Herrera Ernesto,  Rodríguez Garza Claudia,  Mendoza Venegas Diego

Final Pr. ID: Poster #: CR-045

Juvenile-onset systemic lupus erythematosus is a form of systemic lupus erythematosus, an autoimmune disease that occurs in approximately 10–20% of cases before the age of 16. When the central nervous system is involved, the condition is termed neuropsychiatric lupus. These symptoms typically develop within the first year after diagnosis and are linked to a higher risk of mortality.
A 15-year-old male patient with a medical history of systemic lupus erythematosus, antiphospholipid syndrome, and lupus nephritis presented to the emergency department with decreased visual acuity and paralysis of the left sixth cranial nerve. Additionally, elevated blood pressure levels were recorded during his admission.
Given the symptoms, a brain MRI without contrast was performed. Punctate and linear focal areas in the right hemipontine and bulbopontine junction, which were hyperintense on T2/FLAIR and hypointense on T1, with no diffusion restriction or post-gadolinium enhancement, suggestive of malacia. Additionally, irregularities in the caliber of the left vertebral, basilar, and right posterior cerebral arteries were observed, characterized by alternating dilated and stenotic areas resembling a pearl necklace, along with wall irregularities indicative of vasculitis. Treatment was initiated, however the response was inadequate. During hospitalization, the patient experienced a sudden neurological deterioration. A non-contrast head CT and CT angiography were performed, revealing Fisher IV subarachnoid hemorrhage and persistent findings in the posterior cerebral arterial circulation. Later, he developed right hemiparesis, a second brain MRI, which identified a cerebral vascular event in the left middle cerebral artery's partial territory in a subacute stage. Additionally, there was a reduction in caliber and intensity of both middle cerebral arteries, suggestive of vasospasm, while the posterior cerebral circulation showed no changes compared to previous studies. Finally, cerebral angiography was conducted, confirming the previously described findings.
Vasculitis is a characteristic feature of juvenile-onset systemic lupus erythematosus, the incidence of CNS vasculitis in systemic lupus erythematosus is around 7–10%. MRI is the preferred modality for characterization; however, diagnosis is challenging for radiologists due to the diverse clinical manifestations, which present a broad spectrum of severity and nonspecific imaging findings. Read More

Authors:  Herrera Ernesto , Rodríguez Garza Claudia , Mendoza Venegas Diego

Keywords:  Vasculitis, Neurologic

Bailey Christopher,  Hwang Misun

Final Pr. ID: Poster #: EDU-039

Imaging pediatric patients calls for modalities that are rapid and reduce or eliminate radiation exposure. As such, ultrasound is an exceedingly important modality in pediatric radiology. Ultrasound can be used for a large variety of indications and provides clinicians and radiologists with a real-time, point of care evaluation without radiation exposure. Grey scale and color Doppler ultrasonographic images do have some limitations including an inability to accurately define vasculature or detect/characterize lesions in solid organs. Fortunately, contrast enhanced ultrasound (CEUS) is now available for use in the United States. Ultrasound contrast agents are gas-filled microbubbles that are injected into the systemic vasculature that appear echogenic on grey scale ultrasound. Contrast enhanced ultrasound allows for more precise visualization of vasculature, determination of relative blood flow, and enhanced visualization of solid organs and lesions. The availability of CEUS provides pediatric radiologists with a powerful new tool for the evaluation of a variety of pathologies that traditionally required high radiation computed tomography or lengthy magnetic resonance imaging. Read More

Authors:  Bailey Christopher , Hwang Misun

Keywords:  Contrast enhanced ultrasound, Trauma, Neurologic