López Diana,  Arrate Antonia,  Leal Camilo,  Méndez Daniela,  Pérez-marrero Lizbet

Final Pr. ID: Poster #: CR-043

Case report: Congenital bronchobiliary fistula is a rare congenital malformation, with high morbidity and mortality. It is characterized by a communication between the respiratory and digestive tracts, between a bronchus and the bile duct.
This is a full-term female newborn patient, appropriate for gestational age, who from the third day of life presents with progressive respiratory difficulty associated with abundant waste through a nasogastric tube. She evolved with greater respiratory difficulty, so she was kept on a complete bowel rest and with a nasogastric tube, which increased his output. Airway aspiration was suspected, and an esophagus-stomach-duodenum study was performed to evaluate gastroesophageal reflux, which was normal. The study continued with abdominal ultrasound, showing aerobilia.
The patient evolves with severe respiratory distress and requires mechanical ventilation on day 15, so a chest tomography is performed, which shows aerobilia and a communicating tract between the right main bronchus and the bile duct.
Surgical management was performed with closure of the proximal end of the fistula at the supradiaphragmatic level, without intervening the intrahepatic tract.
The newborn later develops cholestatic syndrome, which is studied with cholangiopancreatography magnetic resonance (MRCP) that reports atresia of the extrahepatic bile ducts, performing an entero-biliary anastomosis in a second surgical procedure.
During her childhood after being discharged, she was diagnosed with several obstructive bronchial syndromes, cholangitis and malnutrition, remaining stable at the outpatient level. She is currently 15 years of age, her only chronic illness being with chronic liver disease, without evidence of clinical or elastographic fibrosis.
Bronchobiliary fistula presents as bronchitis and repeated bronchopneumonia, bilioptysis, cholangitis and sepsis in some cases. Proposed etiologies are either union of an accessory bronchus with an aberrant bile duct or duplication of the foregut. This diagnosis can be associated with other malformations such as bile duct atresia and right diaphragmatic hernia. Computed tomography with 2D and 3D reconstructions and MRCP are recommended for diagnostic workup. Read More

Authors:  López Diana , Arrate Antonia , Leal Camilo , Méndez Daniela , Pérez-marrero Lizbet

Keywords:  Bronchobiliary fistula, Congenital malformation, Bilioptysis

Murphy Ryan,  Murati Michael,  Holm Tara,  Dietz Kelly

Final Pr. ID: Poster #: EDU-012

The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist.

Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More

Authors:  Murphy Ryan , Murati Michael , Holm Tara , Dietz Kelly

Keywords:  anterior meningocele, low flow vascular malformation, enteric cyst

Bellew Elizabeth,  Sonstegard Anna Marie,  Finelt Nika,  Goldfisher Rachelle

Final Pr. ID: Poster #: CR-004

A full-term male was born with a 7 x 7 cm subcutaneous mass with central dark blue discoloration and peripheral erythema on the right flank/buttock. Initial hip and pelvis radiograph at one day old did not show evidence of calcifications. An ultrasound demonstrated an ill-defined, heterogeneous mass with internal vascularity with invasion of underlying muscle. MRI of the abdomen and pelvis with contrast at two days of age showed a T2 hyperintense mass with mild postcontrast enhancement within the right flank with infiltration of the underlying muscles including the right psoas, iliacus, gluteal, and the left erector spinae. The differential diagnosis included: kaposiform hemangioendothelioma, rhabdomyosarcoma (RMS), tufted angioma and neuroblastoma.

Given the broad list of differential diagnoses, a core biopsy of the right buttocks was obtained at 6 days of age to further characterize the lesion. Hematoxylin and eosin stained sections demonstrated highly collagenized and sclerotic spindle cells involving the adipose tissues extending into the dermis. Immunohistochemical stained sections showed positivity to desmin, myogenin and MyoD1. Fluorescence in situ hybridization studies indicated the presence of a VGLL2 gene rearrangement. These pathologic findings were consistent with sclerosing spindle cell RMS. At 13 days old, a PET scan showed the right flank lesion with minimal to no FDG uptake, a finding which is consistent with sclerosing RMS given that this sub-type consists mainly of collagen. There were no pulmonary nodules. After multiple chemotherapy cycles, subsequent MRIs of the abdomen and pelvis showed no residual enhancing lesion. The patient will be closely followed for local recurrence.

RMS, the most common soft tissue tumor seen in children, are mesenchymal tumors of skeletal muscle and are most often seen in head and neck, but are less commonly noted on the flank. Sclerosing spindle cell RMS is a subtype often seen in childhood, but exceedingly rare in newborns. Cutaneous RMS should be considered in the differential diagnosis of a large subcutaneous lesion in a newborn. Read More

Authors:  Bellew Elizabeth , Sonstegard Anna Marie , Finelt Nika , Goldfisher Rachelle

Keywords:  Rhabdomyosarcoma, Sclerosing Spindle Cell Rhabdomyosarcoma, Vascular Malformation

Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Final Pr. ID: Poster #: EDU-065

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

Authors:  Gual Fabiana , Lima Natalia , Matsuoka Marcia , Sameshima Yoshino

Keywords:  vascular anomalies, hemangioma, vascular malformations

Gaballah Marian,  Goldfisher Rachelle

Final Pr. ID: Poster #: EDU-096

Lymphatic malformations (LMs) are low-flow vascular malformations which are composed of dilated lymphatic channels, forming septated cyst-like structures (2). LMs are the second most common type of vascular malformation, second to venous malformations (1). The most common locations are in the neck, followed by the axillary region. On MRI, LMs are multiloculated, T2 hyperintense lesions, which may have fluid-fluid levels, and are without flow voids (1, 2). They can involve multiple tissue planes and do not regard anatomical and fascial boundaries (2). Cystic lymphatic malformations are further divided into microcystic, macrocystic, or mixed, based on the size of their cystic components. Macrocystic LMs are composed of larger cysts, while microcystic LMs are composed of smaller cysts and may appear solid on imaging.

