Semple Thomas,  Ashworth Michael,  Aurora Paul,  Owens Catherine

Final Pr. ID: Poster #: EDU-008

To review the CT features of childhood interstitial lung diseases (ChILD). Read More

Authors:  Semple Thomas , Ashworth Michael , Aurora Paul , Owens Catherine

Keywords:  Interstitial, Lung, Pulmonary, Thoracic, CT

W Mustapha Wan Irfan

Final Pr. ID: Poster #: CR-026

Horseshoe lung is a rare congenital anomaly and is mostly accompanied by scimitar syndrome. We reported a 3 months old baby girl was initially referred from the district hospital for ventilator support for severe congenital pneumonia and dextrocardia with features suggestive of elevated pulmonary artery pressure. She was born via emergency caesar for fetal distress with moderate meconium-stained liquor. Apgar's score was 5 in 1 minute and 9 in 5 minutes. She initially required non-invasive ventilation support and was able to wean to nasal prong on day 2 of life subsequently was intubated for worsening respiratory distress on day 8 of life and was transferred to our hospital. In our hospital, she was treated for nosocomial pneumonia and ventilated for 2 days and subsequently able to extubate to nasal prong. She completed a total of 2 courses of antibiotics within 2 weeks of life. Clinically patient is not dysmorphic but in respiratory distress with sub and intercostal recession. No chest deformity. Auscultation reduced air entry over the right lung, and no murmur was heard. Echo showed situs solitus with mesocardia, dominant RA/RV, AV/VA concordant, small PFO with intact IVS, tricuspid regurgitation 3 mmHg, dilated pulmonary artery and PDA 1.2 mm bidirectional predominantly right to left. Chest radiograph showed opacified right chest, dextrocardia and enlarged left hemithorax. CT Thorax showed a tiny right pulmonary artery, the right pulmonary vein is not clear, probably draining into the IVC- RA junction and a hypoplastic right lung suggestive of scimitar syndrome with horseshoe lung complicated with pulmonary hypertension. She was kept on nasal prong oxygen since extubated because of elevated pulmonary artery pressure and respiratory distress and was given sildenafil. Horseshoe lung is rare, and most of the reported cases share the same spectrum of cardiovascular anomalies identified in scimitar syndrome, and it can be confirmed by CT and angiography. Read More

Authors:  W Mustapha Wan Irfan

Keywords:  Scimitar syndrome, horsehoe lung, pulmonary hypertension

Miyazaki Osamu,  Oguma Eiji,  Nishikawa Masanori,  Tanami Yutaka,  Kitami Masahiro,  Hosokawa Takahiro

Final Pr. ID: Poster #: SCI-026

To assess the size and number of pulmonary lesions in patients with hepatoblastoma
Diagnostic criteria of the PRETEXT (Pretreatment Extent of Disease) staging system for hepatoblastoma states that pulmonary lesions are judged to be metastases if there is one nodule greater than 10mm in diameter, or if among several nodules at least one is greater than 5mm in diameter. Read More

Authors:  Miyazaki Osamu , Oguma Eiji , Nishikawa Masanori , Tanami Yutaka , Kitami Masahiro , Hosokawa Takahiro

Keywords:  hepatoblastoma, lung metastasis, chest CT

Critser Paul,  Higano Nara,  Kingma Paul,  Fleck Robert,  Lang Sean,  Hirsch Russel,  Taylor Michael,  Woods Jason

Final Pr. ID: Paper #: 017

BPD is associated with pulmonary hypertension (PH) and patients with BPD-associated PH (BPD-PH) have increased morbidity and mortality. Noninvasive assessment of BPD-PH has traditionally relied on echocardiograms. However, recent advances have allowed the use of MRI in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, increased left ventricular eccentricity index (MR-EI) and decreased MRI septal curvature correlate with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of MR-EI and septal curvature in neonates with BPD and BPD-PH with short term respiratory outcomes and need for pulmonary vasodilator therapies. Read More

Authors:  Critser Paul , Higano Nara , Kingma Paul , Fleck Robert , Lang Sean , Hirsch Russel , Taylor Michael , Woods Jason

