Cristobal Alberto,  Martinez-sicari Jorge,  Vorona Gregory,  Jones Kathryn,  Austin Frances,  Mahdi Eman

Final Pr. ID: Poster #: CR-045

Aspergillus species are ubiquitous environmental molds that healthy humans encounter daily without any adverse effects. However, these molds can cause a range of diseases in immunocompromised individuals, collectively known as invasive aspergillosis. These diseases can affect the sinuses, tracheobronchial tree, lungs, skin, or disseminate. The most common form of invasive aspergillosis is invasive pulmonary aspergillosis, which has high morbidity and mortality rates and requires prompt diagnosis and treatment. A severe form, known as angioinvasive pulmonary aspergillosis, occurs when mold hyphae invade the pulmonary arteries and cause necrosis and hemorrhage of the lung parenchyma. We present such a case in a 17-year old boy with acute myeloid leukemia who developed pulmonary pseudoaneurysms as a complication. The patient was initially admitted to the hospital for scheduled chemotherapy. Several complications occurred, including neutropenic fevers, cough, and pleuritic chest pain, despite broad-spectrum antibiotics. Initial imaging with CT pulmonary angiography showed multifocal nodules and masses with surrounding groundglass opacities. Serum aspergillosis galactomannan and Fungitell were strongly positive. Bronchoalveolar lavage was not performed due to profound anemia and thrombocytopenia. Initial treatment included dual-antifungal therapy with continued treatment upon discharge. Follow-up CT exams demonstrated complications with multiple pseudoaneurysms necessitating repeat hospitalizations, coil embolization, and lobectomy. This case demonstrates classic CT findings of angioinvasive pulmonary aspergillosis, including the "halo" and “air crescent” signs. In our case, the patient developed complications with pulmonary pseudoaneurysms that required multiple interventions. Prompt diagnosis and treatment of this condition is important due to the life-threatening implications. Read More

Authors:  Cristobal Alberto , Martinez-sicari Jorge , Vorona Gregory , Jones Kathryn , Austin Frances , Mahdi Eman

Keywords:  Invasive aspergillosis, Pseudoaneurysm, Immunocompromised

Gupta Amit,  Naranje Priyanka,  Kandasamy Devasenathipathy,  Jana Manisha

Final Pr. ID: Poster #: CR-008

Introduction
Hepatic visceral larva migrans (VLM) is an increasingly recognized parasitic manifestation wherein migratory nematode larvae get lodged in hepatic parenchyma leading to inflammatory granuloma or abscess formation. In this report, we describe a case of VLM presenting with upper gastrointestinal (GI) bleed secondary to a rare complication, a hepatic artery pseudoaneurysm. On literature search, only one such case is reported.
Case Report
A 13-year-old girl presented with abdominal pain and progressively increasing jaundice for the last 2 weeks. The patient had multiple episodes of hematemesis and melaena requiring 2 units of blood transfusion during this time. Ultrasound (USG) abdomen showed multiple ill-defined hyperechoic lesions in the right lobe of liver with presence of anechoic cystic areas within. A dual phase Computed Tomography (CT) scan of the abdomen revealed multiple confluent and discrete hypodense lesions in the right lobe of liver more apparent on portal venous phase, along with presence of a 1.5 cm pseudoaneurysm arising from posterior branch of right hepatic artery. A differential diagnosis of pyogenic liver abscesses, hepatic VLM, disseminated tuberculosis and immunodeficiency with invasive fungal infection was kept along with hepatic artery pseudoaneurysm leading to hemobilia. Lab investigations revealed peripheral eosinophilia (54%) and raised serum IgE (1600 IU/mL). Hydatid serology was negative. Based on these findings, a diagnosis of hepatic VLM was made and the patient was started on Albendazole (400 mg BD). The patient underwent Digital Subtraction Angiography and managed with successful embolization of the pseudoaneurysm using microcoils. There was significant improvement in jaundice and no recurrence of hematemesis over the next ten days along with rapid drop in peripheral eosinophilia. The patient subsequently remained asymptomatic over a follow-up period of 18 months. The inflammation caused by cytotoxic eosinophil-derived proteins associated with helminthic parasites may lead to vascular complications.
Conclusion
Hepatic VLM can be rarely associated with hepatic artery pseudoaneurysm presenting in the form of acute upper GI bleed in the background of progressive abdominal symptoms secondary to hepatic lesions. Prompt diagnosis and management with percutaneous angio-embolization for the aneurysm and anti-helminthic therapy for the underlying parasitic infestation is of paramount importance for a good clinical outcome. Read More