We present ten cases of microcystic, macrocystic, and mixed lymphatic malformations in a variety of anatomical locations. In addition to demonstrating the imaging findings, we present a review of the literature in regards to each anatomical region. Lymphatic malformations in this presentation include right orbit (n=1), mediastinum (n=2), pulmonary bronchovascular bundles/pleural space (n=1), retroperitoneum (n=1), mesentery (n=2), perirectal and scrotal (n=1), lower extremity (n=2). 6 of these children also had additional sites of T2 hyperintense disease involving the bones or spleen, suggestive of additional lymphangiomas.

This presentation summarizes ten cases of lymphatic malformations in a variety of less common anatomical locations and a review of the pertinent literature.

References:

1. Flors L, Leiva-Salinas C, Maged IM et al. (2011) MR Imaging of Soft-Tissue Vascular Malformations: Diagnosis, Classification, and Therapy Follow-up. Radiographics 31:1321-1340.
2. White CL, Olivieri B, Restrepo R et al. (2016) Low-flow vascular malformation pitfalls: from clinical examination to practical imaging evaluation- part 1, lymphatic malformation mimickers. AJR 206: 940 – 951. Read More

Authors:  Gaballah Marian , Goldfisher Rachelle

Keywords:  Lymphatic malformation, Vascular Malformation

Kinariwala Dhara,  Daugherty Reza,  Park Auh Whan

Final Pr. ID: Poster #: EDU-009 (S)

Comprehensive radiologic evaluation and accurate diagnosis of vascular malformations is vital to guide optimal treatment. Technical approaches and sclerotic agents used by interventional radiology vary by the type of malformation, anatomic location, and architecture of the malformation. Proper pre-procedural characterization of hard-to-treat lesions impacts procedural success and long-term outcomes.

Most vascular malformations located superficially on the extremities and trunk, and can be evaluated with ultrasound and color Doppler. However, evaluation can be complicated by unusual locations and difficulty in characterization, requiring MRI and/or MRA. We present interesting pediatric vascular malformations challenging for both imaging diagnosis and treatment.

The objectives of this poster include:
1. To review the classification and nomenclature of vascular malformations.
2. To present multimodal imaging findings of vascular malformations.
3. To discuss diagnostic imaging approaches of vascular malformations.modalities used.
4. To describe the treatment approaches for these malformations and outcomes including technical considerations and follow up. Read More

Authors:  Kinariwala Dhara , Daugherty Reza , Park Auh Whan

Keywords:  Vascular Malformations

Bhalla Deeksha,  Jana Manisha,  Manchanda Smita,  Bhalla Ashu,  Naranje Priyanka

Final Pr. ID: Poster #: EDU-069

Teaching points:

The spectrum of neck masses in neonates and infants (< 2 years) differs considerably from those in older children
Understand characteristic imaging appearances, particularly recognise entities that do not require sampling for diagnosis
Learn algorithmic approach to differential diagnosis based on age and lesion morphology with case based examples

Table of contents:
Introduction: Incidence, clinical considerations
Classification:
Age: Neonate
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst
Solid:
Germ cell tumor
Congenital hemangioma
Neuroblastoma
Mixed
Primitive myxoid mesenchymal tumor (PMMT)
Teratoma

Age: Older infants
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst

Solid:
Lymphoma
Granulocytic sarcoma
Rhabdomyosarcoma
Multinodular vacuolating tumor of infancy (MNTI)
Solitary fibrous tumor (SFT)
Fibrous tumors: Fibrous hamartoma of infancy, infantile fibrosarcoma

Vascular malformation (microcystic lymphatic, venolymphatic, arteriovenous)

Infections
Ludwig angina
Zygomycosis

Practical diagnostic algorithms based on age, location (involved neck space) and morphology
Conclusion Read More

Authors:  Bhalla Deeksha , Jana Manisha , Manchanda Smita , Bhalla Ashu , Naranje Priyanka

Keywords:  Neck tumor, congenital, vascular malformation

Kinariwala Dhara,  Daugherty Reza

Final Pr. ID: Poster #: EDU-078

Although rare, CLOVES syndrome, a PIK3CA-related congenital overgrowth disorder, presents radiologists with opportunity for vital diagnostic and treatment planning. CLOVES syndrome is characterized by Congenital Lipomatous Overgrowth of the trunk, Vascular malformations, Epidermal naevi, and Skeletal and Spinal anomalies. Multimodal imaging findings can help distinguish CLOVES from other overgrowth syndromes such as Proteus syndrome and Klippel-Trenauny syndrome. We present multimodal imaging of four patients with CLOVES syndrome which demonstrate characteristic findings:

- Thoracic lipomatous hyperplasia, a key sign of CLOVES syndrome in which predominantly thoracic lipomatous masses grow in the subcutaneous tissues and invade the pleura, mediastinum, and upper abdomen, often with superficial vascular malformations
- Renal anomalies, including agenesis, hypoplasia, hydronephrosis, and cysts.
- Vascular malformations, including venous, venolymphatic, and lymphatic malformations
- Spinal cord defects, including spina bifida, medullary arteriovenous shunts, and congestive myopathy of the paravertebral venous plexus

Management of CLOVES syndrome focuses on debulking of lipomatous masses, treatment of clinically significant vascular malformations, and medical management of renal and neurologic sequelae. To that end, the role of the radiologist is accurate diagnosis of the syndromic pattern, isolation of the extent of lipomatous masses for pre-operative planning, and identification of renal and spinal cord anomalies.

The purpose of the poster is to:

1. Briefly review the types of congenital overgrowth disorders as demonstrated in various imaging modalities.
2. Focus on characteristic imaging findings of CLOVES syndrome.
3. Review the benefits and disadvantages of various imaging modalities.
4. Identify the most relevant radiologic findings for surgical, interventional and medical management.


Read More

Authors:  Kinariwala Dhara , Daugherty Reza

Keywords:  Congenital, Thoracic, Vascular Malformations

Madden Joseph,  Joya Sosa Yocelin,  Carrico Caroline,  Cao Joseph

Final Pr. ID: Poster #: CR-050

Background: Bronchopulmonary foregut malformations are defined as aberrant communications between an isolated segment of respiratory tissue and the esophagus or stomach. Based on the anatomic relationship of the fistulous connection, these rare malformations are classified into four groups (I–IV). Diagnosis typically involves a combination of cross-sectional imaging (CT or MRI) and an upper gastrointestinal series (UGI). Case: A 1-month-old infant with a history of lipomyelomeningocele was transferred from an outside hospital for neurosurgical evaluation. An incidental right lower lobe (RLL) pulmonary mass was identified on spinal MRI. Further evaluation with contrast-enhanced CT revealed a RLL lesion with a systemic arterial supply from the celiac artery. Internal cystic and branching lucencies were also present, raising concern for a hybrid lesion. The patient was discharged, and readmitted four months later for neurosurgical intervention for spinal dysraphism. The admission was complicated by intermittent oxygen desaturations, suspected to be secondary to gastroesophageal reflux. UGI revealed a communication between the lower esophagus and the isolated pulmonary segment in the right medial lung base confirming a diagnosis of group III CBPFM. Conclusions: This case highlights a hybrid lesion (sequestration and CPAM) with rare communication with the gastrointestinal tract, consistent with a communicating bronchopulmonary foregut malformation (CBPFM). Vague symptoms including recurrent pneumonia and workup for feeding intolerance often lead to delayed diagnosis. Surgical excision of CBPFMs is definitive treatment; however, identification of the communicating esophageal component is necessary prior to resection. Read More

Authors:  Madden Joseph , Joya Sosa Yocelin , Carrico Caroline , Cao Joseph

Keywords:  Bronchopulmonary Malformation, Bronchopulmonary Sequestration, CPAM

Stecher Priscilla,  Ordonez Alvaro,  Noor Abass

Final Pr. ID: Poster #: CR-023

Klippel-Trenaunay Syndrome (KTS) is a rare cutaneous vascular malformation syndrome involving capillary, venous, and lymphatic malformations often involving a unilateral lower limb. Patients with KTS can also have disease involvement of the gastrointestinal (GI) tract, predisoposing patients to GI bleeding. Here, we present a case of a 15-year-old male with known congenital Klippel-Trenaunay Syndrome involving the left lower extremity presenting with acutely worsening rectal bleeding. The patient presented with two weeks of rectal bleeding, fatigue, and weakness. On initial evaluation, the patient was found to have acute drop in hemoglobin concerning for active GI bleeding. Initial imaging included a tagged red blood cell scan, which demonstrated diffuse increased radiotracer activity along the left hemiabdomen, consistent with active bleed. However, the etiology/source of bleeding at this time could not be determined due to the extensive abdominal involvement. Further evaluation included CT angiography of the abdomen and pelvis, which revealed a large, extensive venous malformation extending throughout the wall of the descending and rectosigmoid colon, with venous malformation extending throughout the left lateral pelvic musculature. Arterial phase imaging demonstrated abnormal enhancement of the mucosa of the descending and rectosigmoid colon, and venous phase imaging demonstrated contrast blushing throughout the descending colon concerning for active bleeding, without clear identifiable source. Due to decline in clinical status and refractory anemia requiring massive transfusion, the patient was evaluated surgically and subsequently underwent emergent colectomy and left lower quadrant ostomy placement. Intraoperative findings demonstrated a massively dilated sigmoid colon with complex tangle of cavernous venous malformations involving approximately two feet of bowel. In setting of a technically challenging operation, the patient’s post-operative course has been complicated by rectal stump dehiscence, multiple pelvic abscesses, and guarded prognosis. In summary, KTS is a rare syndrome involving extensive capillary, lymphatic, and venous malformations, with gastrointestinal involvement predisposing patients to potential life-threating GI bleeding. Here we review a case of a 15-year-old male with KTS presenting with refractory GI bleeding in an extensive colonic vascular malformation necessitating emergent colectomy. Read More