Keywords:  Outcomes, Neonatal, lungs

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

Siegel Marilyn,  Ramirez Giraldo Juan Carlos,  Cullinane Mike,  Bhalla Sanjeev

Final Pr. ID: Paper #: 136

Patients undergoing lung and stem cell transplants require serial CT examinations and hence dose reduction techniques are mandatory. The newest 3^rd generation dual-source CT scanner incorporates spectral beam shaping at 100 kilovoltage (kVp) using a dedicated tin filter (100 kVp Sn), which improves dose efficiency by removing low-energy photons that contribute little to noncontrast image quality. The purpose of this study was to compare radiation exposure in non-contrast-enhanced pediatric chest CT at 100 kVp Sn imaging and at conventional low kVp imaging in the same patient cohort. Read More

Authors:  Siegel Marilyn , Ramirez Giraldo Juan Carlos , Cullinane Mike , Bhalla Sanjeev

Keywords:  Dose Reduction, ALARA, Lung and Stem Cell Transplant

Goncalves Luis,  Jamshidi Ramin,  Biyyam Deepa,  Patel Mittun,  Cornejo Patricia

Final Pr. ID: Poster #: SCI-006

The purpose of this case report is to alert the reader to a rare differential diagnosis for infra- as well as intradiaphragmatic lung sequestration. A 38-year-old G2P0010 pregnant patient was referred for fetal magnetic resonance imaging (MRI) due to a 14.2 x 20.2 x 18 mm left paraspinal hyperechogenic mass with no internal vascularity and no convincing systemic arterial feeding vessel concerning for neuroblastoma as seen by ultrasound (US) performed at 34 weeks. Fetal MRI performed the same week showed a homogeneous T2-hyperintense left paraspinal mass in close apposition to and associated with a small area of loss of continuity in the diaphragm. This has been previously reported by postnatal computerized tomography as the "split diaphragm" sign in a case of intradiaphragmatic lung sequestration (Meier AH, Eggli KD, Cillei RE. Intradiaphragmatic extralobar sequestration: a rare pulmonary anomaly. Pediatr Surg 200;44:e27-29). Thus, the differential diagnosis provided at the time was congenital intradiaphragmatic sequestration and neuroblastoma. The fetus delivered via uncomplicated spontaneous vaginal delivery at term. Postnatal US performed at the age of 15 days showed a left hyperechogenic mass extending from the left lower chest to the ipsilateral retroperitoneum through a small defect in the diaphragm, favored to represent an extrapulmonary lung sequestration. The left adrenal gland was normal. A follow-up CT performed at 7 months of age showed a 2.6 cm left paraspinal mass with no systemic arterial blood supply to support the diagnosis of sequestration. The differential diagnosis at the time included neurogenic tumor or a myofibroma arising from the diaphragm. Follow-up CT at 13 months of age showed similar findings. The patient underwent uneventful laparoscopic removal of the mass with a final pathological diagnosis of congenital adrenal rest. Congenital adrenal rest presenting as a diaphragmatic mass is rare and as been reported once in an adult patient with an adenoma in heterotopic adrenal tissue located in the left diaphragm, diganosed because of mass effect in the gastric fundus during an uper gastrointestinal series (Keirns MM. Two unusual tumors of the diaphragm. Radiology 1952; 52:542-547). We hope this report raises awareness of this entity as a potential differential diagnosis for prenatal masses seen in close relationship with the adrenal gland and/or diaphragm. Read More

Authors:  Goncalves Luis , Jamshidi Ramin , Biyyam Deepa , Patel Mittun , Cornejo Patricia

Keywords:  lung sequestration, neuroblastoma, adrenal rest

Defendi Larissa,  Yokoo Patricia,  Shoji Hamilton,  Balancin Marcelo,  Chate Rodrigo

Final Pr. ID: Poster #: EDU-079

Congenital lung malformations are a heterogeneous group of developmental disorders whose etiology is not well stablished. Since they represent a spectrum of anomalies, diverse imaging appearance and clinical manifestations can be found. Although rare, their clinical importance is remarkable. Some of them can be a source of important morbidity and mortality in infants and children. Others, however, remain asymptomatic and may be incidentally detected in adulthood. Nowadays, these malformations are usually diagnosed in utero by prenatal imaging. In order to optimize diagnostic accuracy and disease management, it is imperative for radiologists to be familiar with the imaging characteristics of each lesion and the proper methods employed in their evaluation.

The purpose of this exhibit is:
- To describe the postnatal radiological appearance of some congenital lung diseases on conventional radiography, ultrasound (when available) and cross-sectional imaging methods;
- To conduct a brief review of the literature regarding etiology, epidemiology, clinical features and adequate diagnostic approach;
- To highlight the key imaging findings of each abnormality and their differential diagnoses;
- To briefly discuss management and follow-up of each condition.

