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Society for Pediatric Radiology – Poster Archive

Showing 29 Abstracts.

Laucis Nicholas,  True-malhotra Aisha,  Leschied Jessica

Final Pr. ID: Poster #: CR-019

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm presenting as a mass in the subcutis or deep dermis in the extremities of children and young adults. Although previously regarded as ‘malignant’, due to its benign microscopic appearance and favorable prognosis, this tumor was categorized as an “intermediate tumor of uncertain differentiation” in the 2013 World Health Organization classification.

AFH is often misdiagnosed on imaging and pathology. We will present the unusual case of AFH with extensive lymphadenopathy and multiple episodes of anemia. The imaging findings will be illustrated with radiographic, ultrasound, MRI, and PET/CT exams. We will also present gross specimen and pathology images.

Our case involves a 9 year old male presenting with asymptomatic left upper arm and left chest wall masses for two years. A previous biopsy of the mass and a lymph node had been performed, showing juvenile capillary hemangioma and benign progressive germinal transformation, respectively. The patient had several prior episodes of anemia requiring multiple blood transfusions. Coagulopathy workup was negative, and it was postulated that bleeding into the mass could be the source of the anemia.

Radiographs revealed a 4.5 cm ovoid mass in the posteromedial soft tissues of the upper left arm with stable size but increasing calcific serpiginous opacifications throughout the lesion compared to two years prior. Multiple round soft tissue nodules within the left axillary region were also present.

MRI revealed a heterogeneous lesion with a calcified rim with significant susceptibility artifact likely from hemosiderin. Several enlarged adjacent lymph nodes were present with additional marked lymphadenopathy filling the left axilla abutting the brachial plexus and neurovascular bundles, extending superiorly above the acromion. The largest lymph node measured 2.8 cm within a cluster of lymphadenopathy measuring 9 x 4 x 4 cm, increased compared to MRI two years prior. PET/CT revealed increased radiotracer uptake in the mass with a max SUV of 4.5 and within the left axillary lymphadenopathy with a max SUV of 6.5.

The patient underwent surgical excision of the mass with dissection and removal of two adjacent palpable lymph nodes. The mass had a firm capsule with a red/myxoid appearance measuring 6.0 x 5.0 cm. Pathology of the mass was consistent with angiomatoid fibrous histiocytoma and pathology of the lymph nodes revealed reactive follicular hyperplasia.
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Authors:  Laucis Nicholas , True-malhotra Aisha , Leschied Jessica

Keywords:  angiomatoid fibrous histiocytoma, lymphadenopathy, mass

Jain Nikshita,  E Vairamathi,  John Reetu

Final Pr. ID: Poster #: EDU-039

The differential diagnoses of pediatric abdominal and pelvic tumors arising in solid organs are generally well known, but the pathologic features of tumors originating outside these organs—from the peritoneum, omentum, mesentery and adnexa—is much less familiar. Also, the histopathological sampling of these masses can be challenging - given the propensity of intervening bowel, risk of tumor seeding. Primary tumors of the peritoneum in children are usually mesenchymal in origin. Knowledge of the tumors that arise in these unusual locations is important in directing appropriate clinical management. Localized masses may be caused by inflammatory myofibroblastic tumor, Castleman disease, mesenteric fibromatosis, or other mesenchymal masses. Inflammatory myofibroblastic tumor is a mesenchymal tumor of borderline biologic potential that appears as a solitary circumscribed mass. Mesenteric fibromatosis, or intra-abdominal desmoid tumor, is a benign tumor of mesenchymal origin associated with familial adenomatous polyposis. Diffuse peritoneal disease may be due to desmoplastic small round cell tumor (DSRCT), non-Hodgkin lymphoma, or rhabdomyosarcoma. Burkitt lymphoma manifests with extensive disease because of its short doubling time. Rhabdomyosarcoma may arise as a primary tumor of the omentum or may spread from a primary tumour in the bladder, prostate, or scrotum. Knowledge of this spectrum of disease allows the radiologist to provide an appropriate differential diagnosis and direct appropriate patient management. Read More

Authors:  Jain Nikshita , E Vairamathi , John Reetu

Keywords:  Mass, Peritoneum, Adnexa

Eliades Sarah,  Pomeranz Christy,  Baad Michael,  Roytman Michelle,  Kovanlikaya Arzu

Final Pr. ID: Poster #: EDU-056

Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees.

We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance.

Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup.
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Authors:  Eliades Sarah , Pomeranz Christy , Baad Michael , Roytman Michelle , Kovanlikaya Arzu

Keywords:  Soft tissue mass, Ultrasound, Superficial

Ortega García Diana,  Rodríguez Garza Claudia,  Canales Nañez Sofìa,  Terán Helda Estrella,  Montemayor Martínez Alberto

Final Pr. ID: Poster #: CR-005

Atretic cephalocele is a rare disruption of neural tube closure. The reported incidence ranges from 1 in 3500 to 1 in 5000 live births. Is a small subscalp lesion that consist of dura, fibrous tissue, and dysplastic brain tissue. Its most common presentation it is a palpable midline parietal soft tissue mass, occasionally occipital, with a wide range of clinical presentations, the patient may have normal neurological development or have severe mental retardations, since it could be associated with multiple intracranial malformations including a fenestrated superior sagittal sinus (the most common), persistent falcine sinus, vertical embryonic positioning of the straight sinus, holoprosencephaly, hydrocephalus, eye anomalies, agenesis of the corpus callosum, among others, therefore is important to know about this condition as well as to identify its radiological characteristics using different diagnostic imaging methods to make a certain diagnostic. Transfontanellar brain ultrasound could be used as the first imaging method as it enables a non-invasive method, in addition the patients are not exposed to ionizing radiation, being the most consistent finding a subcutaneous, hypoechoic mass, with a solid fibrous tract connecting the extracranial lesion, through a small bony cranium defect, to the intracranial space; additionally in order to evaluate a further extension of the fibrous tract or the presence of other anomalies, CT or MRI can be performed, considering to the MRI as a better study because it can be used in pediatric population since there is no exposure to radiation. Main differential diagnoses of atretic cephalocele are sinus pericranii and dermoid cyst, other possible causes include haemangioma, sebaceous cyst, inclusion cyst, lipoma, tumors (Langerhans cell histiocytosis, sarcomas, etc.), bone and soft tissue infections and traumatic lesions. This educational poster pretends to review the radiological findings of two cases of patients with atretic cephalocele moreover a literature review since the published works regarding is limited and few case series or case reports have been documented. Read More

Authors:  Ortega García Diana , Rodríguez Garza Claudia , Canales Nañez Sofìa , Terán Helda Estrella , Montemayor Martínez Alberto


Goldwasser Bernard,  Kazmi Faaiza,  Urbine Jacqueline,  Poletto Erica,  Malik Archana,  Mallon Mary

Final Pr. ID: Poster #: EDU-048

There is a wide array of pathologies which can cause diffuse changes in the pediatric kidney. The purpose of the presentation is to show a multimodality pictorial review of characteristic findings of a wide variety of diffuse renal abnormalities in the pediatric patient. Read More

Authors:  Goldwasser Bernard , Kazmi Faaiza , Urbine Jacqueline , Poletto Erica , Malik Archana , Mallon Mary

Keywords:  renal mass, congenital renal abnormalities, syndromes affecting the kidney

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.
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Authors:  Wepking Kelly , Gill Kara , Riedesel Erica

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

Della Grotta Lynn,  Koberlein George

Final Pr. ID: Poster #: EDU-027

Cystic pelvic masses can represent a diagnostic challenge with its broad spectrum of differentials ranging from benign to malignant. Ultrasound is often the preliminary evaluation with MRI a next step when more information is needed. Proper diagnosis provides guidance to the clinical team with management ranging from watchful waiting to surgery. This poster will use a case-based approach to review the variety of cystic pelvic masses in pediatric patients, discuss salient imaging features, an approach to imaging workup, and treatment and prognosis. Read More

Authors:  Della Grotta Lynn , Koberlein George

Keywords:  Pelvic, Cystic Mass, Pediatric

Mata-mbemba Daddy,  Daneman Alan

Final Pr. ID: Poster #: EDU-021

There are a variety of masses in neonates, infants and young children that may disappear spontaneously without active intervention. However, there has been no published review of what type of masses could disappear and what the spectrum of their imaging features is. It is essential for radiologists to understand imaging features of these entities in order to provide pediatrician and pediatric surgeons with critical information that will enable them to manage these patients expectantly without surgical intervention.
The entities that will be illustrate in this review include, among others: multicystic dysplastic kidneys, suprarenal masses (including intraabdominal sequestration, neuroblastoma and adrenal hemorrhage), ovarian cyst and torsion, duplication cyst of gastrointestinal tract, cyst of liver and kidneys. We will:
1. Review the clinical and imaging features of these masses including their changes during follow-up imaging studies.
2. Emphasize the imaging features that are helpful in differentiating these entities from other entities that require active intervention
3. Describe an appropriate approach to deal with uncertain diagnoses.
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Authors:  Mata-mbemba Daddy , Daneman Alan