Authors:  Stecher Priscilla , Ordonez Alvaro , Noor Abass

Keywords:  Klippel-Trenaunay Syndrome, Venous Malformation, Rectal Bleeding

Ugas Charcape Carlos,  Cerron Vela Carmen

Final Pr. ID: Paper #: 016

To characterize the range of cardiac and extracardiac CT findings in children with thoracic ectopia cordis in the setting of Cantrell syndrome.
Read More

Authors:  Ugas Charcape Carlos , Cerron Vela Carmen

Keywords:  Pentalogy Of Cantrell, Cardiac, Malformation

Close Orrie,  Squires Judy

Final Pr. ID: Poster #: EDU-097

There are numerous congenital anomalies of the gastrointestinal tract with varying frequency. Some anomalies are life-threatening and require prompt diagnosis with immediate treatment. Evaluation of patients with these anomalies can be complex, sometimes requiring multiple imaging modalities for accurate diagnoses and timely treatment. It is therefore essential for radiologists to have a firm understanding of specific imaging features. The purpose of this exhibit is to review common and uncommon congenital anomalies of the gastrointestinal tract, including clinical and imaging features as well as treatment options. Read More

Authors:  Close Orrie , Squires Judy

Keywords:  congenital, gastrointestinal, malformations

Funaro Kimberly,  Kucera Jennifer

Final Pr. ID: Poster #: EDU-033

Congenital chest lesions encompass a wide array of pathology with overlapping imaging characteristics. With prenatal ultrasound and MRI, more congenital chest lesions are being detected sooner, and it is important for radiologists to be familiar with their imaging findings for both diagnostic and prognostic purposes. This educational exhibit reviews the spectrum of pediatric congenital chest lesions and their key imaging findings.
Read More

Authors:  Funaro Kimberly , Kucera Jennifer

Keywords:  Chest, Congenital malformations

Plut Domen,  Zupancic Ziva,  Mali Brajovic Senja,  Kljucevsek Tomaz,  Tomazic Mojca,  Glusic Mojca,  Homan Matjaz

Final Pr. ID: Poster #: CR-006

Congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities in which the portal blood drains into a systemic vein. They are results of embryogenetic alterations during the complex development of the portal system in early gestational period. Anatomically they are classified into two groups; extrahepatic and intrahepatic. Extrahepatic shunts were first described in 1793 by Abernethy and are thus also called Abernethy malformations. Presentation of CPVS can be highly variable and consequences severe.

CASE1:
An 8 year old boy was admitted to our hospital due to severe abdominal pain. Doppler ultrasound (US) revealed an abnormal intrahepatic tubular vascular structure. The computed tomography angiography (CTA) confirmed a direct vascular connection between the left portal vein and the dilated left hepatic vein. The right portal vein was small in size, indicating main portal blood flow through the left side bypassing the liver. The treatment for this intrahepatic CPVS was embolization of the shunt. The boy has been well since the procedure.

CASE2:
A routine medical check-up in a 14 year old girl discovered abnormal liver function tests. Abdominal US showed a huge mass in the right lobe of the liver and a big mass of similar structure in the epigastrium. Portal vein was not identified. CTA showed a short main portal vein connected directly to the inferior vena cava, consistent with the Abernethy malformation. The big mass in the epigastrium was shown to be a tumor in the caudate lobe of the liver. Focal nodular hyperplasia (FNH) was considered for liver lesions due to the imaging findings and known association with the Abernethy malformation. Biopsy confirmed the diagnosis. The girl is currently waiting for liver transplantation, as it is the treatment of choice for this extrahepatic CPVS. Read More

Authors:  Plut Domen , Zupancic Ziva , Mali Brajovic Senja , Kljucevsek Tomaz , Tomazic Mojca , Glusic Mojca , Homan Matjaz

Keywords:  Congenital portosystemic venous shunt, Abernethy malformation, Intrahepatic shunt, Extrahepatic shunt

Hirsig Leslie,  Verma Nupur,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-115

Congenital and childhood findings of pulmonary artery anomalies are uncommon but not infrequently encountered by referral centers. We present by case examples anomalies of pulmonary arterial vasculature, and discuss their clinical presentation, associated cardiothoracic anomalies, and overall prognosis. Read More

Authors:  Hirsig Leslie , Verma Nupur , Sharma Priya , Rajderkar Dhanashree

Keywords:  Pulmonary anamolies, Congenital malformations, Pulmonary Origin, Pulmonary Hypertension, Pulmonary complications

Xu Hongmin,  Gagnon Marie-helene,  Ali Sumera,  Linam Leann

Final Pr. ID: Poster #: EDU-039

The purpose of this educational exhibit is to:
1.Review the embryology, classification, and imaging features of anorectal malformations (ARMs).
2.Review the indications and techniques of Contrast-enhanced colosonography (CeCS) in pediatric patients with ARMs.
3.Provide sample cases and clinical courses of patients with specific ARMs.