Illustrative cases from our Radiology Department will be used to demonstrate the following entities:

1. Parenchymal anomalies:
- Lung hypoplasia;
- Congenital bronchial atresia;
- Congenital lobar emphysema;
- Congenital pulmonary airway malformation (previously known as congenital cystic adenomatoid malformation);
- Pulmonary bronchogenic cysts;
- Tracheal bronchus;
- Accessory cardiac bronchus.

2. Vascular anomalies:
- Interruption of a main pulmonary artery;
- Pulmonary artery stenosis;
- Anomalous pulmonary venous drainage.

3. Combined parenchymal and vascular anomalies:
- Bronchopulmonary sequestration;
- Hypogenetic lung (scimitar) syndrome. Read More

Authors:  Defendi Larissa , Yokoo Patricia , Shoji Hamilton , Balancin Marcelo , Chate Rodrigo

Keywords:  Congenital, Vascular, Lung

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

Emerson Miriam,  Barth Richard,  Rubesova Erika,  Halabi Safwan,  Rosenberg Jarrett,  Hintz Susan,  Blumenfeld Yair,  Girsen Anna,  Neves Stephanie,  Homeyer Margaret

Final Pr. ID: Poster #: SCI-039

Congenital Pulmonary Airway Malformation Volume Ratio (CVR) is widely used during prenatal ultrasound to predict outcome of fetuses with bronchopulmonary malformations (BPM). Since fetal MRI is often performed in fetuses with BPM, the aim of our study is to correlate CVR measurements by MRI and US, to compare inter-observer agreement of CVR measured by area-based MRI volume, diameter-based volume and to assess whether large lesions would be prone to more variability in CVRs among observers. Read More

Authors:  Emerson Miriam , Barth Richard , Rubesova Erika , Halabi Safwan , Rosenberg Jarrett , Hintz Susan , Blumenfeld Yair , Girsen Anna , Neves Stephanie , Homeyer Margaret

Keywords:  Bronchopulmonary malformation, CVR, lung

Deboer Emily,  Deterding Robin,  Lynch David,  Humphries Stephen,  Jacob Joseph,  Devaraj Anand,  Ley-zaporozhan Julia,  Griese Matthias,  Schiwek Marilisa,  Stowasser Susanne,  Clerisme-beaty Emmanuelle

Final Pr. ID: Paper #: 034

Children’s interstitial lung diseases (chILD) comprise a large spectrum of rare diffuse lung disorders, with a subset of patients developing chronic fibrosing lung disease. While imaging criteria for lung fibrosis are established for adults and correlate with prognosis and outcome, there are limited data on imaging for diagnosis, prognosis, and outcomes in children with fibrotic lung disease. To fill this gap, a group of ILD specialists aimed to define the imaging features for diagnosis of lung fibrosis for a forthcoming randomized trial of nintedanib versus placebo in pediatric patients with fibrosing ILD (1199-0337; NCT04093024). Read More

Authors:  Deboer Emily , Deterding Robin , Lynch David , Humphries Stephen , Jacob Joseph , Devaraj Anand , Ley-zaporozhan Julia , Griese Matthias , Schiwek Marilisa , Stowasser Susanne , Clerisme-beaty Emmanuelle

Keywords:  childhood interstitial lung disease, computed tomography, fibrosis criteria

Saito Yuki,  Miyazaki Osamu,  Onishi Saki,  Irahara Saho,  Okamato Reiko,  Miyasaka Mikiko,  Tsutsumi Yoshiyuki,  Nosaka Shunsuke,  Matsumoto Kimikazu

Final Pr. ID: Poster #: SCI-033

The objective of this study was to evaluate the benefits of thin-slab maximum intensity projection (MIP) images for the detection of lung nodules in pediatric chest CT. Read More

Authors:  Saito Yuki , Miyazaki Osamu , Onishi Saki , Irahara Saho , Okamato Reiko , Miyasaka Mikiko , Tsutsumi Yoshiyuki , Nosaka Shunsuke , Matsumoto Kimikazu

