Infante Juan

Final Pr. ID: Poster #: CR-014

Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.

The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.

Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma. Read More

Authors:  Infante Juan

Keywords:  trauma, bladder, pelvic anatomy

Cartagena Claudia,  Herliczek Thaddeus,  Dibble Elizabeth,  Swenson David

Final Pr. ID: Poster #: SCI-035

To describe the spectrum and incidence of alternative etiologies for lower abdominal and pelvic pain identified on magnetic resonance imaging (MRI) following indeterminate appendix ultrasound (US) in pediatric patients. Read More

Authors:  Cartagena Claudia , Herliczek Thaddeus , Dibble Elizabeth , Swenson David

Keywords:  abdominal, pelvic, appendix

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

Pace Erika,  Vaidya Sucheta,  De Souza Nandita

Final Pr. ID: Paper #: 150

To measure early (within 3 months) and late (beyond 3 months) changes in ADC of the lumbosacral vertebral marrow following chemotherapy in children with abdomino-pelvic neoplasms and interpret them in the context of ADC measurement reproducibility. Read More

Authors:  Pace Erika , Vaidya Sucheta , De Souza Nandita

Keywords:  bone marrow, chemotherapy, abdomino-pelvic neoplasm

Jackson Dana,  Gould Sharon,  Choudhary Arabinda,  Epelman Monica

Final Pr. ID: Poster #: EDU-082

Acute onset pelvic pain in a pubertal girl has many possible etiologies. Reproductive, urinary and gastrointestinal pathology all can underlie acute onset pelvic pain in this age group and may have similar presentations. We present a series of six cases in which MRI was utilized for further evaluation of US findings and either confirmed the need for surgical intervention, or established the cause of pain and eliminated the need for surgery. Read More

Authors:  Jackson Dana , Gould Sharon , Choudhary Arabinda , Epelman Monica

Keywords:  Pelvic pain, Ovarian torsion, Appendicitis

Ledbetter Karyn,  Leino Daniel,  Trout Andrew

Final Pr. ID: Poster #: CR-007

Lipoblastomas are rare benign soft tissue tumors (6% of all pediatric soft tissue tumors) that are composed of immature lipoblasts and mature adipocytes. Lipoblastomas primarily occur in infants and children younger than three years of age and most frequently occur in the extremities. Less than 10 case reports exist of pelvic lipoblastomas. We report two children with pelvic lipoblastoma with the typical presentation of a rapidly enlarging, painless, fat-containing mass.

A 30-month-old girl presented with an enlarging gluteal mass over a period of four months. CT performed at an outside institution showed a large fat-containing intra-pelvic lesion anterior to the sacrum that extended to the perineum. An atypical sacrococcygeal teratoma was suspected. Subsequently, MRI demonstrated a large fairly-well-circumscribed intra-pelvic lesion that followed fat on all sequences with the exception of a few thin, enhancing septations.

A 14-year-old boy presented with a large firm scrotal/inguinal mass during a wellness visit. The child reported the lesion had been rapidly increasing in size over the past two months. Ultrasound showed a >15 cm inguinal mass that extended both into the pelvis and left hemiscrotum. The mass was homogeneous in echotexture and displaced but did not involve the epididymis and testicle. Based on concern for a malignant lesion, subsequent evaluation with PET-CT showed the lesion to be predominantly composed of fat with only low level F-18-FDG uptake in a few internal septations.

In both cases, lipoblastoma was confirmed after surgical excision with pathologic examination and immunohistochemistry.

Imaging serves to demonstrate the macroscopic fat content of lipoblastomas but cannot reliably differentiate lipoblastoma from liposarcoma. Therefore, imaging primarily contributes information about size and anatomic relationships relevant to surgical approach. Surgical excision is the treatment of choice; however, the lack of a capsule makes complete excision difficult and local recurrence is common. Close clinical follow-up is recommended for a minimum of five years, with imaging follow-up by MRI or CT utilized when the tumor’s anatomic location precludes or limits detection by physical examination. Read More

Authors:  Ledbetter Karyn , Leino Daniel , Trout Andrew

Keywords:  Lipoblastoma, Pelvic, Scrotal

Oliver Brianna

Final Pr. ID: Poster #: EDU-036

Pelvic and scrotal pain are common emergent presenting symptoms in the pediatric population, and these patients are commonly imaged to evaluated for gonadal torsion. In this educational exhibit we will review the entire spectrum of gonadal and paragonadal torsions in the pediatric population, focusing on clinical presentations, key imaging findings, possible pitfalls in diagnosis, and next steps in management. It is essential for the pediatric radiologist to be familiar with this range of pathology in order to render an accurate and timely diagnosis, particularly given that some (but not all) of these diagnoses require emergent surgery. Read More

Authors:  Oliver Brianna

Keywords:  Torsion, Emergencies, Pelvic