Anorectal malformations(ARMs) are a spectrum of congenital anomalies involving abnormal development of the distal rectum and anus, leading to an interruption or misconnection of the normal passage between the rectum and the perineum. The condition occurs in about 1 in 5,000 live births and can range from mild to complex. Children with ARMs require preoperative imaging to assess the presence and location of a fistula. Identifying the location of these fistulas is crucial for surgical planning.

Contrast-enhanced colosonography (ceCS) has emerged as a valuable tool in diagnosing pediatric ARMs, offering superior anatomical visualization and assessment compared to traditional imaging techniques like fluoroscopy, providing more sensitive and specific evaluation of fistula with real-time contrast filling. CeCS avoids ionizing radiation, and ultrasound contrast agents have a high safety profile with low incidence of adverse events compared to other contrast agents.

Contrast-Enhanced colosonography (CeCS) technique should include survey greyscale ultrasound examination of the pelvis to assess for adequate window. Lumason, the ultrasound contrast agent, is prepared and injected into a bag of saline, with a ratio of 1:500 mL. The mucous fistula is examined, and a small Foley catheter is inserted by the radiologist, then balloon is inflated to create a seal. Contrast is then instilled by gravity drip, and perineal structures are imaged through three standard approaches- transabdominal, transperineal and posterior sagittal approaches.

As well as reviewing the topics above, this review will also provide examples of ARM cases demonstrating high, intermediate, and low fistulas seen on CeCS.

Overall, CeCS enhances the diagnostic accuracy and management of pediatric ARMs. By providing detailed anatomical insights and allowing for accurate classification, it plays a critical role in guiding treatment strategies and improving long-term outcomes for affected patients. Read More

Authors:  Xu Hongmin , Gagnon Marie-helene , Ali Sumera , Linam Leann

Keywords:  Anorectal Malformation, Contrast Enhanced Ultrasound, Pre-Surgical Planning

Wepking Kelly,  Gill Kara,  Riedesel Erica

Final Pr. ID: Poster #: CR-068

Currarino’s Syndrome (CS) is a unique form of caudal regression syndrome characterized by triad of sacral dysplasia, anorectal malformation, and presacral mass. Additional congenital malformations of the genitourinary tract and spine may be present.

Currarino's Syndrome has a variety of clinical presentations - from asymptomatic to severe chronic constipation - depending on associated malformations. Early identification and adequate treatment prevents eventual serious complications.

Plain radiograph of the sacrum is the first diagnostic step. Ultrasound or pelvic/spinal MRI is used to better evaluate for presacral mass. Fluoroscopic enema studies may be used for further evaluation of anorectal malformation. Additional imaging of the GU tract with US and VCUG is suggested due to risk for associated GU anomaly or vesicoureteral reflux.

We present two cases of Currarino’s Syndrome which demonstrate classic imaging findings on plain film radiograph, ultrasound, and MRI.

Case 1 presented in infancy with severe chronic constipation. Abdominal radiograph demonstrated classic "scimitar" sacrum. Fluoroscopic enema demonstrated high grade anal stenosis. US and MRI of the spine and sacrum revealed large anterior sacral meningocele.

Case 2 presented at birth with imperforate anus. Abdominal radiograph demonstrated classic "scimitar" sacrum. MRI of the spine and sacrum revealed small anterior sacral meningocele. Additional GU anomalies were discovered including vesicoureteral reflux and uterine didelphis. Read More

Authors:  Wepking Kelly , Gill Kara , Riedesel Erica

Keywords:  Currarino's Triad, Sacral dysplasia, Presacral mass, Anorectal malformation, Case Report

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

Guo Chen,  Wang Qian,  Hu Li-wei,  Zhong Yu-min

Final Pr. ID: Poster #: SCI-004

The purpose of this study was to demonstrate manifestations of MSCT in Abernethy malformation and its diagnostic value. Read More

Authors:  Guo Chen , Wang Qian , Hu Li-wei , Zhong Yu-min

Keywords:  Abernethy malformation, Angiograph, Tomography

Gómez-chiari Marta,  Rebollo Polo Monica,  Planells Mariana,  San Roman Luis,  Eixarch Roca Elisenda,  Perez Cruz Miriam,  Fons Estupiña Maria Del Carmen,  Agut Quijano Thais,  Gonzalez Sandoval Lenia,  Blasco Sola Gerard