Keywords:  maximum intensity projection, lung nodule, CT

Aboughalia Hassan,  Dighe Manjiri

Final Pr. ID: Poster #: EDU-010

Fetal lung maturity is a key factor determining perinatal morbidity and mortality. Clinicians can perform amniocentesis and evaluate the amniotic fluid for certain surfactant byproducts such as lethicin, sphingomyelin, and phosphatidylglycerol to assess lung maturity. However, amniocentesis is invasive, and its results can be prone to errors. Imaging can offer a reliable non-invasive alternative that can be used for prognostication as well as suggestion of further follow up. Ultrasound is the imaging modality of choice to assess fetal development. It is readily available on widespread scale to assess for various abnormalities that can occur during pregnancy. Parameters used to assess fetal lung maturity on ultrasound include lung to head ratio as well as the observed/expected lung to head ratio. However, ultrasound parameters can be subjective, have inter- and intra-observer variability and depend highly on the imaging technique and quality. The advent of ultrafast MRI sequences expanded its use in fetal imaging offering an alternative to ultrasound. It is generally used as a problem-solving tool due its excellent soft tissue resolution. Two parameters are gaining acceptance as means to assess fetal lung development on MRI: lung volume measurements and lung/liver signal intensity ratio. Our exhibit aims at familiarizing pediatric radiologists with parameters used to assess lung development on both ultrasound and MRI. Read More

Authors:  Aboughalia Hassan , Dighe Manjiri

Keywords:  Lung maturity, Fetal Imaging

Shelmerdine Susan,  Semple Thomas,  Spencer Helen,  Pillai Anjay,  Owens Catherine

Final Pr. ID: Poster #: CR-004

To evaluate the radiographic and CT appearances of filamin A (FLNA) mutation related lung disease and review the available medical literature regarding this new entity. Read More

Authors:  Shelmerdine Susan , Semple Thomas , Spencer Helen , Pillai Anjay , Owens Catherine

Keywords:  Lung, CT, Interstitial Lund Disease, ChILD classification, Emphysema

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

Bhatia Anmol,  R Rajath,  Rani Usha,  Saini Shiv,  Saxena Akshay,  Sodhi Kushaljit

Final Pr. ID: Poster #: CR-007

A full-term newborn male was admitted to pediatric emergency on day one of life with respiratory distress and dysmorphism, which included radio-ulnar hemimelia, retrognathia, scoliosis, and clinodactyly. Antenatal fetal echocardiography had shown presence of mildly dilated right atrium and right ventricle with the possibility of aortic arch anomaly. Infantogram showed absent radius on right side with hypoplastic radius on left side, multiple digital anomalies in bilateral hands, and multiple segmentation anomalies in the entire spine. Echocardiography was done and it showed the presence of atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). However, the arch of aorta and the descending thoracic aorta could not be evaluated due to poor acoustic window.
For better delineation of arch anatomy, the child underwent Computed tomography angiography (CTA). CTA confirmed the findings of ASD and VSD. In addition, there was dextrocardia with the heart being placed in the right hemithorax. A band of pulmonary parenchyma was seen extending between the bases of right and left lung between the heart anteriorly and the esophagus and spine posteriorly, thus establishing the diagnosis of horseshoe lung. The right lung was hypoplastic and two blind ending air filled diverticulae were seen arising from trachea at D2-D3 level and D5-D6 level, possibly representing atretic/ rudimentary right-sided bronchi. The bronchus supplying hypoplastic right lung was seen to arise from the left main bronchus suggestive of a bridging bronchus, which was diffusely attenuated in caliber with near complete occlusion in its proximal part near its origin. The main pulmonary artery was dilated. The left pulmonary artery was seen to be coursing anterior to the esophagus behind the left main bronchus, thus confirming the presence of pulmonary arterial sling. The right pulmonary artery was seen arising as a small caliber vessel from the left pulmonary artery and was seen supplying the hypoplastic right lung. Apart from the above findings, there was also presence of coarctation of aorta just distal to the origin of the left subclavian artery for a length of ~6mm with post stenotic dilatation. Considering the various co-existing anomalies on the imaging, a final diagnosis of LACHT syndrome (Mardini-Nyhan association) was made. Read More

Authors:  Bhatia Anmol , R Rajath , Rani Usha , Saini Shiv , Saxena Akshay , Sodhi Kushaljit

Keywords:  LACHT, Mardini-Nyhan, Horseshoe lung

Tanaka Yoshihiro,  Nakagawa Motoo,  Ozawa Yoshiyuki,  Shibamoto Yuta

Final Pr. ID: Poster #: CR-019

The case was a fetus in a 29-year-old mother (gravida 3, para 1). At 29 weeks of gestation, she was referred to our hospital due to abnormality of fetal heart sounds. On fetal MRI, the right pulmonary agenesis was suspected. A 3.5-kg baby girl was born at 41 weeks and 1 day of gestational ages by cesarean section with Apgar scores of 6 and 9 at 1 and 5 minutes respectively. Her respiratory status was stable under administration of 30% oxygen in an incubator. Read More