Authors:  Gupta Amit , Naranje Priyanka , Kandasamy Devasenathipathy , Jana Manisha

Keywords:  Visceral larva migrans, Pseudoaneurysm, GI bleed

Ritchie David,  Negrete Lindsey,  Naheedy John

Final Pr. ID: Poster #: EDU-045

Trauma poses significant challenges to the pediatric emergency provider. From 1 to 14 years of age, traumatic injuries remain the leading cause of death for children in the United States. The majority of total mortality is attributable to motor vehicle collisions followed by bicycle accidents, falls, burns, and physical assaults. While the practice of interventional radiology (IR) in adults is undergoing considerable growth and expansion, so too are the techniques in their application to children.

We first review techniques that are more commonly encountered in pediatric IR trauma such as minimally invasive control of hemorrhage, percutaneous stenting, and arterial embolization. We then present cases that are less commonly encountered such as: hepatic laceration with pseudoaneurysm formation, pelvic fracture with CT-guided iliofixation, and humeral contusion with pseudoanuerysm formation of the anterior humeral circumflex artery. In all cases, the initial imaging performed in the emergency department will be highlighted throughout for each patient prior to showing any of the corresponding interventions.

After reviewing this exhibit, an attendee should be familiar with frequently encountered and less commonly encountered trauma in the pediatric IR setting. We hope the learner will gain comfort in the prompt recognition of acute traumatic pediatric imaging that may go on to subsequently require the intensivist’s attention. Read More

Authors:  Ritchie David , Negrete Lindsey , Naheedy John

Keywords:  Interventional, Trauma, Pseudoaneurysm

Foo Madeline,  Mcdaniel Janice

Final Pr. ID: Poster #: CR-011

Pseudoaneurysms are uncommon vascular abnormalities contained by surrounding adventitial and perivascular tissues, often caused by a disruption of the arterial wall secondary to arterial injury or inflammation. Post-traumatic and iatrogenic pseudoaneurysms in children are especially rare, contributing to the insufficient literature regarding their care. Traditional treatment in adults for these lesions include surgical repair and angiography with embolization. Recently, minimally invasive endovascular techniques, such as percutaneous ultrasound-guided thrombin injection (UGTI), have become the first-line therapeutic choice for certain types of pseudoaneurysm. We present 3 patients with pseudoaneurysms treated with UGTI in uncommon locations.

Cases:
Case 1: 6-year-old female with trauma to the spleen from a bike accident who later developed a 1.6cm pseudoaneurysm of the spleen, which was treated with an injection of thrombin using ultrasound guidance.
Case 2: 9-year-old female with trauma to the lower leg after falling through a glass table who developed a 3.8cm pseudoaneurysm off the anterior tibial artery, which was treated with an injection of thrombin using ultrasound guidance.
Case 3: 13-year-old female with a 2.3cm iatrogenic pseudoaneurysm off the gluteal artery related to percutaneous transgluteal abscess drain placement, which was treated with an injection of thrombin using ultrasound guidance. Read More

Authors:  Foo Madeline , Mcdaniel Janice

Keywords:  Pseudoaneurysms, Ultrasound-Guided Thrombin Injection, Pediatric IR

Patel Falguni

Final Pr. ID: Poster #: CR-002 (R)

To demonstrate the finding of a Femoral artery Pseudoaneurysm on a Left Lower extremity venous and arterial doppler ultrasound and under Interventional Radiology sonographically guided compression of the neck of the Pseudoaneurysm and guided injection of thrombin into the Pseudoaneurysm resulted in successful thrombosis of a Pseudoaneurysm. Follow up ultrasounds to document resolving of a Left Femoral artery Pseudoaneurysm in an infant. Read More

Authors:  Patel Falguni

Keywords:  Doppler Lower extremity Ultrasound, Pseudoaneurysm, Interventional procedure.

Deaver Pamela,  Masand Prakash

Final Pr. ID: Poster #: CR-048

In a child with escalating hemoptysis, negative TB testing, and history of penetrating thoracic trauma, chronic inflammation and vascular injury as a result of radiolucent foreign body should be considered. Read More

Authors:  Deaver Pamela , Masand Prakash

Keywords:  Foreign Body, Pseudoaneurysm, Tuberculosis