Final Pr. ID: Poster #: EDU-026

Fetal central nervous system (CNS) vascular malformations are rare, complex lesions requiring a structured, multidisciplinary approach. Fetal Magnetic Resonance Imaging (MRI) plays a pivotal role in lesion characterization, prognostic assessment, and perinatal planning.
This educational exhibit presents four representative entities—superior sagittal sinus thrombosis (SSST), vein of Galen malformation (VOGM), pial arteriovenous fistula (PAVF), and dural arteriovenous fistula (DAVF)—to illustrate a systematic MRI-based evaluation model integrating anatomic, hemodynamic, and prognostic data.
A vascular evaluation checklist is proposed for consistent interpretation, including:
Identification of abnormal arteriovenous connections (pial vs dural) and the presence or absence of a nidus.
Assessment of arterial feeders for hypertrophy or flow steal.
Evaluation of venous drainage patterns, sinus thrombosis, or aneurysmal venous dilation.
A prognostic checklist complements this approach, focusing on biomarkers of adverse outcome: parenchymal volume loss, white matter abnormalities (including Wallerian degeneration), irregular cortical contour, ventriculomegaly, intracranial hemorrhage, and signs of cardiac overload. In VOGM, a straight or falcine sinus diameter >7 mm identifies high-risk neonates requiring early intervention.
Dedicated fetal vascular MRI sequences—notably 3D time-of-flight (TOF) and angiographic/venographic acquisitions—are crucial for delineating arterial feeders, draining sinuses, and confirming arterialized flow. These sequences improve risk stratification, particularly in high-flow lesions such as VOGM and PAVF, where early recognition of parenchymal injury and hemodynamic impact is essential.
Finally, the integration of genetic testing (e.g., EPHB4, RASA1, ENG, COL4A1/2) refines classification, guides counseling, and identifies syndromic associations.
Overall, combining a structured MRI checklist with prognostic and genetic assessment enables accurate diagnosis, meaningful prenatal counseling, and standardized multidisciplinary management of fetal neurovascular malformations. Read More

Authors:  Gómez-chiari Marta , Rebollo Polo Monica , Planells Mariana , San Roman Luis , Eixarch Roca Elisenda , Perez Cruz Miriam , Fons Estupiña Maria Del Carmen , Agut Quijano Thais , Gonzalez Sandoval Lenia , Blasco Sola Gerard

Keywords:  Vascular Malformations, Vascular Imaging, Fetal Brain MRI

Seekins Jayne,  Newman Beverley

Final Pr. ID: Poster #: EDU-096

Most congenital lung anomalies are discovered in utero, often at the early 2nd trimester US screening, this may be followed by a prenatal MR for more detailed characterization. Many “mass-like” lesions decrease in size and conspicuity during the 3rd trimester and are asymptomatic and not visible or missed with only subtle changes on a postnatal chest radiograph. A 3–6-month postnatal CT or MR scan is often obtained to visualize the lesion and evaluate its features, size and extent and decide on surgical or conservative management. Lesions that are not diagnosed prenatally, dismissed or forgotten because of a normal appearing neonatal CXR or are managed conservatively or with partial surgical treatment (e.g. multiple lesions or incomplete resection) may be seen later in life either incidentally, in follow-up or with associated complications such as infection. Additionally, there are several acquired entities that can mimic or be mistaken for congenital lung anomalies. This poster will review and illustrate the late presentation of multiple congenital lung lesions beyond the neonatal period including bronchogenic cyst, lobar/segmental bronchial atresia and overinflation, CPAM, sequestration and hybrid CPAM/sequestration, several with clinical symptoms/complications as well as residual post-surgical lesions. Mimics of congenital lung lesions illustrated will include infectious acquired lobar overinflation, mediastinal lesion compressing airway causing lung/lobar overinflation and pneumonia with pneumatoceles mimicking infected CPAM. Read More

Authors:  Seekins Jayne , Newman Beverley

Keywords:  Sequestration, Congenital Bronchopulmoary Malformation, Congenital Lobar Overinflation

Rajderkar Dhanashree,  Sharma Priya,  Verma Nupur

Final Pr. ID: Poster #: EDU-133

GI Emergencies and congenital malformation in the neonate are variable in their presentation and can be seen from the hypo-pharynx to the anus. The pediatric radiologist often plays a key role in diagnosis and planning of early surgical management. Read More

Authors:  Rajderkar Dhanashree , Sharma Priya , Verma Nupur

Keywords:  Congenital, GI malformations, Newborn bowel obstruction, New born GI emergencies, GI congenital emergencies

Jordan Gregory,  Zavaletta Vaz,  Malone Ladonna,  Katz Danielle,  Nakano Taizo,  Kulungowski Ann,  Annam Aparna

Final Pr. ID: Poster #: EDU-051

Generalized Lymphatic Anomaly (GLA) is a rare multisystem congenital disorder originating from the abnormal development of the lymphatic system which occur under the spectrum of Complex Lymphatic Anomaly (CLA). In addition to GLA, other CLAs include Kaposiform Lymphatic Anomaly (KLA) and Gorham-Stout Disease (GSD). Lymphatic malformations (LM) associated with GLA are usually apparent at birth or by two years of age. GLA can affect almost any organ of the body but is most commonly associated with lymphatic abnormalities in the skin, abdominal/thoracic viscera and bone.

Multisite soft tissue LM can occur in all CLAs, with macrocystic lymphatic malformations being most common in GLA. These lesions can be found in the mediastinum, retroperitoneum, and subcutaneous tissue. Abdominal viscera involved include the spleen and liver. The frequency of focal splenic lesions is higher with GLA and KLA in comparison to GSD. On MRI, the lesions exhibit marked T2 hyperintensity with no discernable enhancement. In patients with larger splenic lesions, areas of T1 hyperintensity have been documented. Liver lesions in GLA have a similar appearance to the previously described splenic lesions. Nakamura et al. found that more than 30 focal splenic lesions and/or focal splenic lesions with maximum diameters greater than >10 mm were observed only in patients with GLA. On contrast enhanced CT, the lesions are generally well-circumscribed and hypodense. Within the thorax, mediastinal LMs can be seen in GLA but are more common in KLA and GSD. Chylous effusions can occur in all of the CLAs, although it has been reported that effusions in GLA were more likely to be associated with mediastinal involvement. Osseus involvement is common in patients with GLA. GLA has a predilection for the appendicular skeleton, in which the ribs are most affected although cranial, vertebral and lower extremity lesions have been reported. The lesions are usually non-contiguous with medullary destruction and sparing of the cortex. This is in contrast to GSD where cortical destruction, progressive osteolysis, contiguous lesions, and soft tissue infiltration are more common.

