Lish James,  Richardson Randy,  Lin Alice

Final Pr. ID: Poster #: CR-015

Traumatic laryngotracheal transection is an uncommon occurrence most often secondary to blunt trauma to the neck. The most commonly described mechanism is a “clothesline” injury or strangulation, involving high speed impact of the neck across a chain, rope, chord, or strap, usually associated with the use of a motor or recreational vehicle. It is often instantaneously fatal, and those who survive may have severe respiratory compromise requiring immediate advanced airway placement, or astonishingly, they may be asymptomatic. Tracheal transection may be identified when laryngoscopic intubation fails, during the placement of a surgical airway, or during initial CT or bronchoscopic evaluation.

We describe an 8-year-old male who experienced blunt neck trauma and was intubated successfully in the pre-hospital setting. Initial radiographic evaluation was significant for severe subcutaneous emphysema and pneumomediastinum. Bilateral thoracostomy tubes were placed. Initial CT evaluation again showed extensive pneumomediastinum without pneumothorax. Four days after initial hospitalization the patient was extubated without difficulty. Post-extubation chest x-ray showed irregular tracheal borders with focal hyperlucency adjacent the mid-cervical trachea in the former position of the endotracheal tube cuff. Repeat CT of the chest showed complete tracheal transection of the mid-cervical trachea. The patient subsequently underwent surgical repair and was discharged without complication. This is the first reported case of traumatic tracheal transection not identified on initial CT examination secondary to the position of the endotracheal balloon, with subsequent discovery of the complete transection on the post-extubation radiograph.

There is 1 reported case of tracheal transection identified on initial CT evaluation in the presence of a well-positioned endotracheal tube. Additionally, there is 1 reported case of tracheal transection not identified on initial CT evaluation, however the patient was not intubated and had minimal symptoms. Tracheal transection was confirmed via bronchoscopy in that case.

Tracheal transection is rare traumatic injury that can be difficult to identify. High clinical suspicion and careful examination with multiple modalities is often necessary to make a definitive diagnosis. Read More

Authors:  Lish James , Richardson Randy , Lin Alice

Keywords:  tracheal resection, neck trauma, airway

Buras Megan,  Mulliken Dolores,  Pennino Adriana,  Rooks Veronica,  Marcelo Karina,  Fong Brandon,  Carlson Terri,  Wilson Tina,  Stewart J Alex,  Husson Christopher

Final Pr. ID: Poster #: CR-011

Illustrate radiological manifestations and clinical course from benign to severe subgaleal processes, highlighting the crucial role of advanced imaging in diagnosis, management, and outcome prediction. Read More

Authors:  Buras Megan , Mulliken Dolores , Pennino Adriana , Rooks Veronica , Marcelo Karina , Fong Brandon , Carlson Terri , Wilson Tina , Stewart J Alex , Husson Christopher

Keywords:  Head And Neck, Scalp, Child

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

Chauhan Ankita,  Dillard Roger

Final Pr. ID: Poster #: EDU-076

Children often present to the emergency room (ER) with painful neck swelling, sore throat, and difficulty breathing. Careful clinical examination and good communication with pediatric physicians help plan the appropriate imaging workup for such pediatric patients. Knowing the various imaging appearances of the many encountered disorders of the neck in children further helps diagnose and plan the most appropriate management. Read More

Authors:  Chauhan Ankita , Dillard Roger

Keywords:  Neck, Pediatric, Imaging

Molto Jose,  Loomis Judyta,  Cielma Tara,  Whitehead Matthew

Final Pr. ID: Poster #: EDU-070

Dermoid cysts are a sequestration of ectoderm containing secondary skin structures, usually at characteristic locations of embryologic fusion lines. The midventral suprasternal fusion line is one such location in the developing embryo with both simple and complicated dermoids of this region reported in the literature. We reviewed our academic pediatric institutional experience with dermoid cysts of the suprasternal notch, focusing on the initial presentation as a palpable nodule referred for sonographic evaluation.

The purpose of this educational exhibit is to depict the ultrasound imaging features of suprasternal notch dermoid cysts in the pediatric population.

