Chang Santos Santiago,  Garcia Cristian,  De Barbieri Florencia

Final Pr. ID: Poster #: CR-018

Show the imaging findings in a series of 4 OHVIRA syndrome, cases reported, in our hospital in a period of 10 years (May 2009 and May2019). Read More

Authors:  Chang Santos Santiago , Garcia Cristian , De Barbieri Florencia

Keywords:  Ohvira, didelfous uterus, renal agenesia

Bruno Costanza,  Minniti Salvatore

Final Pr. ID: Poster #: EDU-013

To offer a complete overview of the diagnostic hypotheses of the various fluid-containing masses which can be found in the neonatal abdomen. Read More

Authors:  Bruno Costanza , Minniti Salvatore

Keywords:  Ovarian cysts, renal dilation, duodenal atresia

Gupta Ayushi,  Monforte Hector,  Schaaf William,  Kucera Jennifer

Final Pr. ID: Poster #: EDU-031

Pediatric patients can host a variety of benign and malignant renal tumors and tumor mimics. Their clinical presentation is nonspecific as patients may be asymptomatic or present with an abdominal mass, flank pain, or hematuria. Proper patient management requires an accurate diagnosis based on a combination of radiological and pathological findings. Read More

Authors:  Gupta Ayushi , Monforte Hector , Schaaf William , Kucera Jennifer

Keywords:  renal tumor, Wilms tumor, renal cell carcinoma

Wermers Joshua,  Batlivala Sarosh,  Li Yinan,  Zhang Bin,  Towbin Alexander

Final Pr. ID: Poster #: SCI-004

Diffuse serosal and soft tissue enhancement (SSTE) is a unique pattern of contrast enhancement seen on abdominal radiographs after cardiac catheterization in newborns. While thought to be benign, SSTE can be misdiagnosed as pneumoperitoneum, resulting in unnecessary and potentially invasive diagnostic procedures. The purpose of this study is to describe the incidence of SSTE on abdominal radiograph performed in infants within 2 days of cardiac catheterization and identify clinical features associated with this imaging finding. Read More

Authors:  Wermers Joshua , Batlivala Sarosh , Li Yinan , Zhang Bin , Towbin Alexander

Keywords:  Radiography, Contrast, Renal

Moore Tyler,  Hopkins Katharine

Final Pr. ID: Poster #: EDU-082

Functional magnetic resonance urography (fMRU) provides not only anatomic information but quantitative functional information as well. Several free tools are available to perform functional analysis. One such tool, CHOP-fMRU, is appealing because its creators have provided extensive instructions on their software and scan protocols.

Several barriers were encountered in attempting to implement CHOP-fMRU at OHSU. First, to perform the analysis, the appropriate DICOM files must be acquired from PACS. CHOP-fMRU is compatible with a limited number of transfer syntaxes, so a conversion is required after PACS download if the encoding is incompatible. Second, CHOP-fMRU is incompatible with some types of data elements that can be found in files with valid DICOM formats. Third, only the dynamic series can be included when importing a study into CHOP-fMRU, and every image in the set must be present. If an image from another series is included or an image from the dynamic series is excluded, the user encounters an error. Finally, when the analysis has been performed, it is desirable to send the results to PACS. Unless the user has purchased an Interactive Data Language (IDL) license, the images may only be exported as JPEG files. These files must be packaged into DICOM files with the correct header data before they are sent to PACS using DICOM network protocol.

While these tasks could each be accomplished with any one of many available DICOM tools, some of the tasks are moderately complex, and performing them manually would be time consuming. Instead, an additional piece of software desigend solely to perform these functions as simply and efficiently as possible can be helpful. Such a solution was attempted at OHSU, and the resulting software, CHOP-fMRU Assistant, is presented here.