Educational Goals:
1) Illustrate the most common imaging characteristics by each organ system affected by GLA and how to differentiate GLA from other CLAs.
2) Raise awareness of the optimal imaging evaluation in patients with GLA.
3) Outline an approach to multidisciplinary management of patients with GLA through a vascular anomalies center. Read More

Authors:  Jordan Gregory , Zavaletta Vaz , Malone Ladonna , Katz Danielle , Nakano Taizo , Kulungowski Ann , Annam Aparna

Keywords:  Generalized Lymphatic Anomaly, Lymphatic Malformations, Complex Lymphatic Anomaly

Schild Wenzel Isabel,  Whittle Carolina,  Andrews Anita,  Kramer Daniela,  Downey Camila,  Fajre Ximena,  Pérez-marrero Lizbet

Final Pr. ID: Poster #: EDU-067

Glomovenous malformations (GVM) are rare, low-flow vascular malformations arising from glomus body components. They often present as bluish, compressible nodules or plaques, usually located in the extremities. Because they are infrequent and may mimic more common venous malformations, they are frequently underrecognized. Read More

Authors:  Schild Wenzel Isabel , Whittle Carolina , Andrews Anita , Kramer Daniela , Downey Camila , Fajre Ximena , Pérez-marrero Lizbet

Keywords:  Ultrasound, Soft Tissue, Vascular Malformations

Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-064

Review the causes of cerebral hemorrhage in the pediatric patient based on clinical cases.

Stroke is a major cause of morbidity and mortality in children worldwide. The reported annual incidence ranges from 2.3 to 13 per 100,000 children per year in developed countries. In contrast to the adult, in children, diagnosis is not as straightforward, because when children present with acute neurological deficits, stroke is often not the first diagnosis considered by the medical providers.

Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly.

Stroke in children can be ischemic or hemorrhagic, referring to the term hemorrhagic stroke as a intracerebral hemorrhage that is nontraumatic and whose most common etiology is secondary to a vascular malformation (Arteriovenous Malformation (AVM), Dural/Pial Arteriovenous Fistula (Dural AVF/Pial AVF), Cavernous Malformation, Vein of Galen Aneurysmal Malformation (VGAM), Developmental Venous Anomaly (DVA), Capillary telangiectasia, Sinus Pericranii, Aneurysms).

The most commonly used classification of vascular malformation is based on angioarchitectural and histomorphological characteristics. To differentiate these classic types, in a first step, shunting lesions have to be discerned from nonshunting lesions, as well as other features of the vascular contribution that will be evaluated by image.

We cannot forget the hemorrhage associated with coagulopathy, haematological disorders, brain tumors and cerebral sinovenous thrombosis (CSVT) which in the latter case can be found as venous infarction or hemorrhage; and other less common causes of hemorraghe in pediatrics as the intracranial aneurysms, in 15% of all pediatric aneurysms are secondary to an infection (micotic aneurysm).

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Authors:  Rodríguez Garza Claudia , Guillen Gutierrez Cinthia , Elizondo Riojas Guillermo

Keywords:  vascular malformations, hemorrhage, pediatric stroke

Shah Jignesh,  Chauhan Ankita,  Sandhu Preet

Final Pr. ID: Poster #: EDU-082

1. To discuss etiologies of unilateral hyperlucent hemithorax in children.
2. To discuss radiographic and cross-sectional imaging features of various conditions leading to unilateral hyperlucent hemithorax. Read More

Authors:  Shah Jignesh , Chauhan Ankita , Sandhu Preet

Keywords:  Unilateral hyperlucent hemithorax, congenital lobar overinflation, congenital pulmonary airway malformation

Markovitz Michael,  Hemmrich Megan,  Francis Christopher

Final Pr. ID: Poster #: CR-017

Cystic teratoma and lymphatic malformation (LM) are two generally benign differential considerations for congenital masses which demonstrate overlapping clinical and imaging findings. It is important to distinguish between these etiologies as cystic teratomas may require surgical excision whereas lymphatic malformations may be treated with minimally invasive sclerotherapy. We present two contrasting cases: a cervical neck teratoma mimicking a LM and an abdominal LM resembling a cystic teratoma.

Case 1: A 9-month-old female presented with a right craniofacial neck mass discovered on prenatal screening. Postnatal ultrasound demonstrated a complex multiloculated cystic lesion with peripheral vascularity. MRI confirmed a predominantly cystic, mixed soft tissue and cystic right anterolateral neck mass, most consistent with mixed type lymphatic malformation. Despite two rounds of percutaneous sclerotherapy with doxycycline, the lesion continued to enlarge on repeat MRI, crossing the midline and causing mass effect on the trachea with associated airway compromise. Respiratory distress was exacerbated by COVID-19 infection requiring intubation and eventual tracheostomy. She was started on sirolimus and underwent a third sclerotherapy treatment with doxycycline and STS without improvement. Surgical debulking was performed with pathology returning as mature multicystic teratoma composed of endodermal, neuroglial and mesodermal elements with minimal fat.

