture mimic. Read More

Authors:  Epps Caleb , Smith Benjamin

Keywords:  Duplicated Urethra, Penile Fracture, Urethral Injury

Sameshima Yoshino,  Gual Fabiana

Final Pr. ID: Poster #: EDU-092

Pediatric and childbirth-related traumatic head injuries (THI) are frequent and responsible for a high rate of hospital admissions, in addition to significant rates of morbidity and mortality. Children under one year of age are at greater risk of skull fractures with intracranial complications The radiologist plays a fundamental role in identifying and characterizing these injuries using the imaging methods available in emergency care. Transfontanellar or cranial ultrasound is the method of choice for the initial evaluation of THI in babies with an open fontanel, as it is free from ionizing radiation, very useful due to its portability, allowing the patient to be evaluated at the bedside with diagnosis in real time. The objectives of this work is to propose a flowchart to guide imaging assessment and management in these pediatric and childbirth-related THI based on 248 patients (babies and children under 2 years of age) seen in our pediatric emergency service in the period from 2010 to 2022, who presented with THI, focusing on the role of ultrasound as an initial diagnostic tool. As teaching points, we will address the ultrasound assessment of different types of extra and intracranial hemorrhages, showing the techniques and main images and the main pitfalls. Read More

Authors:  Sameshima Yoshino , Gual Fabiana

Keywords:  pediatric head trauma, ultrasound, childbirth-related traumatic head injuries

Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Vedajallam Schadie,  Thai Ngoc Jade

Final Pr. ID: Paper #: 132

Hypoxic ischemic injury (HII) is a leading cause of neonatal encephalopathy and resultant cerebral palsy. Most studies focus on early magnetic resonance imaging (MRI) findings and patterns of injury, with few studies evaluating patterns in delayed MRI of patients with cerebral palsy.

We aim to categorise the delayed imaging MRI findings and distribution of abnormalities in a large cohort of children with cerebral palsy and obtained for medicolegal purposes to determine the causes of cerebral palsy, and to map the frequency of anatomic involvement in those with hypoxic ischemic injury. Read More

Authors:  Chacko Anith , Andronikou Savvas , Goncalves Fabricio , Vedajallam Schadie , Thai Ngoc Jade

Keywords:  hypoxic ischaemic injury, HII, Patterns of hypoxic ischemic injury

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

Gilligan Leah,  Davenport Matthew,  Trout Andrew,  Su Weizhe,  Zhang Bin,  Goldstein Stuart,  Dillman Jonathan

Final Pr. ID: Paper #: 089

Acute kidney injury (AKI) remains a concern in hospitalized children undergoing computed tomography (CT) examinations with intravenous (IV) iodinated contrast material (ICM). Adult studies have shown frequencies of AKI after CT with IV ICM to be similar to propensity score-matched ICM unexposed cohorts. The purpose of this study is to evaluate the association between IV ICM exposure and AKI in hospitalized pediatric patients with stable kidney function undergoing computed tomography (CT). Read More

Authors:  Gilligan Leah , Davenport Matthew , Trout Andrew , Su Weizhe , Zhang Bin , Goldstein Stuart , Dillman Jonathan

Keywords:  contrast induced nephropathy, acute kidney injury, iodinated contrast material