Rapp Maurisa,  Kaufman John,  Kaufman Claire

Final Pr. ID: Poster #: CR-004

Lymphatic malformations are congenital vascular anomalies caused by abnormal formation of lymphatic channels. These can be characterized as microcystic, macrocystic or mixed with an incidence of approximately 1 in 6000. These lesions are often asymptomatic, however may present with pain, swelling, recurrent infections or complications due to mass effect. Sclerotherapy is often first line treatment for many of these lesions as they are prone to recurrence after surgery if not completely resected. Sclerotherapy can be painful and require multiple treatments. Pain can preclude prolonged dwell of sclerosants during sclerotherapy. In this poster we describe our case series of sclerotherapy protocol with prolonged sclerosant dwell, 4 hours, formulated with our pediatric anesthesia team. Patients with macrocystic lymphatic malformations of the axilla, abdomen, and chest wall who underwent multi-session sclerotherapy with our new sedation protocol were reviewed. Four patients met the inclusion criteria for our case series. Patient ages ranged from 3-16. The initial procedures were performed with general anesthesia with placement of a locking pigtail drain ranging in size from 6.3 to 8.5 French. Sclerosants used included Sotradecol, bleomycin, with doxycycline left for prolonged dwell. The patients were subsequently extubated however monitored on a dexmedetomidine drip in the PACU. After 4 hours the doxycycline was aspirated and drains attached to bulb suction. Repeat procedures were performed every other day using dexmedetomidine and repeat 4 hours dwell for up to three procedures if needed. Others sclerosants were used during sclerotherapy however did not undergo prolonged dwell and were aspirated prior to the dwell. No sclerosant dwell was terminated early due to pain or complication. All patients tolerated the sedation and procedure well without complication. Three of the four patients underwent a subsequent multi-session sclerotherapy. All four patients had excellent response to therapy. This case series will review the details of the protocol and specifics of the cases. Read More

Authors:  Rapp Maurisa , Kaufman John , Kaufman Claire

Keywords:  Lymphatic Malformation, Sclerotherapy

Vo Hieu,  Maxwell Jacqueline,  Kujawski William,  Yao Connor,  Dale Joshua

Final Pr. ID: Poster #: EDU-008

Vascular malformations in pediatric populations range from simple venous malformations to complex arteriovenous malformations. These present a spectrum of clinical and imaging findings. As radiologists, understanding these vascular anomalies is crucial for accurate diagnosis and determining appropriate therapeutic strategies. This educational exhibit aims to provide a comprehensive review of pediatric vascular malformations, enriched with insights from clinical cases. Read More

Authors:  Vo Hieu , Maxwell Jacqueline , Kujawski William , Yao Connor , Dale Joshua

Keywords:  Ultrasound, Embolization, Sclerotherapy

Meti Shraddha,  Porter Daniel,  Ali Khalid,  Watkins Linda

Final Pr. ID: Poster #: CR-024

Aneurysmal Bone Cysts (ABCs) are benign, expansile lesions representing 2.5% of primary bone tumours, most often affecting children and adolescents. Traditional surgical approaches, such as curettage or wide local excision, carry recurrence rates of up to 70%, emphasising the need for less invasive and more effective alternatives. Image-guided sclerotherapy with agents including doxycycline has emerged as a promising interventional option. We present a case of recurrent tibial ABC successfully treated with single-session CT-guided percutaneous sclerotherapy.

A teenage boy presented with 2 month history of right ankle pain and swelling following minor trauma to the area. Radiographs demonstrated an expansile, multiloculated, cystic lesion in the distal tibial metaphysis. Subsequent MRI showed multiple fluid-fluid levels, circumferential periostitis and mid para-osseous oedema of the distal tibia. Biopsy confirmed the diagnosis of ABC. The patient underwent curettage with allograft, followed by wide local excision and external fixation after recurrence within 6 months. 1-year surveillance CT again demonstrated recurrence and following multidisciplinary tumour board discussion and repeat biopsy, CT-guided percutaneous doxycycline sclerotherapy with bone void filler was performed.

Under general anaesthesia, two 11G bone access needles were advanced into the cystic portion via a posterolateral approach. After aspiration and contrast injection with no spillage demonstrated on CT, doxycycline liquid was instilled and allowed to dwell before being aspirated and bone void filler instilled. The procedure was uncomplicated - the patient was discharged the same day. At 11-month follow-up, the patient reported no pain, had returned to full activity and demonstrated radiographic consolidation without recurrence.

This case highlights the value of CT-guided percutaneous sclerotherapy as a minimally invasive alternative for recurrent ABC, particularly in skeletally immature patients where repeat open surgery risks growth plate injury, deformity, and functional impairment. Compared with multiple-session doxycycline-albumin foam regimens reported in the literature, our case demonstrates successful consolidation with a single-session doxycycline alone injection. Read More

Authors:  Meti Shraddha , Porter Daniel , Ali Khalid , Watkins Linda

Keywords:  Aneurysmal Bone Cyst, Sclerotherapy, Image-Guided