Authors:  Tanaka Yoshihiro , Nakagawa Motoo , Ozawa Yoshiyuki , Shibamoto Yuta

Keywords:  Horseshoe lung, pulmonary　hypoplasia, pulmonary agenesis

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

Singh Jaspreet,  Tuburan Smyrna

Final Pr. ID: Poster #: CR-077

We report the case of a neonatal male with alveolar capillary dysplasia with misalignment of the pulmonary veins (ACD/MPV). ACD/MPV is a rare, fatal disorder of the development of the alveolar vasculature. In this disorder, alveolar capillaries are reduced in number and are improperly located within the walls of the alveoli impeding oxygen exchange. In addition to alveolar capillary abnormalities, there are other associated abnormalities with the cardiovascular, gastrointestinal tract, and genitourinary systems. In this report, we describe the case of a term male neonate with a prenatal diagnosis of hypoplastic left heart who developed respiratory distress shortly after birth. The patient required prolonged ECMO and underwent evaluation with CT angiography of the chest. CT findings included diffuse bilateral interstitial thickening with enhancing airspace disease scattered in the left lung. The respiratory distress continued to be unresponsive to treatment, with difficulty weaning ECMO and respiratory support. Life support was withdrawn on day 30. Pathologic examination at autopsy demonstrated ACD/MPV. Our case adds to the limited literature available in describing imaging findings of ACD/MPV and support for early diagnosis with lung biopsy as it can prevent aggressive futile interventions. Read More

Authors:  Singh Jaspreet , Tuburan Smyrna

Keywords:  Interstitial Lung Disease, diffuse lung developmental disease

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

Bezzant Braydan,  Guo Grace,  Roberie Dustin

Final Pr. ID: Poster #: CR-048

Down syndrome, typically caused by Trisomy 21, is the most common chromosomal abnormality resulting in intellectual disability affecting 1 in 600-800 pregnancies worldwide. Respiratory problems are the leading cause of hospitalizations and excess mortality in DS, accounting for 42% of admissions through age 2 years. Respiratory issues include pulmonary vascular disease, recurrent respiratory infection, sleep-disordered breathing, airway abnormalities, or subpleural cysts. Abnormalities like craniofacial anomalies, developmental delay, chronic aspiration, and hypotonia contribute to the severity of respiratory issues. Independent of congenital heart defect status, the lungs of DS children have widened alveolar ducts, and fewer and enlarged alveoli. These alveolar changes along with connective tissue abnormalities are believed to contribute to the development of subpleural cysts found in up to 20-36% of DS children. The clinical significance of these cysts is variable. It is important for radiologists to be familiar with subpleural cysts associated with DS as it may prevent misdiagnosis with other serious conditions. Additionally, subpleural cysts may increase the risk for pneumothorax or parenchymal damage during mechanical ventilation or surgery. Generally, subpleural cysts are poorly seen on radiographs and have been primarily identified using CT. We present a 5 year old male with DS, born at 36 weeks gestation, who presented to the emergency room with cough, rhinorrhea, and fever. He had no history of respiratory issues and received routine vaccinations. Chest radiograph revealed bilateral apical predominant subpleural cystic lucencies, perihilar fullness, and peribronchial cuffing. He was diagnosed with acute upper respiratory infection and discharged home with symptomatic management and outpatient follow-up. Sedated CT of the chest two weeks later had findings of diffuse bilateral subpleural and perilymphatic cysts, small subpleural calcifications, and mild scattered interlobular septal thickening. Since he did not have respiratory issues at baseline or after his illness, there was less concern for progressive disease requiring intervention and he was managed with conservative monitoring. Our case highlights the importance of recognizing pulmonary manifestations frequently associated with DS to improve disease recognition and prevention of complications. Read More

Authors:  Bezzant Braydan , Guo Grace , Roberie Dustin

Keywords:  Cystic Lung Disease

Sharma Priya,  Schaiberger Gregory,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-076

In this educational exhibit, we will present a series of childhood interstitial lung diseases (chILD) cases from our institution and present the x-ray and computed tomography (CT) images. We will describe a wide variety of pathologies that are encountered but are rare. We will discuss key imaging features and include teaching points of these chILDs. Read More