Keywords:  disappear mass, neonate, infant and young children

Goldwasser Bernard,  Malik Archana,  Poletto Erica,  Urbine Jacqueline,  Kazmi Faaiza,  Mallon Mary

Final Pr. ID: Poster #: EDU-087

When evaluating the pediatric neuroaxis, it is important to include the extra-axial spaces in the radiologists’ search pattern. The purpose of the presentation is to show a multimodality pictorial review of characteristic findings of extra-axial CNS lesions detected on CT and MRI. Read More

Authors:  Goldwasser Bernard , Malik Archana , Poletto Erica , Urbine Jacqueline , Kazmi Faaiza , Mallon Mary

Keywords:  dural mass, extra-axial masses

Green Jared,  Jaju Alok,  Richard Jamie

Final Pr. ID: Poster #: CR-047

A 17-month-old female presented with a one-month history of abnormal soft tissue protruding from the vaginal introitus.

The patient’s past medical history was significant for hemi-hypertrophy of the left lower extremity. Physical examination demonstrated normal external genitalia, with pink solid tissue protruding from the vagina posterior aspect, and mild associated white fluid discharge. Laboratory analysis revelaed a normal CBC, serum HCG and AFP.

An ultrasound examination of the pelvis demonstrated a heterogeneous echogenicity soft tissue mass with scant internal vascularity centered in the vagina and cervix, measuring approximately 4.0 x 2.3 x 2.5 cm.

The patient’s clinical and imaging findings were most concerning for malignancy, namely vaginal rhabdomyosarcoma, so consultation was requested from Pediatric Surgery and Oncology. As a result of these consultations, the patient was scheduled for vaginoscopy with biopsy under general anesthesia, as well as surgical port placement due to the high suspicion for malignancy. Also to be performed under the same anesthetic was a CT examination of the chest and MR examination of the pelvis.

Vaginoscopy revealed a “pebbly appearance” of the vaginal walls, which also reportedly “felt thickened” on digital exam. Multiple surgical biopsy specimens were obtained from the visibly abnormal areas.

MR examination immediately post biopsy showed circumferential mural thickening of the cervix and vagina, with a more prominent area of soft tissue thickening at the level of the vaginal introitus. The areas of mural thickening appeared T1 and T2 signal isointense with mild post-contrast enhancement and no evidence of abnormal restricted diffusion. No focal mass was identified. CT examination of the chest was normal.

Histopathologic analysis revealed a benign lesion composed of a relatively small number of spindle cells embedded in a loose fibrous stroma. No significant numbers of mitoses or atypia were observed, including in the lining squamous epithelium. These features were most consistent with a fibroepithelial stromal polyp.

In light of the pathology findings, the port implant was removed, and the patient has since undergone surveillance vaginoscopy examinations.

This case illustrates MRI findings of a rare benign condition which may mimic vaginal rhabdomyosarcoma on the basis of clinical and ultrasound findings. MRI demonstrating an absence of aggressive features may help to suggest this rare differential consideration.
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Authors:  Green Jared , Jaju Alok , Richard Jamie

Keywords:  Vaginal, Infant, Mass

Rapp Jordan,  Anupindi Sudha,  Bellah Richard

Final Pr. ID: Poster #: SCI-033

To describe ultrasound (US) and magnetic resonance imaging (MRI) findings of giant hepatic regenerative nodules (GHRN) in pediatric patients with Alagille Syndrome (AS). Read More

Authors:  Rapp Jordan , Anupindi Sudha , Bellah Richard

Keywords:  liver mass, cirrhosis

Infante Ignacio,  Amoretti Natalia,  Roa Cintia,  Rizzi Ana,  Lipsich Jose

Final Pr. ID: Poster #: CR-004 (S)