CHOP-fMRU Assistant is a program written in C# using the Grassroots DICOM (GDCM) library. Current features include automatic transfer syntax conversion, removal of many potentially incompatible data elements, easy exclusion of unwanted series, analysis of the dynamic series for missing images, and conversion of the results from CHOP-fMRU to DICOM files for upload to PACS. CHOP-fMRU Assistant is available at https://github.com/overtone1000/CHOP-fMRU_Assistant under an open-source license and is offered with an associated wiki to help other institutions who have encountered similar barriers while attempting to implement CHOP-fMRU. Read More

Authors:  Moore Tyler , Hopkins Katharine

Keywords:  MR, Functional, Renal

Goldwasser Bernard,  Kazmi Faaiza,  Urbine Jacqueline,  Poletto Erica,  Malik Archana,  Mallon Mary

Final Pr. ID: Poster #: EDU-048

There is a wide array of pathologies which can cause diffuse changes in the pediatric kidney. The purpose of the presentation is to show a multimodality pictorial review of characteristic findings of a wide variety of diffuse renal abnormalities in the pediatric patient. Read More

Authors:  Goldwasser Bernard , Kazmi Faaiza , Urbine Jacqueline , Poletto Erica , Malik Archana , Mallon Mary

Keywords:  renal mass, congenital renal abnormalities, syndromes affecting the kidney

Montgomery Stormy,  Kodger Nicole,  Johnson Melissa,  Harris Kelly,  Tutman Jeffrey

Final Pr. ID: Poster #: EDU-020

Interrogation of the renal vasculature in the pediatric patient is challenging, requiring meticulous sonographic technique and attention to detail. Ultrasound, and Doppler sonography in particular, plays a key role in evaluation of suspected renal vascular abnormalities given its portability, availability, and lack of ionizing radiation. Attempts must be made to optimize the performance of this technically challenging examination. Additionally, the radiologist must be familiar with the frequently subtle findings in these examinations.

The purpose of this exhibit is the educate the audience on the proper performance and interpretation of renal Doppler ultrasound. We will first review the normal vascular anatomy of the kidney and normal arterial and venous waveforms. Sonographic technique will be reviewed, including tips and tricks for optimizing image acquisition and including a review of appropriate technique for color and spectral Doppler interrogation. A case-based pictorial review will then follow, including the following diagnoses:

1. Renal artery thrombosis
2. Renal vein thrombosis
3. Renal artery stenosis, including discussion of congenital vs. acquired causes and associated syndromes
4. Manifestations of systemic processes in the renal vasculature (including patent ductus arteriosis, aortic coarctation, and LVAD)
5. Spectrum of abnormal vascular findings in renal transplants
6. Pseudoaneurysm and AV fistula
7. Nutcracker syndrome Read More

Authors:  Montgomery Stormy , Kodger Nicole , Johnson Melissa , Harris Kelly , Tutman Jeffrey

Keywords:  Renal, Doppler, Ultrasound

Taylor Erin,  Graeber Brendon,  Ehrlich Lauren

Final Pr. ID: Poster #: EDU-041

Sickle cell disease (SCD) is characterized by repeated episodes of vaso-occlusion and hemolysis beginning in the pediatric period that result in serious multi-organ system complications. In particular, renal complications are often the cause of morbidity and reduced life expectancy of patients with SCD. Therefore, it is essential that radiologists be able to identify the imaging features early to help guide prompt and appropriate treatment.

Sequelae in pediatric patients include sickle cell nephropathy, infarction and papillary necrosis, and assorted glomerulopathies. These in turn can lead to altered hemodynamics, impaired urinary concentrating ability, hematuria, proteinuria, and acute and chronic kidney injury. Children with SCD are also at increased risk of asymptomatic bacteriuria and urinary tract infection. Even those children and young adults who only have sickle cell trait (SCT) rather than SCD may develop chronic kidney disease later in life and carry markedly increased risk for renal medullary carcinoma. Segmental testicular infarction can compromise fertility in patients with both SCD and SCT.

The genitourinary manifestations of SCD and SCT in the pediatric patient will be reviewed in this educational exhibit, with an emphasis on radiologic appearances. For each entity, the clinical presentation, pathophysiology, and differential diagnosis of the imaging findings will also be briefly reviewed.