Case 2: A 13-year-old male with no significant past medical history presented with three weeks of right-sided abdominal pain and constipation. CT showed a right abdominal multiseptated cystic lesion. MRI confirmed a 27 cm multicystic abdominal mass with small soft tissue component and calcification with mass effect on the small bowel and right ureter causing partial small bowel obstruction and hydronephrosis, most consistent with a large cystic teratoma. However, following surgical excision pathology demonstrated a multicystic mass containing vascular structures with lymphocytic aggregates and nodules consistent with LM.

Expanding on these cases, this exhibit will also review the clinical presentations and management of cystic teratoma and LM with an emphasis on imaging workup and radiology-pathology correlation. It is important for radiologists and their interdisciplinary colleagues to be cognizant of the overlapping features of these conditions to avoid errors in diagnosis and management as their treatments differ. Read More

Authors:  Markovitz Michael , Hemmrich Megan , Francis Christopher

Keywords:  Lymphatic Malformation, Teratoma, Cystic

Chalard François,  Barillon Jeanne,  Blondiaux Eleonore,  Ducou Le Pointe Hubert

Final Pr. ID: Poster #: EDU-071

Complex lymphatic anomalies (CLA) are extremely rare sporadic diseases of genetic origin, primarily affecting children, adolescents, and young adults. According to the International Society for the Study of Vascular Anomalies classification, there are five types of CLA: generalized lymphatic anomaly (GLA), Gorham-Stout disease (GSD), kaposiform lymphangiomatosis, central conducting lymphatic anomaly, and generalized lymphatic dysplasia. These lymphatic malformations are characterized by lymphatic proliferation under the influence of vascular endothelial growth factor.
Our educational exhibit aims to briefly review the pathophysiology of CLA and illustrate the spectrum of lesions in 14 patients, including 9 with GSD and 5 with GLA.
Gorham-Stout disease, also known as vanishing bone disease, is characterized by progressive bone destruction with cortical resorption. The primary lesion, a punched-out osteolysis, typically extends from the initially affected bone to nearby bones and is more frequently observed in the axial skeleton (skull, spine, ribs, pelvic bones and shoulder girdle). It can progress rapidly and sometimes stabilize spontaneously. There is usually no periosteal reaction or bone reconstruction. Patients can present with pain (particularly in case of pathological fracture and vertebral collapse), chronic lymphedema, lower limb length discrepancy, assymetric girth, scoliosis/kyphosis, pericardial ou pleural effusion, and rarely meningitis due to a breach of the skull base.
Generalized lymphatic anomaly, formely called lymphangiomatosis, is a diffuse or multicentric disease involving soft tissues, bones, spleen, liver, intestine, lungs, mediastinum, and skin. Thoracic involvment may result in respiratory failure due to chylous pleural effusion, interstitial syndrome or restrictive syndrome related to spinal deformity, as well as pericardial effusion. Bone lesions primarily involve the axial skeleton, as in GSD. Compared with GSD, bone lesions may be multifocal, bone destruction is less severe and fracture are uncommon. Abdominal involvement includes splenic lesions, retroperitoneal mass, ascites, intestinal hemorrhage, and lymphorrhea. Read More

Authors:  Chalard François , Barillon Jeanne , Blondiaux Eleonore , Ducou Le Pointe Hubert

Keywords:  Lymphatic Malformation, Generalized Lymphatic Anomaly, Children

Woon Tian Kai,  Bee Stella,  Rasheed Shabana,  Fortier Marielle

Final Pr. ID: Poster #: EDU-050

Congenital extrahepatic portosystemic shunt (CEPS), also known as Abernethy malformation, is a rare congenital vascular abnormality in which portosplenomesenteric blood drains directly into the systemic venous system, thus bypassing the liver via an extrahepatic shunt. CEPS classification is based on the shunt anatomy and presence of an intrahepatic portal venous supply, which affects the form of definitive treatment available. Complications can arise due to the metabolic abnormalities and altered hemodynamics brought about by the shunt. Imaging plays a crucial role in the initial diagnosis and surgical planning, as well as the identification and monitoring of complications.
The purpose of this educational exhibit is to review the CEPS embryological origins, classification system and complications through various case examples across different imaging modalities (ultrasound, CT, MRI and angiography). Read More

Authors:  Woon Tian Kai , Bee Stella , Rasheed Shabana , Fortier Marielle

Keywords:  Abernethy Malformation, Vascular Anomalies, Shunts

Jain Nikshita,  Haider Seemab,  Boag Graham,  Bhandal Samarjeet

Final Pr. ID: Poster #: EDU-019

Anorectal malformations are a fairly common group of congenital anomalies presenting at birth and often as part of a syndrome, with various other associated entities. The purpose of this article is to detail the role of imaging in the evaluation of the anomalies and provide a simple approach to reporting that will provide all the necessary anatomic details to the surgeons for best possible surgical and functional outcome. Read More

Authors:  Jain Nikshita , Haider Seemab , Boag Graham , Bhandal Samarjeet

Keywords:  Anorectal, congenital, malformations