Liver tumors account for 1-4% of all pediatrics malignancies. Most primary liver tumours in children are malignant, but one-third are benign. Mesenchymal hamartoma of the liver, though rare is the second most frequent benign liver mass in children. Generally occurs in children less than 2 years of age with a male preponderance (male: female, 2:1). We report a case of mesenchymal hamartoma of the liver in an 11 month-old female presented at the emergency department with abdominal distension of two months of evolution associated with intermittent vomiting, diarrhea and chronic malnutrition. Abnormal labs included elevated alpha-fetoprotein levels (15006 ng/ml) and non detectable beta Human Chorionic Gonadotrophin. The liver function was normal. Imaging demonstrated an abnormal abdominal X-ray, with soft tissues mass enlargement and displacement of bowel. An ultrasound revealed a mixed mass (cystic-solid) liver in segment VII. On colour-Doppler flow imaging, there was evidence of increased vascularity. Contrast-enhanced CT scan of the abdomen in arterial and venous phases showed a large cystic mass in the left lobe of the liver, with peripheral solid tissue, very vascularized in both vascular secuences. Percutaneous biopsy was done and pathology confirmed mesenchymal hamartoma. The patient underwent left hepatectomy. The patient evolved successfully. Read More

Authors:  Infante Ignacio , Amoretti Natalia , Roa Cintia , Rizzi Ana , Lipsich Jose

Keywords:  Cystic Mass, tumor, Imaging

Alam Aisha,  Maier Pia,  Smitthimedhin Anilawan,  Acord Michael,  Cahill Anne Marie,  Vatsky Seth

Final Pr. ID: Paper #: 072

Lymphoma is the most common mediastinal mass in children. Obtaining tissue for diagnosis can be challenging due to reported low diagnostic yield and risk of cardiorespiratory collapse, especially in the setting of anesthesia. We report our experience with biopsy of mediastinal masses, report the diagnostic rate for lymphoma and biopsy/anesthetic complications related to the procedure. Read More

Authors:  Alam Aisha , Maier Pia , Smitthimedhin Anilawan , Acord Michael , Cahill Anne Marie , Vatsky Seth

Keywords:  Image guided biopsy, Mediastinal Mass, Lymphoma

Gerrie Samantha,  Rosenbaum Daniel,  Hughes Emily

Final Pr. ID: Poster #: EDU-071

Pediatric calvarial lesions are uncommon and range in significance from incidental developmental variants to life-threatening disorders. Lesions often come to attention as nonspecific palpable abnormalities and initial imaging work-up may vary. A structured approach is therefore critical to differentiate between non-aggressive and aggressive lesions, between lesions germane to bone and those with secondary calvarial involvement, as well as between truly localized lesions and focal manifestations of multifocal or systemic disease. Lesions with a characteristic imaging appearance include atretic cephalocele, occipital encephalocele, parietal foramina, calcified cephalohematoma, dermoid cyst and fibrous dysplasia. Other lesions may require further imaging of other body regions in conjunction with clinical features and laboratory tests including pathology, laboratory markers and genetic testing. These include chronic non-bacterial osteomyelitis, Langerhans cell histiocytosis, sarcoidosis and neoplastic lesions such as Ewing sarcoma, osteosarcoma, lymphoma and metastasis. The aim of this pictorial essay is to illustrate the multi-modality imaging appearance of the most common focal pediatric calvarial lesions to aid in narrowing the differential diagnosis and to direct subspecialty referral where appropriate. Read More

Authors:  Gerrie Samantha , Rosenbaum Daniel , Hughes Emily

Keywords:  Calvarial, focal, mass

Emerson Miriam,  Isaacson Jared,  Chauvin Nancy,  Dahmoush Hisham

Final Pr. ID: Poster #: EDU-016

Lipoblastoma is a benign, rare pediatric mesenchymal tumor that develops in a myriad of anatomic locations. The imaging appearance of lipoblastoma sometimes overlaps with other tumors. Familiarity with lipoblastoma and a knowledge of benign and malignant tumors with similar imaging features will benefit practicing Radiologists, Pediatricians, and Surgeons. Our exhibit aims to expand awareness of lipoblastoma by providing a comprehensive pictorial review of cases showcasing representative MRI, CT, sonographic, and radiographic images. Suggestive imaging features of lipoblastoma that distinguish them from other fat-containing lesions will be highlighted and an emphasis on the discussion of lipoblastoma within the spectrum of pediatric lipomatous lesions will be detailed. Read More

Authors:  Emerson Miriam , Isaacson Jared , Chauvin Nancy , Dahmoush Hisham

Keywords:  Lipoblastoma, Tumor, Mass

Wachs Jonah,  Desai Sudhen,  Garica Angela,  Greer Jade,  Nissim Lavi

Final Pr. ID: Poster #: EDU-014

A 33-day old infant was presented to the hospital after difficulty breathing and breastfeeding. The patient had a history of hyperbilirubinemia with acute hypoxic respiratory failure, felt secondary to a mediastinal mass, severe metabollic lactic acidosis, anemia, and acute severe coagulopathy.