The renal complications covered will include renal infarction, papillary necrosis, renal vein thrombosis (as a complication of nephrotic syndrome), urinary tract infection, hematuria, renal medullary carcinoma, and acute and chronic kidney disease. Testicular and penile sequelae of SCD including segmental testicular infarction and priapism will also be discussed. A variety of imaging modalities will be used to illustrate the various complications, including ultrasonography, computed tomography, and magnetic resonance imaging. Read More

Authors:  Taylor Erin , Graeber Brendon , Ehrlich Lauren

Keywords:  Sickle, Renal, Genitourinary

Infante Juan

Final Pr. ID: Poster #: EDU-026

Renal dysfunction in a transplant kidney is a common clinical problem which is usually attributed to either rejection or arterial stenosis. While the overall incidence of transplant renal artery stenosis is low, the question of stenosis remains after Doppler examinations although abnormal Doppler ultrasounds are often later proven to be false positives. In the author's experience, these false positive cases are almost always associated with high correction angles (at or near 60 degrees). Conversely, repeating a positive Doppler study by maneuvering the transducer to produce a lower correction angle often resolves the apparently elevated velocity.

A contributing factor to the usage of high correction angles is the actual angle of takeoff of the transplant renal artery relative to the external iliac artery. This can make performing the study with a low correction angle a physically challenging task for the sonographer. Nevertheless, proper effort when scanning these cases is indicated to save the patients from unnecessary follow-up studies and possibly unnecessary invasive procedures.


This educational exhibit aims to address the following learning points:

1) The basis for avoiding high correction angles can be traced to back to basic trigonometric principles which we must keep in mind during image acquisition and interpretation
2) The mechanism for false positive Doppler studies in post-transplant renal artery stenosis is often an unnecessarily high Doppler correction angle
3) Repeating a positive Doppler study with the aim of minimizing the correction angle through optimal probe placement can help avoid unnecessary further testing including possibly invasive procedures
4) The angle of takeoff and variable trajectories of transplant renal arteries can pose difficult physical and cognitive problems for the ultrasound operator Read More

Authors:  Infante Juan

Keywords:  renal artery stenosis, renal transplant, Doppler

Moore Ryan,  Basta Amaya,  Schmitz Kelli,  Hopkins Katharine,  Vajtai Petra

Final Pr. ID: Poster #: EDU-101

Renal trauma is not uncommon in the pediatric population and can be seen in a wide variety of settings, from minor sports-related injuries to serious motor vehicle accidents. The imaging appearance is as varied as the etiology of injuries, ranging from minor parenchymal defects to avulsion of the vascular pedicle. Our educational poster aims at exploring a variety of injuries of the kidney in children, including chronic subcapsular hematoma, different severities of laceration, renal rupture without and with urine extravasation, injuries to the ureter, trauma involving kidneys with congenital anomalies, and trauma in an undiagnosed Wilms' tumor. Because renal trauma can present with many different faces, we aim to highlight essential diagnostic pearls as well as some unusual factors which may predispose the kidney to injury. Read More

Authors:  Moore Ryan , Basta Amaya , Schmitz Kelli , Hopkins Katharine , Vajtai Petra

Keywords:  renal, trauma, injury, hematoma, laceration

Bareño Sandra,  Pérez-marrero Lizbet,  Fuentealba Isabel,  Pose Georgette,  Soto Gloria,  Silva Claudio,  Salinas Cesar

Final Pr. ID: Poster #: SCI-056

To determine the cause of obstructive hydronephrosis using fMRU in pediatric patients with inconclusive conventional studies. Read More

Authors:  Bareño Sandra , Pérez-marrero Lizbet , Fuentealba Isabel , Pose Georgette , Soto Gloria , Silva Claudio , Salinas Cesar

Keywords:  Hydronephrosis, Magnetic Resonance Urography Scan, Ureteropelvic junction stenosis, Obstructive hydronephrosis, Differential renal function