Secondary purposes are to describe the anatomy of the suprasternal notch, demonstrate CT and MR correlates of the these dermoids, and depict regional inflammatory complications. Read More

Authors:  Molto Jose , Loomis Judyta , Cielma Tara , Whitehead Matthew

Keywords:  Dermoid, neck, Suprasternal

Lopez-rippe Julian,  Rosenbaum Dov,  Sim Jeffrey,  Charles Christina,  Kirby Jaime,  Lerebo Wondwossen,  Kaplan Summer

Final Pr. ID: Poster #: SCI-021

Neck/airway radiographs in children are difficult due to variable soft tissues from swallowing/crying and positioning; short necks and limited cooperation further impact quality. No pediatric image-quality or technique guidelines exist. We aimed to develop a quantitative image-quality assessment tool. Read More

Authors:  Lopez-rippe Julian , Rosenbaum Dov , Sim Jeffrey , Charles Christina , Kirby Jaime , Lerebo Wondwossen , Kaplan Summer

Keywords:  X-Ray, Neck, Airway

Ksiazek Kathleen

Final Pr. ID: Poster #: EDU-016 (T)

Medical imaging of the soft tissue of the neck or airway is one of the most common, and sometimes challenging, exams performed at a pediatric hospital. Imaging of the airway can help identify enlarged adenoids, the presence of a foreign body, an abscess, pathology or anatomical abnormality. It is crucial to understand the proper technique, breathing instructions and positioning in order to obtain optimal imaging for correct diagnosis. Different radiographic findings will be presented with examples of incorrect positioning, grid usage, exposure factors, artifacts and ways to improve the image quality. This poster will also provide technologists with tips and recommendations to help them to feel prepared and confident to work with all pediatric patients. Read More

Authors:  Ksiazek Kathleen

Keywords:  Airway, Soft tissue of neck

Park Ji Eun,  Shin Su-mi,  Yoo So Young,  Jeon Tae Yeon,  Kim Ji Hye

Final Pr. ID: Poster #: SCI-038

Kimura’s disease is rare chronic inflammatory disorder of unknown etiology. The cause and pathogenesis is unclear. Our study is to describe the clinical and radiologic features of Kimura’s disease (KD) in children and young adults, which often presents as a diagnostic challenge. Read More

Authors:  Park Ji Eun , Shin Su-mi , Yoo So Young , Jeon Tae Yeon , Kim Ji Hye

Keywords:  Head & Neck, Mass

Papaioannou Georgia,  Tagalakis Panagiotis,  Meleti Christina,  Manopoulou Evangelia,  Yarmenitis Spyros,  Kritikos Nikolaos

Final Pr. ID: Poster #: EDU-026

To illustrate the findings of multimodality imaging exploration of the lumps and bumps in the pediatric neck and head. Read More

Authors:  Papaioannou Georgia , Tagalakis Panagiotis , Meleti Christina , Manopoulou Evangelia , Yarmenitis Spyros , Kritikos Nikolaos

Keywords:  lump, head, neck

Sheikh Zishan,  Kumbla Surekha,  Bracken Jenny

Final Pr. ID: Poster #: EDU-060

Neck lesions are a common clinical scenario encountered in children. They can present as neck lumps or be discovered incidentally on medical imaging performed for other indications. While most paediatric neck lesions are benign, they can be a source of morbidity to patients and cause considerable anxiety to their care givers. Neck lesions in infants are made additionally more challenging as this area can be difficult to assess clinically. A clinically evident or suspected neck mass has, as a result, become a common indication for medical imaging in this age group. Being aware of the spectrum of neck lesions seen in infants and their respective imaging manifestations helps direct management appropriately in these cases.

A review of neck lesions seen in infants seen at a tertiary paediatric centre over the last two decades is presented with correlation of imaging findings across multiople modalities with the final diagnosis. Our aim is to provide an overview of both common and rare neck lesions seen in this age group by using broad categories of congenital, inflammatory and aggressive/malignant lesions. As well as showcasing cases with classic imaging findings we will include some cases where features overlapped between different varieties of neck lesions to illustrate pitfalls in imaging neck lesions in infants. Read More

Authors:  Sheikh Zishan , Kumbla Surekha , Bracken Jenny

Keywords:  infant, neck, lesion

Siu Navarro Youck Jen,  Poletto Erica,  Malik Archana,  Mallon Mea

Final Pr. ID: Poster #: EDU-061

A neck mass is a frequent chief complaint in the pediatric population and includes a wide variety of etiologies. The age of the child, symptoms and physical exam findings may narrow the differential diagnoses. The radiologist can aid in diagnosis and management by guiding the selection of the appropriate imaging modality. It is important for the radiologist to recognize the features of common and rarer neck masses in children. This pictorial review will describe the multimodal imaging features of a variety of pediatric neck masses in four categories:

1. Congenital/developmental
Thyroglossal duct cyst
Branchial cyst
Dermoid cyst
Epidermoid cyst
Venolymphatic malformation
Cervical extension of thymus

2. Infection/inflammatory
Lymphadenitis
Retropharyngeal/peritonsillar abscess

3. Neoplastic
Hemangioma
Neurofibroma
Neuroblastoma/ganglioneuroblastoma
Rhabdomyosarcoma
Lymphoma
Thyroid carcinoma
Teratoma

4. Miscellaneous
Ranula
Fibromatosis colli Read More

Authors:  Siu Navarro Youck Jen , Poletto Erica , Malik Archana , Mallon Mea

Keywords:  Neck Masses

Sensbach Jessica,  Ghias Adeeba,  Anderson Kelly,  Rooks Veronica

Final Pr. ID: Poster #: CR-025

The thyroglossal duct cyst (TGDC) is the most common congenital malformation in the neck. The Sistrunk procedure is the standard surgical treatment and includes resection of the central hyoid and a cuff tongue base musculature toward the foramen cecum.

We present a 24yr old F with a TGDC complicated by fistulous drainage and multiple surgeries. Imaging was critical for definitive identification of a sinus tract and treatment. She presented initially with a cystic neck lesion treated as a ranula with sublingual then submandibular gland excision. She subsequently presented with spontaneous drainage of saliva from the neck 2 yrs later and underwent Sistrunk procedure. When she presented with persistent salivary draining within 1 week of Sistrunk, there was concern for a persistent thyroglossal duct tract or alternate connection to the oropharynx not visualized despite direct laryngoscopy.

Obturation of the wound was attempted, without success. This novel concept of balloon occlusion pullback fistulogram in the open surgical wound led to discovering a tract extending superiorly toward the tongue base. A 14 Fr Foley catheter was inserted into the draining neck wound, balloon expansion in the cavity. Gentle traction was used to occlude the wound and fill the cavity. Ten mL of Omnipaque 180 contrast was infused through the catheter, outlining the balloon in the subcutaneous cavity and an opacified fistulous tract extending midline toward the tongue base posteriorly.

The otolaryngologist, present during flouroscopic exam, employed a similar technique in the OR with methylene blue diluted with saline. This created a roadmap resulting in a revised Sistrunk procedure, excising all abnormal appearing tissue and tongue base. The procedure was completed under direct laryngoscopy identifying the tongue base tissue that needed to be cored out. Only a few reported cases in the literature used fistulograms to identify TGDCs and determine the extent including associated sinus tracts, none of which described the same novel technique of balloon occlusion pullback within the open wound.

Radiographic demonstration of the thyroglossal tract is useful to indicate the extent and location. We present this novel balloon occlusion pullback fistulogram to provide crucial information about the fistulous tract regarding extent, direction, and relationship with adjoining structures for complicated or recurrent TGDCs. This information is crucial in definitive surgical planning. Read More

Authors:  Sensbach Jessica , Ghias Adeeba , Anderson Kelly , Rooks Veronica

Keywords:  Fluoroscopy, Thyroid, Neck

Naseri Mitra,  Wilson Nagwa,  Meriky Lama

Final Pr. ID: Poster #: EDU-074

The maxillary and mandibular bone lesions encompass diverse spectrum of conditions, including congenital, inflammatory and neoplastic processes with both odontogenic and non-odontogenic origins. Various syndromes and metabolic diseases can also involve or affect jaw bones. There is also a meaningful difference between the incidence of jaw lesions in adults and children, for example the inflammatory odontogenic cysts such as periapical cysts are less common in pediatrics compared to the adult. Also, the primary and metastatic neoplasms are not histologically and statistically similar in two age groups.
On the other hand, for many radiologists the maxillary and mandibular lesions are terra incognito (unknown land).
In this pictorial assay, we will review the distinct radiological features of the common and uncommon jaw lesions in different imaging modalities in the pediatric age group. The radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable narrowing the differential diagnosis which will guide following steps in diagnosis and management. Read More

Authors:  Naseri Mitra , Wilson Nagwa , Meriky Lama

Keywords:  Neck, Masses, Imaging Features

Lewis Heidi,  Kucera Jennifer

Final Pr. ID: Poster #: EDU-038

The pediatric orbit presents a wide spectrum of possible abnormalities which differ significantly from those seen in adults. Evaluation of the various pediatric orbital abnormalities depends on radiologic assessment with different imaging techniques to aid in diagnosis. The purpose of this exhibit is to describe and differentiate the more commonly encountered pediatric orbital abnormalities using a multimodality approach. Read More