This patient was denied vitamin K prophylaxis at birth at discretion of the parents. Vitamin K deficency subsequently caused coagulopathy and jaundiced skin, which associate with Vitamin K Deficiency Bleeding.

Presented is a case of thymic hemorrhage in a neonate demonstrating as a mimic lesion on imaging. Further invasive work-up to distinguish etiology of mass was not required demonstrating biopsy or surgery is not always necesary for diagnostic purposes. The identified symptoms represent the potential sequelae of thymic hemorrhage.
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Authors:  Wachs Jonah , Desai Sudhen , Garica Angela , Greer Jade , Nissim Lavi

Keywords:  mediastinal mass, thymoma, hematoma

Katirtzidou Eirini,  Laurent Meryle,  Habre Celine,  Toso Seema

Final Pr. ID: Poster #: CR-019

Ovarian masses are the most common tumours in paediatric population. Although there is data available on imaging characteristics of different types of masses, benign and malignant, there is no standard imaging classification system. The Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS) classification system currently used for adults, has not been extensively applied and tested in children and adolescents. Read More

Authors:  Katirtzidou Eirini , Laurent Meryle , Habre Celine , Toso Seema

Keywords:  ovarian mass, O-RADS, diagnostic accuracy

Mcbee Morgan,  Towbin Alexander,  Dillman Jonathan,  Trout Andrew

Final Pr. ID: Poster #: EDU-004

Cystic liver lesions in the pediatric population are relatively uncommon but encompass a wide range of pathologies. It is important for radiologists to be familiar with the differential diagnosis and imaging characteristics of each entity because prognosis and treatment vary widely. This educational exhibit will review the appearance of various cystic liver lesions in the pediatric population by ultrasound, CT, and MRI and will review clinical presentation and genetic/biologic causes. Read More

Authors:  Mcbee Morgan , Towbin Alexander , Dillman Jonathan , Trout Andrew

Keywords:  hepatic cyst, Cystic mass, Fluid lesion

Nadim Bardia,  Samet Jonathan

Final Pr. ID: Poster #: SCI-027

The prevalence, imaging features, and etiologies of pediatric intra-articular soft tissue masses are not well described in the literature. Therefore, intra-articular masses can present diagnostic dilemmas for pediatric radiologists. The purpose of this study was to further evaluate pediatric intra-articular soft tissue masses. Our hypothesis was that intra-articular masses have a limited differential diagnosis and are mostly benign. Read More

Authors:  Nadim Bardia , Samet Jonathan

Keywords:  intra-articular mass, PVNS, knee MRI

Maier Pia,  Alam Aisha,  Acord Michael,  Cahill Anne Marie,  Vatsky Seth

Final Pr. ID: Paper #: 036

Evaluate patient demographics, current imaging patterns, extent of disease, and tumor types in pediatric patients with mediastinal masses to assist with developing an imaging algorithm to streamline patient care. Read More

Authors:  Maier Pia , Alam Aisha , Acord Michael , Cahill Anne Marie , Vatsky Seth

Keywords:  Mediastinal Mass, Airway

Maier Pia,  Alam Aisha,  Acord Michael,  Cahill Anne Marie,  Vatsky Seth

Final Pr. ID: Poster #: SCI-034

Evaluate patient demographics, current imaging patterns, extent of disease, and tumor types in pediatric patients with mediastinal masses to assist with developing an imaging algorithm to streamline patient care. Read More

Authors:  Maier Pia , Alam Aisha , Acord Michael , Cahill Anne Marie , Vatsky Seth