Sandhu Preet

Final Pr. ID: Poster #: EDU-126

1. To describe imaging appearance of OHVIRA ( Obstructed hemivagina and ipsilateral renal agenesis) on different imaging modalities including Ultrasound, CT and MRI.
2. To understand the close interrelationship between urinary and reproductive system development during embryogenesis. Stress the importance of association of urinary and reproductive abnormalities so that if multicystic dysplastic kidney (MCDK), renal dysplasia or agenesis is seen in a female neonate, a careful search for associated genital malformation such as uterus didelphys with obstructed hemivagina (UDWOH) /OHVIRA should be performed.
3. To demonstrate the association of MCDK with OHVIRA and to further support the fact that renal agenesis seen in cases of OHVIRA may actually represent involuted MCDK rather than true renal agenesis.
4. To stress the importance of early diagnosis of OHVIRA (obstructed hemivagina with ipsilateral renal agenesis), so that correct management at the onset of puberty can prevent abdominal pain and dysmenorrhea and other complications.

Embryology of urinary and reproductive system will be discussed briefly. Imaging appearance of OHVIRA on different imaging modalities including US, CT and MRI with cases showing both prenatal and postnatal imaging will be presented. Read More

Authors:  Sandhu Preet

Keywords:  OHVIRA, Renal agenesis, Herlyn-Werner-Wunderlich syndrome

Farhat Ahmed,  Huang Pauline,  Servaes Sabah,  Hailemichael Eyassu

Final Pr. ID: Poster #: CR-020

A “pancake” kidney is a rare subtype of cross fused renal ectopia, in which there is both fusion of the upper and lower poles of the kidneys in the pelvis, resulting in a disc or cake shaped appearance of the fused kidneys. The cross fused renal ectopia is a rare congenital anomaly caused by abnormal growth of the ureteric bud and separation failure of metanephric tissues with an estimated incidence of 1 in 2000, with a male predominance. Patients are often asymptomatic, but urinary tract infections, ureteropelvic junction obstruction, vesicoureteric reflux, and renal stones can be associated with renal ectopia. We present a case of a 7 year old boy who initially presented to the ED with back pain and clinical concerns of hydronephrosis, with an incidental finding of a “pancake” kidney. Read More

Authors:  Farhat Ahmed , Huang Pauline , Servaes Sabah , Hailemichael Eyassu

Keywords:  Renal Ectopia, Pancake kidney

Evans Catherine,  Ardestani Allen,  Watterson Christopher,  Patel Snehalkumar

Final Pr. ID: Poster #: EDU-106

The objectives of this educational exhibit are (1) To review the radiologic appearance of pediatric renal tumors in multiple imaging modalities, (2) To review the demographic and clinical contexts in which pediatric renal tumors occur, and (3) To survey various syndromes classically associated with pediatric renal tumors. Read More

Authors:  Evans Catherine , Ardestani Allen , Watterson Christopher , Patel Snehalkumar

Keywords:  Wilms tumor, renal cell carcinoma, WAGR, tuberous sclerosis, mesoblastic nephroma

El-ali Alexander,  Mittal Sameer,  Boyer Kathleen,  Long Christopher,  States Lisa,  Back Susan,  Khrichenko Dmitry,  Serai Suraj

Final Pr. ID: Paper #: 093

Nephron sparing surgery for renal masses is indicated for pediatric patients with bilateral renal masses and masses associated with syndromic conditions predisposed to recurrence. However, there is a paucity of literature on MRI-based biomarkers in patients undergoing partial nephrectomy. Relating these imaging biomarkers to patient outcomes might inform surgical decision making and patient counseling. Read More

Authors:  El-ali Alexander , Mittal Sameer , Boyer Kathleen , Long Christopher , States Lisa , Back Susan , Khrichenko Dmitry , Serai Suraj

Keywords:  Imaging Biomarkers, MRI, Renal Tumor

Smitthimedhin Anilawan,  Sridharan Anush,  Darge Kassa,  Back Susan,  Cahill Anne Marie

