Malavia Mira,  Rivard Douglas

Final Pr. ID: Poster #: EDU-068

Ischial tuberosity avulsion fractures, though not uncommon in adolescent athletes, are often overlooked or misdiagnosed. These fractures occur more frequently in males than females. Primary cause of this fracture type is usually a sudden eccentric load on the proximal hamstrings, typically seen during a kicking action in dance, football, or soccer. Due to the limited use of imaging in the evaluation of such injuries, these fractures often are misdiagnosed or underdiagnosed. Recent injuries warrant more conservative management, including rest and relative immobilization. In cases of late diagnosis, delayed healing, or persistent symptomatology, surgical intervention can be undertaken to restore normal anatomy, alleviate symptoms, and facilitate healing. Minimally invasive CT-guided percutaneous needle fenestration has been introduced for symptomatic delayed union ischial tuberosity fractures in adolescents. This percutaneous procedure involves the creation of multiple channels into the bone at the fracture site with an 18 gauge Chiba needle via image guided needle fenestration to enhance blood flow and promote healing of the target area. Following this, a tailored physical therapy program is implemented based on patient symptomatology, individual tissue healing rates, and the current literature related to proximal hamstring injuries. Outcomes to this minimally invasive approach have been promising including cases of complete pain relief, full functional recovery, and a return to sports without limitations.

Outline of Teaching Points:
Ischial tuberosity avulsion fractures are common in adolescent athletes, with a higher incidence in males, caused by sudden eccentric loads on proximal hamstrings during activities like dance, football, or soccer.
Due to limited imaging use, these fractures are often overlooked or misdiagnosed, leading to delayed healing or persistent symptoms.
Recent injuries may benefit from conservative management, involving rest and relative immobilization.
Surgical intervention becomes necessary for late diagnoses, delayed healing, or persistent symptoms to restore normal anatomy and alleviate symptoms.
Minimally invasive CT-guided percutaneous needle fenestration has shown promising outcomes, facilitating healing with complete pain relief and a return to sports without limitations. Read More

Authors:  Malavia Mira , Rivard Douglas

Keywords:  fracture, interventional radiology

Kleedehn Mark,  Witt Jessica,  Laeseke Paul,  Woods Michael,  Monroe Eric

Final Pr. ID: Poster #: SCI-009

To evaluate patient and procedural variables for association with clinical outcomes in pediatric patients receiving IR drains. Read More

Authors:  Kleedehn Mark , Witt Jessica , Laeseke Paul , Woods Michael , Monroe Eric

Keywords:  Abscess, Interventional Radiology

Acord Michael,  Termine Carl,  Cahill Anne Marie,  Escobar Fernando

Final Pr. ID: Poster #: SCI-037

To assess the rate of dislodgement of posteriorly tunneled central lines, over-the-shoulder, in children. Read More

Authors:  Acord Michael , Termine Carl , Cahill Anne Marie , Escobar Fernando

Keywords:  venous access, back, interventional radiology

Hampton Erica,  Fuentealba Cargill Andrea,  Trenbeath Zachary,  Alazraki Adina,  Stence Nicholas,  Milla Sarah

Final Pr. ID: Poster #: EDU-076

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis.
In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography.
Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Authors:  Hampton Erica , Fuentealba Cargill Andrea , Trenbeath Zachary , Alazraki Adina , Stence Nicholas , Milla Sarah

Keywords:  Nuclear Medicine, Interventional Radiology

Yen Christopher,  Kukreja Kamlesh,  Masand Prakash

Final Pr. ID: Poster #: CR-010

Female conjoined throraco-omphalopagus twins were delivered via cesarean section at 35 weeks 5 days gestational age to a 38-year-old mother who received standard prenatal care. After resuscitation, the twins were transferred to the neonatal ICU, where they remained for monitoring and growth as they were assessed for potential separation.
CT angiography was performed at 3-4 months of life using a staged approach. Selective IV and oral contrast administration was used over two visits to delineate shared and non-shared structures. Most significantly, there was a single shared liver with anomalous hepatic venous drainage. Twin A had three normal caliber hepatic veins draining into a normal IVC, but a large branch of the middle hepatic vein traversed midline into Twin B and received hepatic venous drainage from Twin B via numerous anomalous vessels. Twin B had a normal IVC but three diminutive hepatic veins, thought to be due to reduced venous drainage as a result of the anomalous shared vasculature.
After multidisciplinary discussion, interventional radiology was consulted for hepatic venogram and intervention as needed. The anomalous communicating vessels were identified on hepatic venogram via Twin A femoral approach. Occlusion of the anomalous branches was achieved with serial embolization of the primary draining vessel on the Twin A side using Amplatzer vascular plugs. Successful occlusion was confirmed on venography after the final embolization procedure.
Follow-up Doppler ultrasound exams confirmed improved hepatic venous outflow in Twin B, initially with reversal of flow in the anomalous veins back toward the IVC of Twin B, followed by nonvisualization of the anomalous veins on later exams. CT angiography later showed enlarged caliber of the native Twin B hepatic veins. Following the optimization of hepatic venous outflow, the multispecialty surgical team proceeded with separation. The twins were separated at 13 months of age without complication. In addition to restoring venous outflow to allow for a successful surgical outcome, it was noted that the Amplatzer devices were used as surgical landmarks during separation for identification of shared anatomy. Through careful planning and execution, diagnostic and interventional radiology techniques played a critical role in this successful outcome. Read More

Authors:  Yen Christopher , Kukreja Kamlesh , Masand Prakash

Keywords:  Conjoined twins, Interventional Radiology, CT Angiography

Hailu Tigist,  Ginader Abigail,  Bodo Nicole,  Sze Alyssa,  Corder William,  Thompson Lynn,  Escobar Fernando,  Sze Raymond,  Balmer Dorene

Final Pr. ID: Paper #: 144

Little is known about how families of children undergoing interventional radiology (IR) procedures experience their interactions with IR teams; therefore, we conducted a qualitative study to explore and learn from families experience with IR teams in order to educate pediatric IR staff and ultimately improve delivery of care. Read More

Authors:  Hailu Tigist , Ginader Abigail , Bodo Nicole , Sze Alyssa , Corder William , Thompson Lynn , Escobar Fernando , Sze Raymond , Balmer Dorene

Keywords:  Interventional Radiology, patient experience