Authors:  Lewis Heidi , Kucera Jennifer

Keywords:  Orbit, Neuroradiology, Head and Neck

Oliva Vanesa,  Daneman Alan,  Alsakran Sulaiman,  Amirabadi Afsaneh,  Carpio Olga,  Wasserman Jonathan,  Martinez-rios Claudia

Final Pr. ID: Poster #: SCI-058

Diffuse thyroid disease (DTD) encompasses a spectrum of thyroid disorders, including autoimmune conditions such as Hashimoto's thyroiditis (HT). The association between HT and thyroid carcinoma remains controversial. Particularly in children, a robust, large-scale investigation is lacking, and the nature of this potential correlation and outcomes remains poorly elucidated.
The aim of this study is to evaluate the US features of the thyroid gland and cervical lymph nodes, the clinical characteristics and outcomes of pediatric patients with DTD and thyroid carcinoma (TC). Read More

Authors:  Oliva Vanesa , Daneman Alan , Alsakran Sulaiman , Amirabadi Afsaneh , Carpio Olga , Wasserman Jonathan , Martinez-rios Claudia

Keywords:  Ultrasound, Cancer, Neck

Baker Scott,  Gebarski Kathleen,  Gebarski Stephen

Final Pr. ID: Poster #: EDU-088

Sonography is often the initial evaluation of facial lumps and bumps. Most of these lesions are benign, although some malignant lesions may present in this fashion. For education and reference, we composed a pictorial guide of a wide variety of etiologies of facial lumps and bumps.
Read More

Authors:  Baker Scott , Gebarski Kathleen , Gebarski Stephen

Keywords:  Sonography, Head and Neck, Lumps

Waldman Spencer,  Goldfisher Rachelle

Final Pr. ID: Poster #: CR-013

A full-term infant presented at day five of life with gagging, desaturations and bilateral neck swelling. On physical exam, the patient was noted to have a hypopigmented patch on the chest. Family history reveals an older sibling with tuberous sclerosis complex (TSC). Genetic testing on the parents was performed after the previous delivery and as per report from the outside hospital was negative. Given the family history, further imaging was performed. Brain MRI revealed multiple cortical and subependymal tubers consistent with TSC, and echocardiography demonstrated intraventricular rhabdomyomas. Genetic testing demonstrated tuberous sclerosis complex. Given the neck swelling, a CT and MRI were performed and suggested a large mass extending from the deep neck into the mediastinum with concerns for a neurogenic tumor. Tracheostomy was required for airway stabilization. The coexistence of typical TSC lesions with an atypical neck and mediastinal neurogenic mass prompted biopsy, which revealed findings consistent with neurofibroma. Whole-genome sequencing confirmed pathogenic variants in both TSC1 and NF1, establishing the exceedingly rare coexistence of dual phakomatoses. Only a handful of such cases have been reported worldwide, with fewer than a dozen molecularly confirmed instances in the literature (1–2). The infant subsequently developed short-gut syndrome after necrotizing enterocolitis and remains TPN-dependent. Targeted therapy with sirolimus (mTOR inhibitor) and trametinib (MEK inhibitor) was initiated for tumor stabilization. <div> </div> <div>This case represents a rare neonatal presentation of concurrent TSC and NF1 (1–2). Recognition of discordant imaging findings—rhabdomyomas and cortical tubers typical of TSC alongside a mediastinal neurofibroma characteristic of NF1—was pivotal in guiding molecular confirmation. Radiologic pattern recognition thus proved essential for diagnosis, therapeutic direction, and prognostic counseling in a patient exhibiting two distinct neurocutaneous syndromes within the first days of life.

References:
1. Wheeler PG, Sadeghi-Nejad A. Simultaneous occurrence of neurofibromatosis type 1 and tuberous sclerosis in a young girl. Am J Med Genet A. 2005;133A(1):78-81. doi:10.1002/ajmg.a.30530.