Final Pr. ID: Paper #: 142

Conventional Doppler US is known to have low sensitivity for the diagnosis of renal artery stenosis (RAS), in particular segmental renovascular disease. This study aims to determine if contrast-enhanced US (CEUS) can quantitatively provide assessment of renal arterial and parenchymal perfusion pre- and post- renal artery angioplasty in children and potentially be used as a follow-up imaging tool. Read More

Authors:  Smitthimedhin Anilawan , Sridharan Anush , Darge Kassa , Back Susan , Cahill Anne Marie

Keywords:  CEUS, Renal Artery Stenosis, Contrast-Enhanced Ultrasound

Dabadie Alexia,  Lee Anna,  Bray Heather

Final Pr. ID: Poster #: EDU-070

The purpose of this educational exhibit is to review the patterns of clinical presentation of common and uncommon renal tumors of infancy and to illustrate their imaging and pathologic features. Read More

Authors:  Dabadie Alexia , Lee Anna , Bray Heather

Keywords:  Radiology-pathology correlation, Renal tumors, Infants

Kariher Julia,  Duden Peter,  Clark Meghan,  Hook Marcus

Final Pr. ID: Poster #: EDU-019

Learning Objectives:
Review normal kidney development and embryology
Understand spectrum of renal fusion abnormalities, associated genitourinary abnormalities, and their clinical manifestations
Recognize imaging findings and important associations

Kidney Development and Abnormalities:
The metanephric blastema becomes the functioning kidney and the ureteric bud develops into the ureters and upper collecting system. Typical kidney development begins at 4 weeks gestation. Over 4-7 weeks gestations, the developing kidneys rise from the sacrum to the abdomen moving apart from each other and rotating medially with final positioning at week 9.

Renal positioning defects include malrotation which is abnormal rotation of the kidney along its long axis. The hilum often faces anteriorly, as the kidney fails to medially rotate during ascent.

Ectopic kidneys are position defects where the kidneys are not located in the renal fossa. Renal ectopia can be simple, wherein the kidney remains ipsilateral, or crossed, wherein the kidney is located contralateral to the distal ureter insertion. Pelvic kidney is the most common simple ectopia. Ectopic kidneys may coexist with fusion defects. Associated symptoms include vesicoureteral reflux, increased urinary tract infections, and renal calculi formation.

The horseshoe kidney is the most common congenital partial renal fusion abnormality (1/400 live births with male predilection).

Case Report:
Our case report had a prenatal diagnosis of absent left kidney and postnatal diagnosis of imperforate anus. Ultrasound revealed left to right crossed fused renal ectopia. Voiding cystourethrogram demonstrated additional abnormalities in the genitourinary tract, including a fistulous connection between the bladder and uterine segment/vagina and bifid appearance of the uterus with bilateral grade II vesicoureteral reflux. MRI redemonstrated left-to-right crossed fused renal ectopia and vesicovaginal/rectovaginal fistulas.

Conclusion
Cross fused renal ectopia is part of a spectrum of congenital genitourinary abnormalities and are common in prenatal assessment. Read More

Authors:  Kariher Julia , Duden Peter , Clark Meghan , Hook Marcus

Keywords:  Cross fused renal ectopia, Renal, Embryology

Southard Richard,  Chen Lingyun,  Williams Carla,  Bardo Dianna

Final Pr. ID: Poster #: EDU-001

Spectral or multi-energy CT (MECT), obtains raw data at more than one energy spectra which allows the decomposition of materials into their constituent elements. As opposed to conventional CT which yields data based on linear attenuation, MECT yields both structural and material-specific information. Only limited experience and literature are available regarding use and applications of MECT in the pediatric patient population. Our institution has recently installed a spectral MECT scanner which uses a single x-ray source modified multilayered detector CT, in our emergency department (ED). It is currently the only such scanner used for routine clinical pediatric imaging in the US, and 4^th such unit in a children’s hospital in the world. In this educational exhibit we will review the basic physics of MECT, the benefits and limitations of the single-source multi-layered detector geometry, and clinical applications of MECT and our experience to date in the pediatric population. Read More

