Bhatt Malay,  Kirsch Alyssa,  Metz Terrence

Final Pr. ID: Poster #: EDU-049

To familiarize the audience with our institution’s technique utilizing ultrasound (US) and electrocardiogram (ECG) for anatomic localization and technical guidance for PICC placement in a pediatric intensive care unit (PICU) procedure suite utilizing intravenous (IV) sedation without general anesthesia to eliminate patient and operator radiation exposure and decrease sedation specifically in a pediatric population. Read More

Authors:  Bhatt Malay , Kirsch Alyssa , Metz Terrence

Keywords:  PICC, Vascular Access

Bharde Pravinkumar,  Kinariwala Dhara,  Venkatakrishna Shyam Sunder Billapura,  Bale Christina,  Acord Michael

Final Pr. ID: Poster #: EDU-006

Pediatric esophageal varices almost uniformly occur as a consequence of portal hypertension in children with chronic liver disease or extrahepatic portal vein obstruction. Varices in these cases typically evolve in the distal esophagus at the intersection of the left gastric and esophageal veins. We report a rare case of “downhill” varices that developed in the proximal esophagus due to extensive chronic thrombosis of the SVC and brachiocephalic veins in a child with intestinal failure requiring lifelong central venous access for parenteral nutrition. We report a case of downhill varices associated with thrombosis of the SVC and brachiocephalic veins, secondary to a central line.
A 14-year-old boy with an ACTG2 (actin gene) mutation-related history of parenteral nutrition dependent chronic intestinal pseudo-obstruction and central venous catheter-associated thrombi on prophylactic anticoagulation presented with new onset dysphagia. On endoscopy, Grade II esophageal varices without stigmata of recent bleeding were unexpectedly identified in the upper and middle esophagus. Imaging was then performed to assess for advanced liver disease or abnormal portal flow. CT of the abdomen and pelvis showed no splenomegaly, ascites, or radiographic signs of cirrhosis. There was, however, partial visualization of dilated para-esophageal vessels coursing from the chest.
Subsequent chest CT demonstrated chronic occlusion of the right internal jugular and brachiocephalic veins, along with severe narrowing of the SVC. There were extensive venous collateral pathways through the azygos and para-esophageal venous system and engorged submucosal veins were present in the esophagus. Echocardiography confirmed a stable chronic thrombus in the SVC.
Given the high risk of intervention, the decision was made to forgo immediate SVC balloon dilation and stenting and to continue active surveillance.
This case highlights the important role of imaging in differentiating “downhill” esophageal varices from their “uphill” counterpart. This distinction is critical, as each entity necessitates a different treatment approach. Definitive management of downhill varices is aimed at alleviating SVC obstruction but carries significant risk and was deferred in this case. Read More

Authors:  Bharde Pravinkumar , Kinariwala Dhara , Venkatakrishna Shyam Sunder Billapura , Bale Christina , Acord Michael

Keywords:  Venous Recanalization, PICC, Thrombosis

Gnannt Ralph,  Patel Premal,  Amaral Joao,  Parra Dimitri,  Connolly Bairbre

Final Pr. ID: Poster #: SCI-009

Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to explore the outcome (patency, success and infection) of PICC repairs in children and to compare those risks to that of PICC exchange. Read More

Authors:  Gnannt Ralph , Patel Premal , Amaral Joao , Parra Dimitri , Connolly Bairbre

Keywords:  PICC, repair, infection

Durand Rachelle,  Acord Michael,  Srinivasan Abhay,  Krishnamurthy Ganesh,  Saade-lemus Sandra,  Cahill Anne Marie,  Kaplan Summer

Final Pr. ID: Paper #: 120

Neonates with prolonged hospitalization often require PICCs. The concern for PICC-related complications, including venous thrombosis, infection, catheter migration and breakage, often prompts Doppler ultrasound (US) evaluation. However, peri-catheter thrombus in a neonate can be challenging to evaluate, as the accessed peripheral veins in neonates are small, some less than 1mm in luminal diameter. Small-bore catheters may occupy the entirety of the vessel lumen, which can produce absence of peri-catheter flow, which is confounding for thrombus. This distinction has implications for hematologic management. Read More

Authors:  Durand Rachelle , Acord Michael , Srinivasan Abhay , Krishnamurthy Ganesh , Saade-lemus Sandra , Cahill Anne Marie , Kaplan Summer

Keywords:  PICC, Thrombosis, Neonate