2. Alaraj AM, Valyi-Nagy T, Roitberg B. Double phakomatosis: neurofibromatosis type 1 and tuberous sclerosis. Acta Neurochir (Wien). 2007;149(6):505-509. doi:10.1007/s00701-007-1140 Read More

Authors:  Waldman Spencer , Goldfisher Rachelle

Keywords:  Neurofibromatosis 1, Head And Neck, Neonatal

Chukus Anjeza,  Vossough Arastoo,  Dahmoush Hisham

Final Pr. ID: Poster #: EDU-074

Sinonasal tumors in the pediatric population are uncommon. Tumors affecting the nasal cavity and paranasal sinuses in children can arise from either soft tissue or bony structures and differ substantially from adult sinonasal masses. The aim of our exhibit is to review imaging features of a myriad of sinonasal neoplasms and tumor-like masses unique to the pediatric population ranging from the more well-known rhabdomyosarcoma and Ewing’s sarcoma to rarer lesions such as desmoplastic fibroma, nasal chondromesenchymal hamartoma, and melanotic neuroectodermal tumor of infancy. Read More

Authors:  Chukus Anjeza , Vossough Arastoo , Dahmoush Hisham

Keywords:  head & neck, sinonasal tumors, paranasal sinuses

Alsarhani Haifa,  Somerville Scott,  Ahmet Alexandra,  Sawyer Sarah,  Tomiak Eva,  Martinez-rios Claudia

Final Pr. ID: Paper #: 145

Cancer predisposition syndromes (CPS) are rare genetic disorders with increased risk of benign and malignant neoplasms. A few of these syndromes predispose to thyroid gland pathology, including thyroid carcinoma. The purpose of this study is to review the spectrum of diagnostic outcomes of thyroid abnormalities in pediatric patients diagnosed with a CPS at a tertiary care pediatric hospital. Read More

Authors:  Alsarhani Haifa , Somerville Scott , Ahmet Alexandra , Sawyer Sarah , Tomiak Eva , Martinez-rios Claudia

Keywords:  Cancer predisposition syndromes, Neck

Medina Perez Mariangeles,  Gupta Saurabh,  Badar Zain,  Salastekar Ninad,  Majmudar Anand

Final Pr. ID: Poster #: EDU-075

Neck masses are commonly seen in the pediatric population and are a frequent reason for pediatric consults and can represent a diagnostic challenge. Although there is a broad spectrum of differentials, the vast majority of these lesions are benign, however malignant etiologies can also be encountered. Ultrasonography has become the first-line imaging modality in the evaluation of neck masses, given the ability to avoid radiation, wide availability and cost-effectiveness. Also, ultrasound represents an option when trying to avoid contrast administration or sedation.

The main teaching points of this exhibit will be:
1. Review variety of congenital and acquired neck masses in the pediatric patients.
2. Discuss imaging features and approach to various vascular, congenital abnormalities, benign and malignant tumors and other acquired abnormalities with Ultrasound.
3. Discuss the role of anatomic imaging in management.

A case-based pictorial review will be used to demonstrate:
1. Approach to vascular tumors and malformations based on clinical and imaging features including congenital, infantile hemangioma, low flow, various types of vascular malformations, locally aggressive lesions like kaposiform hemangioendothelioma, malignant tumors likely angiosarcoma and hemangioendothelioma.
2. Reviewing salient features of various congenital and acquired abnormalities including branchial cleft cysts, thyroglossal duct cysts, congenital goiter and midline frontal masses.
3. Discuss imaging features of other benign and malignant masses including teratomas, primary cervical neuroblastomas, soft tissue tumors (myofibroblastic), lipoblastoma. Also malignant tumors like fibrosarcoma, rhabdomyosarcoma.
4. Describe masses which mimic tumors such as fibromatosis coli and ectopic thymus.
5. Treatment and prognosis. Read More

Authors:  Medina Perez Mariangeles , Gupta Saurabh , Badar Zain , Salastekar Ninad , Majmudar Anand

Keywords:  neck, masses, ultrasound

Laurindo Mariano De Oliviera Gabrielle,  García Gallegos Víctor,  Cobián Machuca Humberto

Final Pr. ID: Poster #: SCI-028

The presence of abnormal masses in the neck of children always represents a diagnostic challenge. Ultrasound can provide useful information about the origin of an inflammatory mass in the neck and is effective in differentiating solid from cystic lesions. The aim of this study was to evaluate the diagnostic performance of ultrasound in the characterization of abnormal neck masses of the pediatric population. Read More

Authors:  Laurindo Mariano De Oliviera Gabrielle , García Gallegos Víctor , Cobián Machuca Humberto

Keywords:  Neck Masses, Children, Ultrasound