Authors:  Southard Richard , Chen Lingyun , Williams Carla , Bardo Dianna

Keywords:  Spectral CT, Multi-energy CT, renal stones

Didier Ryne,  Chow Jeanne,  Kwatra Neha,  Lebowitz Robert

Final Pr. ID: Poster #: EDU-055

Duplicated collecting systems can be associated with vesicoureteral reflux, urinary obstruction, ureteroceles, incontinence, and renal parenchymal scarring which can result in decreased renal function, therefore, early identification by radiologists and clinicians is crucial. The purpose of this educational exhibit is to review the embryology, highlight the imaging manifestations, and discuss the clinical ramifications of duplicated renal collecting systems in the pediatric population. Read More

Authors:  Didier Ryne , Chow Jeanne , Kwatra Neha , Lebowitz Robert

Keywords:  Duplication, Urinary tract, Renal

Riemann Monique,  Bailey Smita,  Angadi Siddhartha,  Biyyam Deepa,  Turman Martin

Final Pr. ID: Poster #: SCI-016

Approximately 800 children in the United States undergo renal transplant each year. Allograft failure is driven by interstitial fibrosis often due to chronic antibody mediated rejection. Renal biopsy is the gold standard to detect allograft dysfunction but limited by sampling error and inherent procedural and anesthesia risk. Ultrasound shearwave elastography (US-SWE) is a non-invasive imaging technique that assesses the mechanical stiffness of tissue. The primary aim of this study was to examine the relationship between US-SWE values, pathologic fibrosis/rejections scores and serology in pediatric recipients of renal transplant. Read More

Authors:  Riemann Monique , Bailey Smita , Angadi Siddhartha , Biyyam Deepa , Turman Martin

Keywords:  ultrasound, elastography, pediatric renal transplant

Smitthimedhin Anilawan,  Otero Hansel,  Cahill Anne Marie,  Durand Rachelle

Final Pr. ID: Paper #: 143

Renal artery stenosis (RAS) is an important cause of hypertension in children. When suspected, imaging options include Doppler US, CTA and MRA. However, conventional angiography remains the gold standard. We investigate the accuracy and inter-reader reliability of CTA in children with suspected renal artery stenosis. Read More

Authors:  Smitthimedhin Anilawan , Otero Hansel , Cahill Anne Marie , Durand Rachelle

Keywords:  Renal Artery Stenosis, CTA, Angiography

Kolluri Akhil,  Smith Stephen,  Gowda Madhu,  Austin Frances,  Bagwell Charles,  Oiticica Claudio,  Vorona Gregory

Final Pr. ID: Poster #: CR-007

Wilm’s tumor (nephroblastoma) is the most common pediatric renal mass, with rare reports of extra-renal Wilm’s tumors which primarily arise elsewhere in the retroperitoneum. We present a small series of patients who have recently been treated at our institution with histologically-proven extra-renal Wilm’s tumors. The first patient is a six year old female who initially presented to an outside hospital with a draining “perianal abscess”, who on subsequent workup was found to have a large infiltrative pelvic mass and multiple pulmonary metastases (image 1). The second patient is a six year old female who initially presented with abrupt onset of right-sided abdominal pain which woke her from sleep, and who was found on imaging to have a large right-sided retroperitoneal hemorrhage originating from a hemorrhagic suprarenal mass (images 2 and 3).

We will review the pertinent imaging and histological findings from these patients, as well as briefly review what has been previously published about this rare rumor.

The imaging features of extra-renal Wilm’s tumor are heterogeneous and not specific, making it important that the radiologist consider this etiology when presented with a retroperitoneal mass in a pediatric patient within the first decade of life. Read More

Authors:  Kolluri Akhil , Smith Stephen , Gowda Madhu , Austin Frances , Bagwell Charles , Oiticica Claudio , Vorona Gregory

Keywords:  Wilm's tumor, nephroblastoma, extra-renal