Authors:  Sharma Priya , Schaiberger Gregory , Rajderkar Dhanashree

Keywords:  chILD, Interstitial Lung Disease, Infectious

Barrera Christian,  Andronikou Savvas,  Tapia Ignacio,  White Ammie,  Biko David,  Otero Hansel

Final Pr. ID: Paper #: 008 (S)

To describe the normal progression of quantitative CT chest parameters in children Read More

Authors:  Barrera Christian , Andronikou Savvas , Tapia Ignacio , White Ammie , Biko David , Otero Hansel

Keywords:  Quantitative, CT, Lung

Chang Hailey,  Gill Christopher,  Setty Bindu,  Castro-aragon Ilse,  Camelo Ingrid,  Etter Lauren,  Pieciak Rachel,  Thompson Russell,  Wang Kaihong,  Li Jason

Final Pr. ID: Poster #: EDU-060

Pneumonia is a leading cause of pediatric morbidity and mortality worldwide. In 2017, 15% of under-5 mortalities were due to pneumonia. Children in sub-Saharan Africa are disproportionately affected. Chest radiography (CXR) is currently the reference standard for imaging diagnosis of pediatric lung diseases. However, radiographic equipment is not available in many clinical settings, particularly in low and middle-income countries. In these scenarios, point-of-care lung ultrasound (LUS) is much more readily accessible. Thus, it is important to understand the US appearance of both interstitial and bacterial pneumonias and how they correlate with CXR findings.

In this pictorial essay, we will discuss the US appearance of common lower respiratory tract infections such as RSV, COVID-19, and bacterial pneumonia using images obtained from patients ages 1 month to 5 years with symptomatic respiratory illness in Lusaka, Zambia. All images were obtained by a technologist with a Butterfly portable ultrasound probe connected to an iPad. Images were obtained in the anterior, lateral, and posterior lung fields bilaterally. US images will be correlated with CXR findings.

The following examples of LUS findings will be discussed: 1) Normal LUS: The pleural line is thin and smooth with normal lung sliding. A-lines are present, and B-lines are limited to less than three in each field of view. 2) Abnormal B-lines: When three or more B-lines are seen in a single field of view, there is an abnormal increase in interstitial fluid. A focal B line is an abnormally thickened B-line and likely represents a confluence of multiple B-lines. 3) White lung: Confluent echogenicity involving two or more rib interspaces. 4) Pleural irregularity: The pleural line is jagged or fragmented and may also appear thickened with small sub-centimeter subpleural consolidations. 5) Pleural effusion: Well-defined fluid above the diaphragm. In a simple transudative effusion, the fluid appears anechoic. In a complex exudative effusion, the fluid may have loculations, septations, and/or internal echogenic floating debris. 6) Consolidation: Poorly defined, tissue-like region within the lung, usually seen adjacent to the pleural line. 7) Lung necrosis or abscess: Well-defined, hypoechoic region within an area of consolidation. By understanding the US appearance of lung pathologies, LUS can be used to diagnose pediatric lung diseases in areas where CXRs are currently unavailable. Read More

Authors:  Chang Hailey , Gill Christopher , Setty Bindu , Castro-aragon Ilse , Camelo Ingrid , Etter Lauren , Pieciak Rachel , Thompson Russell , Wang Kaihong , Li Jason

Keywords:  Lung Ultrasound, RSV, Pneumonia

Biko David,  Johnstone Jordan,  Dori Yoav,  Itkin Maxim,  Oliver Edward,  Victoria Teresa

Final Pr. ID: Poster #: SCI-004

Clinical signs of the Neonatal Lymphatic Flow Disorder (NLFD) are a combination of the congenital chylothorax, chylous ascites and body edema. It can present as neonatal chylothorax (NC), neonatal chylous ascites, or congenital lymphatic dysplasia (CLD). The prenatal appearance of lymphangiectasia has been described as nutmeg lung. The purpose of this study is to describe prenatal and postnatal imaging features and outcomes of neonates with NLFD.
Read More

Authors:  Biko David , Johnstone Jordan , Dori Yoav , Itkin Maxim , Oliver Edward , Victoria Teresa

