Showing 3 Abstracts.
Olushekun Abdul Hamid, Rutkin Melissa
Final Pr. ID: Poster #: CR-037
Neuropsychiatric symptoms are common manifestations of lupus, often presenting within a year of diagnosis. The American College of Rheumatology (ACR) published a list of 19 neuropsychiatric syndromes observed in SLE citing an up to 20% incidence of generalized or focal seizures. PRES, which typically presents with seizures, headache, altered mental status and visual disturbances, may mimic neuropsychiatric SLE (NPSLE), as presented in this case.
The patient is a 17-year-old female with a history of SLE (diagnosed 2 months prior), lupus nephritis (class IV), GAD, and prior suicide attempt who presented via EMS after an unwitnessed fall. En route to the hospital, she had a seizure which lasted less than 5 minutes. In the ED, she was hypertensive to 146/92 mmHg and physical exam was notable for dilated but reactive pupils and GCS 11. While undergoing a CT scan of the head, she had 2 more seizures. CT scan revealed no acute abnormalities. She was medically stabilized and subsequently transferred to the PICU for further management. Blood pressure had increased to 162/106 mmHg. MRI brain and MRA Head and Neck were obtained which revealed findings most consistent with PRES without any evidence of vasculitis or high-grade stenosis.
Hospital course was complicated by ARDS secondary to pulmonary hemorrhage requiring intubation, increased PTT, MRSA and C Diff infections, for which the patient was treated. 24-hour vEEG did not reveal any seizure activity but showed diffuse slowing of brain waves suggestive of gross cerebral dysfunction. Repeat MRI 5 days after admission showed no changes in above described MRI findings. Patient’s blood pressure improved to 146/92, but she remained intubated and sedated due to ARDS, making it difficult to assess for any improvement in her mental status. Patient was subsequently transferred to an ECMO-capable hospital due to profound hypoxia.
PRES, which often presents with seizures, has been described as a presenting feature of SLE in case reports, and can mimic NPSLE. The underlying pathophysiology and management of NPSLE and PRES are distinct, therefore identifying the imaging features of the many presentations of NPSLE and the imaging findings of PRES is imperative. PRES typically has a favorable outcome if recognized and treated promptly. We present a case of PRES in newly-diagnosed SLE to highlight the imaging features and importance of blood pressure monitoring in early SLE.
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Authors: Olushekun Abdul Hamid , Rutkin Melissa
Keywords: PRES, Systemic lupus erythematosus
Xu Hongmin, Gagnon Marie-helene, Ali Sumera, Linam Leann
Final Pr. ID: Poster #: EDU-039
The purpose of this educational exhibit is to:
1.Review the embryology, classification, and imaging features of anorectal malformations (ARMs).
2.Review the indications and techniques of Contrast-enhanced colosonography (CeCS) in pediatric patients with ARMs.
3.Provide sample cases and clinical courses of patients with specific ARMs.
Anorectal malformations(ARMs) are a spectrum of congenital anomalies involving abnormal development of the distal rectum and anus, leading to an interruption or misconnection of the normal passage between the rectum and the perineum. The condition occurs in about 1 in 5,000 live births and can range from mild to complex. Children with ARMs require preoperative imaging to assess the presence and location of a fistula. Identifying the location of these fistulas is crucial for surgical planning.
Contrast-enhanced colosonography (ceCS) has emerged as a valuable tool in diagnosing pediatric ARMs, offering superior anatomical visualization and assessment compared to traditional imaging techniques like fluoroscopy, providing more sensitive and specific evaluation of fistula with real-time contrast filling. CeCS avoids ionizing radiation, and ultrasound contrast agents have a high safety profile with low incidence of adverse events compared to other contrast agents.
Contrast-Enhanced colosonography (CeCS) technique should include survey greyscale ultrasound examination of the pelvis to assess for adequate window. Lumason, the ultrasound contrast agent, is prepared and injected into a bag of saline, with a ratio of 1:500 mL. The mucous fistula is examined, and a small Foley catheter is inserted by the radiologist, then balloon is inflated to create a seal. Contrast is then instilled by gravity drip, and perineal structures are imaged through three standard approaches- transabdominal, transperineal and posterior sagittal approaches.
As well as reviewing the topics above, this review will also provide examples of ARM cases demonstrating high, intermediate, and low fistulas seen on CeCS.
Overall, CeCS enhances the diagnostic accuracy and management of pediatric ARMs. By providing detailed anatomical insights and allowing for accurate classification, it plays a critical role in guiding treatment strategies and improving long-term outcomes for affected patients.
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Authors: Xu Hongmin , Gagnon Marie-helene , Ali Sumera , Linam Leann
Keywords: Anorectal Malformation, Contrast Enhanced Ultrasound, Pre-Surgical Planning
Mcgovern Jonathan, Zuccoli Giulio, Goyal Rakesh
Final Pr. ID: Poster #: CR-063
To evaluate multimodal magnetic resonance imaging (MRI) characteristics in pediatric patients diagnosed with posterior reversible encephalopathy syndrome (PRES). Read More
Authors: Mcgovern Jonathan , Zuccoli Giulio , Goyal Rakesh