Keywords:  Mediastinal Mass, Airway

Kong Tracie,  Ledbetter Luke

Final Pr. ID: Poster #: EDU-087

Radiology plays a crucial role in the detection, diagnosis, and longitudinal surveillance of tumors and their mimics in the pediatric orbit. Familiarity with the imaging spectrum of orbital pathology is necessary for making an accurate assessment to guide treatment, referrals, and in some cases further workup such as genetic testing. This exhibit will highlight the key imaging features of benign and malignant masses in the pediatric orbit, many of which are unique to this age group. Retinoblastoma, medulloepithelioma, optic pathway glioma, rhabdomyosarcoma, and plexiform neurofibroma will be amongst the neoplasms presented. Non-neoplastic lesions including lymphatic and vascular malformations, dermoid cysts, and congenital orbital fibrosis will be reviewed. Lesions of the bony orbit with intra-orbital extension will also be presented, including Langerhans cell histiocytosis, fibrous dysplasia, and neuroblastoma metastasis. Each type of pathology will be illustrated by representative case(s) from our institution. Read More

Authors:  Kong Tracie , Ledbetter Luke

Keywords:  orbit, tumor, mass

Gokli Ami,  Barrera Christian,  Bellah Richard

Final Pr. ID: Poster #: EDU-045

The complete ultrasound (US) evaluation of the urinary tract in a pediatric patient should include both the urinary bladder and kidneys. Evaluation of the bladder as part of that overall US examination, however, can be deemphasized or incomplete due a number of factors, such as one’s neglecting to fully image the bladder from dome to bladder neck, suboptimal bladder distension, incomplete distension due to presence of an indwelling drainage catheter or vesicostomy, or in some instances, because the bladder is not included as part of the routine kidney ultrasound exam. True masses arising from the urinary bladder in children are generally rare, and at times, subtle and non-specific, and potentially mimicked by so-called pseudomasses, so we emphasize that correlation of findings with patient history is of paramount importance.

This pictorial review will illustrate and describe the US appearances (along with selective cross-sectional imaging), clinical manifestations, and tumor growth patterns of common and uncommon conditions arising from the pediatric urinary bladder, i.e. path-proven masses that include leiomyosarcoma, pheochromocytoma, nephrogenic adenoma, vascular malformation, low grade urothelial neoplasms, neurofibromatosis, fibroepithelial polyps, rhabdoid tumor, and rhabdomyosarcoma. Pseudomasses of the bladder that will also be illustrated and briefly discussed include hematomas, urachal remnants, complex ureteroceles, Deflux injection sites, foreign bodies, and cystitis (viral, eosinophilic, parasitic). In addition to emphasizing the importance of the complete bladder examination, the purpose of this review is to increase radiologist’s awareness of the US appearances of the common and uncommon conditions which afflict the pediatric urinary bladder, as well as those conditions that can mimic bladder masses, in order to determine proper clinical management.
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Authors:  Gokli Ami , Barrera Christian , Bellah Richard

Keywords:  Bladder, Mass, Ultrasound

Shah Jignesh,  Gupta Saurabh,  Sandhu Preet,  Cohen Harris

Final Pr. ID: Poster #: EDU-139

1. To discuss anatomy and development of pelvic retroperitoneal structures
2. To discuss etiologies and pathogenesis of pelvic retroperitoneal masses in children
3. To review multimodality imaging features with implications on management
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Authors:  Shah Jignesh , Gupta Saurabh , Sandhu Preet , Cohen Harris

Keywords:  presacral mass

Funes Poblete Flavia,  Mackintosh Cecilia,  Vargas Maria,  Gonzalez Veronica

Final Pr. ID: Poster #: CR-021

We report a case of 2-year-old female, twin, low birth weight (37 weeks, 1630 g - 3.59 lb), who was referred to our hospital to study an indurated nodular tumor involving her left leg, which extended from her pelvis to her left foot. Blood tests showed only an increase in alkaline phosphatase (862 mg/dl). Lower-limb X-ray was performed, which showed an extensive calcified mass with fibrillar pattern affecting dermis and deep connective tissue. MRI was also performed and showed an extensive signal alteration in muscle and dermis with hipointense signal in relation to heterotopic calcifications.
The differential diagnoses were Albright hereditary osteodystrophy (AHO), fibrodysplasia ossificans progressiva (FOP), and progressive osseous heteroplasia (POH).
AHO was ruled out because of the lack of compromise of muscle plane, and the absence of congenital malformations (such as brachydactyly, obesity, low height), hypocalcemia and hyperphosphatemia. Similarly, FOP was also ruled out since it is characterized by muscle ossification, with no dermal calcifications, and hallux malformation (also absent in this case).
The diagnosis reached was POH, which is a rare genetic (autosomal dominant inheritance) disorder characterized by progressive periarticular ossification of dermis and deep connective tissues (muscles, tendons and ligaments), with no congenital malformations. The diagnosis is built upon the clinical symptoms, imaging findings and genetic study (GNAS mutation). There is no effective treatment, with frequent progression to ankylosis.
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Authors:  Funes Poblete Flavia , Mackintosh Cecilia , Vargas Maria , Gonzalez Veronica