Keywords:  lymphatic imaging, nutmeg lung, neonatal lymphatic flow disorder

Tan Fei,  Zapala Matthew,  Durand Rachelle,  Chan Marilynn,  Larson Peder

Final Pr. ID: Poster #: SCI-035

MRI is not routinely used in clinical practice for lung imaging because of the low proton density and respiratory motion artifact. However, the ultrashort echo time (UTE) MRI technique can increase the signal in the lung. Image reconstruction techniques, such as iterative motion compensated (iMoCo) reconstruction, have improved respiratory motion management for free-breathing lung MRI scans. With the advantage of no ionizing radiation, MRI can benefit patients with immunodeficiency who often require repeat imaging, patients with heightened radiation sensitivity, and/or pediatric patients. In this abstract, we aim to evaluate the imaging quality of UTE lung MRI in the pediatric population. Read More

Authors:  Tan Fei , Zapala Matthew , Durand Rachelle , Chan Marilynn , Larson Peder

Keywords:  MRI, Image Quality, Lung

Alford Raphael,  Rubesova Erika,  Halabi Safwan,  Blumenfeld Yair,  Hintz Susan,  Barth Richard

Final Pr. ID: Poster #: SCI-049

The purpose of this study is to determine the reliability of sonographic (US) lung measurements compared with Fetal MR in fetuses with congenital diaphragmatic hernia. The sonographic lung head ratio (LHR) is a widely used prognostic tool in CDH, but can be difficult to obtain due to shifted mediastinum and fetal position. To our knowledge, comparison of MRI measured LHR with US has not been previously reported. Read More

Authors:  Alford Raphael , Rubesova Erika , Halabi Safwan , Blumenfeld Yair , Hintz Susan , Barth Richard

Keywords:  Congenital diaphragmatic hernia, Lung head ratio, LHR, Fetal MRI, Lung volumes

Rodriguez Ruiz Felipe,  Benscoter Dan,  Tiao Gregory,  Feng Christina,  Hart Catherine,  Fleck Robert

Final Pr. ID: Poster #: CR-013 (S)

Demonstrate a rare cause of respiratory distress in a full-term newborn to illustrate the importance of chest radiography (CXR) in guiding the work up. Read More

Authors:  Rodriguez Ruiz Felipe , Benscoter Dan , Tiao Gregory , Feng Christina , Hart Catherine , Fleck Robert

Keywords:  Bronchogenic Cyst, Chest MRI, hyperlucent lung

Castro Denise,  Kolar Mila,  Soboleski Don

Final Pr. ID: Poster #: EDU-103

Post-traumatic intercostal lung herniation (ICLH) is defined as a protrusion of lung tissue through a defect in the intercostal space musculature and is a rare result of chest trauma. Due to its rarity, the management and imaging work up has been based on the adult experience, with Computed Tomography (CT) the most common diagnostic tool and surgery the primary management approach.
The purpose of this study is to describe the sonographic appearance and technique utilized in diagnosis of post-traumatic ICLH and to support their inclusion in a proposed imaging algorithm to aid in management in the pediatric population. Read More

Authors:  Castro Denise , Kolar Mila , Soboleski Don

Keywords:  intercostal lung herniation, sonography, imaging algorithm

Steinhardt Nicole,  Meyers Mariana,  Brown Brandon

Final Pr. ID: Poster #: EDU-007

Fetal MRI is now an important adjunct imaging modality in the evaluation of complex fetal anomalies, including cystic renal disease. The improved resolution and anatomic detail of the renal parenchyma offered by MRI can assist with identification, localization, and characterization of cystic lesions which are less clearly visualized on ultrasound. Advanced imaging adds value through enabling prenatal prognostication and patient counseling. In this presentation, we evaluate the spectrum of renal cystic abnormalities at the microscopic and macroscopic scale, and review the patterns of disease by cyst location, effect on parenchymal integrity, and obstruction of the collecting system. A clearer understanding of the diverse appearances and broad spectrum of outcomes of these fetal anomalies can contribute to more detailed treatment planning and more precise, family-centered care.
In this presentation, we review the varied patterns of cystic renal disease as identified on fetal MRI, highlighting those forms known to be more associated with perinatal morbidity and mortality. Further, we correlate their appearance on MRI with pre- and post-natal US imaging, as well as pathologic findings. Finally, we will describe secondary prenatal imaging biomarkers that may be valuable in counseling and also with both definitive and palliative surgical planning.
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Authors:  Steinhardt Nicole , Meyers Mariana , Brown Brandon

Keywords:  MCDK, ARPKD, Lung