Alkhudari Anas,  Galal Maad,  Aljabr Aljoharah

Final Pr. ID: Poster #: CR-004

In the treatment of infant hydrocephalus, ventriculoperitoneal (VP) shunts are considered the standard of care. Various complications are associated with VP shunting. Ventriculoperitoneal shunt catheter migration remains a rare but documented complication seen in one in 1000 patients who receive a VP shunt. Migration of the VP shunt into the scrotum is even more uncommon and requires surgical treatment.

We report a unique case of a 6-month-old preterm male with history of hydrocephalus treated with surgically placed VP shunt. He presented with vomiting and was found to have a right inguinoscrotal sac swelling with the tip of the catheter appreciated upon palpation of the sac and later confirmed by abdominal radiograph. After admission, the patient started to show rapid and significant improvement without significant intervention. On further imaging, the positioning of the VP shunt improved with a sufficiently reduced tip highlighting the spontaneous reduction of the distal catheter tip. Repeated imaging months later showed no recurrence.

Scrotal migrations are more common in children, and this is commonly thought to be due to an unobliterated processus vaginalis allowing the catheter tip to enter the scrotal sac. As most patients remain asymptomatic and present only after an exacerbation with co-infections, the importance of early diagnosis should not be neglected. This is crucial to avoid subsequent complications such as acute hydrocephalus, testicular torsion, and peritoneal perforation. For nearly all scrotal VP shunt migration cases, definitive treatment is surgical with manual repositioning followed by hernia repair. VP shunt migration should remain an essential differential of scrotal masses in that patient population. We also want to raise awareness to radiologists about the malposition of the VP shunt catheter and the rare ability for it to reduce and retract into appropriate positioning spontaneously. We believe that these recommendations will help improve quality of care management in pediatric hydrocephalus patients. Read More

Authors:  Alkhudari Anas , Galal Maad , Aljabr Aljoharah

Keywords:  Hydrocephalus, Ventriculoperitoneal Shunt Migration, Scrotal Sac Swelling

Mchendrie Mariska,  Rasheed Shabana

Final Pr. ID: Poster #: EDU-049

The purpose of this article is to review some of the different causes of scrotal pain in the pediatric population. In the acute setting, the most common cause of testicular pain is testicular torsion, however, the causative etiologies are broad. These include infectious, inflammatory, traumatic, referred pain, idiopathic or chronic causes. Sonography is the imaging modality of choice for the evaluation of scrotal pain in children. We will present various causes of scrotal pain in children, apart from testicular torsion and demonstrate comprehensive ultrasound features of each. Accurate differentiation and a definitive diagnosis without delay, is crucial for the proper management and favourable outcome of the patient. Read More

Authors:  Mchendrie Mariska , Rasheed Shabana

Keywords:  Scrotal Pain, Torsion, Other causes

Ledbetter Karyn,  Leino Daniel,  Trout Andrew

Final Pr. ID: Poster #: CR-007

Lipoblastomas are rare benign soft tissue tumors (6% of all pediatric soft tissue tumors) that are composed of immature lipoblasts and mature adipocytes. Lipoblastomas primarily occur in infants and children younger than three years of age and most frequently occur in the extremities. Less than 10 case reports exist of pelvic lipoblastomas. We report two children with pelvic lipoblastoma with the typical presentation of a rapidly enlarging, painless, fat-containing mass.

A 30-month-old girl presented with an enlarging gluteal mass over a period of four months. CT performed at an outside institution showed a large fat-containing intra-pelvic lesion anterior to the sacrum that extended to the perineum. An atypical sacrococcygeal teratoma was suspected. Subsequently, MRI demonstrated a large fairly-well-circumscribed intra-pelvic lesion that followed fat on all sequences with the exception of a few thin, enhancing septations.

A 14-year-old boy presented with a large firm scrotal/inguinal mass during a wellness visit. The child reported the lesion had been rapidly increasing in size over the past two months. Ultrasound showed a >15 cm inguinal mass that extended both into the pelvis and left hemiscrotum. The mass was homogeneous in echotexture and displaced but did not involve the epididymis and testicle. Based on concern for a malignant lesion, subsequent evaluation with PET-CT showed the lesion to be predominantly composed of fat with only low level F-18-FDG uptake in a few internal septations.

In both cases, lipoblastoma was confirmed after surgical excision with pathologic examination and immunohistochemistry.

Imaging serves to demonstrate the macroscopic fat content of lipoblastomas but cannot reliably differentiate lipoblastoma from liposarcoma. Therefore, imaging primarily contributes information about size and anatomic relationships relevant to surgical approach. Surgical excision is the treatment of choice; however, the lack of a capsule makes complete excision difficult and local recurrence is common. Close clinical follow-up is recommended for a minimum of five years, with imaging follow-up by MRI or CT utilized when the tumor’s anatomic location precludes or limits detection by physical examination. Read More

Authors:  Ledbetter Karyn , Leino Daniel , Trout Andrew

Keywords:  Lipoblastoma, Pelvic, Scrotal

Alves Timothy,  Gebarski Kathleen

Final Pr. ID: Poster #: EDU-044

While hydroceles, patent processus vaginalis, inguinal hernias, varicoceles, epididymitis, orchitis, torsion of testes and appendages are common in pediatric radiological practice, other pathology and anatomical variants are unusual and may not be included in every day practice. We composed a pictorial guide of a wide variety of variants and diseases for education and reference. Read More

Authors:  Alves Timothy , Gebarski Kathleen

Keywords:  scrotal, testicular, ultrasound

Durfee Teela,  Cielma Tara

Final Pr. ID: Poster #: CR-003 (T)

Pediatric scrotal ultrasound pathology can be difficult because of the similar presentation of different pathology such as scrotal torsion, epididymitis, inguinal hernia, epididymal appendix torsion, and trauma. Identifying key factors of each condition is paramount to providing a clear diagnostic picture in the setting of an atypical presentation of any pathology.

Epididymitis is an inflammatory process precipitated by bacterial or viral infections. Symptoms typically present as increasing scrotal pain with swelling of the epididymis. Depending on degree of severity imaging presentation can mimic other pathology.

A 5 year old male transferred to a pediatric facility from an area hospital to assess suspected incarcerated hernia with outside CT and ultrasound images.
Read More

Authors:  Durfee Teela , Cielma Tara

Keywords:  epididymitis, pediatric scrotal Ultrasound, Acute scrotal pain

Tijerin Bueno Marta,  Martinez-rios Claudia,  Daneman Alan,  De La Puente Gregorio Alejandro,  Navarro Oscar

Final Pr. ID: Poster #: EDU-044

To review unusual sonographic findings of tumors and tumor-like conditions one can encounter in pediatric scrotal ultrasound and to design a diagnostic algorithm that can be useful with the challenges of differential diagnosis in this situation. Read More

Authors:  Tijerin Bueno Marta , Martinez-rios Claudia , Daneman Alan , De La Puente Gregorio Alejandro , Navarro Oscar

Keywords:  scrotal, ultrasound, testis, tumour