Keywords:  heteroplasia, dermal calcification, calcified mass

Artunduaga Maddy,  Jadhav Siddharth,  Ketwaroo Pamela,  Masand Prakash

Final Pr. ID: Poster #: CR-006

Papillary fibroelastomas are benign primary cardiac tumors that usually arise from the valve apparatus and are rare in the pediatric population. Involvement of the tricuspid valve is even rarer, with only a few cases reported in the literature. We present the case of an 11-month-old female referred by her pediatrician after a non-cardiovascular acute visit to investigate a murmur noted since birth. The patient was asymptomatic. Family history was negative for congenital heart disease, seizures or genetic disorders. Her physical exam revealed a soft holosystolic murmur at the left lower sternal border but was otherwise normal. Initial work up with ECG and echocardiogram revealed limb lead reversal and a large mass in the right ventricle. Subsequent MRI showed a mobile 15mm oval mass along the septal surface of the right ventricle, in close proximity to the tricuspid valve, without valve inflow or right ventricular outflow tract obstruction. The mass was faintly visualized on TFE, isointense on T1, centrally-hyperintense and peripherally-hypointense on T2, and peripherally enhancing on post-contrast images. After a multidisciplinary review of the case, the decision was made to proceed with surgical resection. A preoperative CT of the chest did not reveal pulmonary embolism. During surgery, the mass was attached to the septal leaflet and the chordae of the tricuspid valve but not to the septum. Visually, the mass was compatible with a fibroelastoma. Off-bypass intraoperative transesophageal echocardiogram showed moderate tricuspid regurgitation that required on-bypass annuloplasty. Pathology confirmed the diagnosis of papillary fibroelastoma. There were no surgical complications. She was discharged on postoperative day 6 and had been doing well until her most recent follow-up four months after surgery. Papillary fibroelastomas are typically asymptomatic, although they carry potential risks for complications such as pulmonary or systemic emboli, depending on their location. MRI is a valuable examination that can characterize intracardiac tumors and thrombi. To our knowledge, this is the first report of a pathology-proven papillary fibroelastoma of the tricuspid valve characterized by MRI in such a young child Read More

Authors:  Artunduaga Maddy , Jadhav Siddharth , Ketwaroo Pamela , Masand Prakash

Keywords:  Papillary fibroelastoma, MRI, intracardiac mass

Kelleher Sean,  Lampl Brooke,  Park Ellen

Final Pr. ID: Poster #: EDU-049

Scrotal ultrasound is commonly performed in a pediatric practice with the nonspecific clinical presentation of pain, palpable abnormality, or enlargement of the scrotum. A wide variety of pathologies including congenital, neoplastic, infectious, and traumatic etiologies can occur within the scrotum due to its complex anatomy. A thorough understanding of the anatomy and spectrum of disease is necessary for diagnosis and potential treatment of these abnormalities. This educational exhibit will illustrate typical and atypical scrotal abnormalities, including testicular torsion, torsion of the testicular and epidydimal appendix, and infectious processes associated with the clinical finding of pain. Additionally, we will provide a collection of testicular and extra-testicular masses, some demonstrating an unusual presentation. Read More

Authors:  Kelleher Sean , Lampl Brooke , Park Ellen

Keywords:  Ultrasound, scrotum, Mass

Gleason Miranda,  Sharma Pooja,  Omar Lena,  Pfeifer Cory,  Kwon Jeannie

Final Pr. ID: Poster #: SCI-035

The purpose of this exhibit is to demonstrate the characteristic sonographic appearance of benign masses in the pediatric population in order to address the wide variation in management of palpable, hypoechoic, circumscribed masses seen on ultrasound. Currently, management includes fine needle aspiration/core needle biopsy, excision, imaging follow-up, and reassurance. This exhibit proposes guidelines for management of palpable pediatric breast masses with ultrasound findings most suggestive of fibroadenomas. Read More

Authors:  Gleason Miranda , Sharma Pooja , Omar Lena , Pfeifer Cory , Kwon Jeannie

Keywords:  Breast, Mass, Benign