Zawin Joan,  Buyukkaya Ayla

Final Pr. ID: Poster #: CR-031

Subcutaneous fat necrosis of the newborn (SCFN) is an infrequent, self-limiting panniculitis observed in neonates. We report an unusual presentation of SCFN in a premature infant who developed a progressively enlarging mass in the supraclavicular region. Lesions commonly develop on the shoulders, back, buttocks, thighs, and cheeks.
The patient was a male infant born via emergency cesarean delivery at 30 weeks and 6 days gestation due to fetal distress. Maternal history was significant for diabetes. His postnatal course was complicated by hypoglycemia, episodes of apnea associated with hypoxia, and hypotension.
Physical examination revealed a firm, non-tender, subcutaneous mass without overlying skin changes in the left supraclavicular area. Ultrasonography demonstrated ill-defined thickening of the subcutaneous fat with heterogeneous echogenicity and internal blood flow. MRI showed reduced T1 signal intensity lower than that of normal fat and increased signal on T2 and fat-suppressed T2 sequences, indicating abnormal subcutaneous fat.
The differential diagnosis included SCFN, infantile myofibromatosis, embryonal rhabdomyosarcoma, hemangioma, and neurofibroma. Embryonal rhabdomyosarcoma is the most prevalent tumor affecting young children. Unlike subcutaneous fat necrosis, however, rhabdomyosarcoma typically arises after the first few months of life. It usually presents as a solitary, rapidly growing, firm mass involving striated muscle. Infantile myofibromatosis commonly involves multiple sites, including the bone, lungs, heart, and gastrointestinal tract. Given the infant’s prematurity and clinical history of perinatal hypoxia, metabolic derangements, and maternal diabetes, SCFN was considered the most likely diagnosis.
While SCFN resolves spontaneously, the most significant potential complication is hypercalcemia, which occurs in approximately 28% of cases. Additionally, renal ultrasound should be performed to assess nephrocalcinosis and nephrolithiasis.
In summary, subcutaneous fat necrosis may be present in premature infants with relevant perinatal risk factors. Its clinical and radiologic features can mimic neoplastic or infectious conditions. It is essential for radiologists to recognize the clinical and imaging characteristics of this rare condition to enable timely diagnosis and avoid unwarranted surgical intervention. Read More

Authors:  Zawin Joan , Buyukkaya Ayla

Keywords:  Soft Tissue Mass, MR, Ultrasound

Beckhorn Catherine,  Lee Rachel,  Cao Joseph

Final Pr. ID: Poster #: CR-028

Background: Granular cell tumors (GCT) are rare Schwann cell-derived soft tissue tumors typically presenting as a solitary, painless nodule in adults in the 4th to 6th decades of life, rarely presenting in children. GCT most commonly originate from gastrointestinal mucosa of the tongue or oral cavity, and are 2-3 times more common in women. While generally benign, approximately 2% of cases may be malignant; therefore, GCTs are typically treated with local surgical control.
Case: A 7-year-old male with sickle cell trait presented to clinic for a painless “pea-sized lump” on his penile shaft, which had been present since infancy but had recently grown larger. Ultrasound demonstrated a 1.8 cm lenticular-shaped mass on the dorsal mid shaft of the penis superficial to the fascial borders of the cavernous cavernosum. There was mild internal vascularity, but no invasion past fascial borders, surrounding soft tissue changes. On MRI, the mass was uniformly T1 iso-intense and T2 slightly hyperintense, with slight postcontrast enhancement. The mass was well-circumscribed, wrapped around the corpus cavernosum without invasion of the tunica albuginea, and exhibited uniform restricted diffusion, calcification, or internal fat. No lymph node involvement was noted on imaging. Surgical resection 8 months later noted a 3 cm mass, which now extended into the glans, with pathology consistent with benign GCT, with positive staining for S-100, CD68, SOX10, and calretinin, Ki-67 of 1%, and negative for SM actin. Due to depth of glans penetration, R2 resection was achieved based on the pediatric urologist’s decision to spare the glans, rather than performing a more aggressive distal penectomy. Post-operative MRI 4 months later demonstrated residual tumor with interval reduction in mass size. Additional investigation of the patient’s past medical history revealed that a benign GCT had been removed from the inside of his lip the previous year which helped support the final histopathologic diagnosis. While multifocal GCTs have been described in genetic syndromes, this patient had not undergone genetic testing to date. Read More

Authors:  Beckhorn Catherine , Lee Rachel , Cao Joseph

Keywords:  MRI, Genitourinary, Soft-Tissue Tumors

Eliades Sarah,  Pomeranz Christy,  Baad Michael,  Roytman Michelle,  Kovanlikaya Arzu

Final Pr. ID: Poster #: EDU-056

Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees.

We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance.

Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup. Read More

Authors:  Eliades Sarah , Pomeranz Christy , Baad Michael , Roytman Michelle , Kovanlikaya Arzu

Keywords:  Soft tissue mass, Ultrasound, Superficial

Golden Eleza,  Simoneaux Stephen,  Dickson Paula

Final Pr. ID: Poster #: CR-049

To describe the radiographic appearance of subclinical calcified brown fat necrosis and to delineate the associated clinical and laboratory findings. While brown fat necrosis has been described in infants with underlying cardiac disease treated with prostaglandins, we emphasize hypotension from cardiac or respiratory arrest as a primary risk factor. Read More

Authors:  Golden Eleza , Simoneaux Stephen , Dickson Paula

Keywords:  fat necrosis, soft tissue calcification, congenital heart disease

Kazelka Maryam,  Shao Lei,  Mcgraw Marty,  Neville Kucera Jennifer

Final Pr. ID: Poster #: CR-016

Spindle cell sarcomas are a rare and aggressive type of soft-tissue sarcoma. Although rhabdomyosarcomas are the most common childhood sarcoma, the spindle cell type is incredibly rare. A 25-year-old healthy G2P1001 female presents at 34 weeks gestational age with fetal growth restriction of a male fetus. Prenatal ultrasound showed a complex vascular mass exophytic to the distal spine, with a presumed diagnosis of sacrococcygeal teratoma (SCT). For further characterization, a fetal MRI was performed at 35 weeks gestation, which showed a solid appearing mass exophytic to the pelvis and involving the proximal thigh. Many features of the tumor were atypical for sacrococcygeal teratoma: the mass being more homogenous than expected, lacking cystic components that would normally been seen in a SCT, and involving the thigh but without definite involvement of the spine. It was also noted that the normal T1 meconium signal in the rectum was displaced posteriorly by the mass. At that time, an alternative differential diagnosis was suggested: sarcoma including fibrosarcoma or rhabdomyosarcoma, myofibroma, or less likely atypical sacrococcygeal teratoma. The baby was born via C-section at 37 weeks and 1 day gestation. A postnatal MRI showed the mass exophytic to the pelvis with some intrapelvic extension via the inguinal canal. Lack of spine involvement was confirmed. Signal characteristics of the tumor were similar to that of skeletal muscle, with a few focal areas of internal hemorrhage. The tumor had mass effect on multiple structures: deviating and tethering of the rectum to the right and stretching it inferiorly; displacing the anus posteriorly; uplifting the bladder; and abutting the base of the penis with no clear fat planes. Surgical resection was performed when the baby was 6 days old. Pathology evaluation revealed a sarcoma that was diffusely infiltrative with NTRK reactivity by immunohistochemistry. Molecular studies by next-generation sequencing reported TPM3-NTRK1 fusion in the tumor. Pathology was most suggestive of a spindle-cell sarcoma. It is important for the pediatric radiologist to be familiar with fetal soft tissue tumors to help facilitate family counseling and delivery planning. The radiologist should understand imaging features that may help distinguish more rare soft tissue tumors from sacrococcygeal teratomas. Although an exact diagnosis may not be possible prenatally, a multidisciplinary approach ensures the best possible patient outcomes. Read More

Authors:  Kazelka Maryam , Shao Lei , Mcgraw Marty , Neville Kucera Jennifer

Keywords:  Sarcomas, Fetal Magnetic Resonance Imaging, Soft Tissue Sarcoma

Schild Wenzel Isabel,  Whittle Carolina,  Andrews Anita,  Kramer Daniela,  Downey Camila,  Fajre Ximena,  Pérez-marrero Lizbet

Final Pr. ID: Poster #: EDU-067

Glomovenous malformations (GVM) are rare, low-flow vascular malformations arising from glomus body components. They often present as bluish, compressible nodules or plaques, usually located in the extremities. Because they are infrequent and may mimic more common venous malformations, they are frequently underrecognized. Read More

Authors:  Schild Wenzel Isabel , Whittle Carolina , Andrews Anita , Kramer Daniela , Downey Camila , Fajre Ximena , Pérez-marrero Lizbet

Keywords:  Ultrasound, Soft Tissue, Vascular Malformations

Ksiazek Kathleen

Final Pr. ID: Poster #: EDU-016 (T)

Medical imaging of the soft tissue of the neck or airway is one of the most common, and sometimes challenging, exams performed at a pediatric hospital. Imaging of the airway can help identify enlarged adenoids, the presence of a foreign body, an abscess, pathology or anatomical abnormality. It is crucial to understand the proper technique, breathing instructions and positioning in order to obtain optimal imaging for correct diagnosis. Different radiographic findings will be presented with examples of incorrect positioning, grid usage, exposure factors, artifacts and ways to improve the image quality. This poster will also provide technologists with tips and recommendations to help them to feel prepared and confident to work with all pediatric patients. Read More

Authors:  Ksiazek Kathleen

Keywords:  Airway, Soft tissue of neck

Chitalkar Sachin,  Shet Narendra

Final Pr. ID: Poster #: EDU-055

To review the characteristic imaging findings of pediatric fibroblastic/myofibroblastic masses to aid in their diagnosis and management.
Soft tissue lesions in pediatric patients encompass a wide variety of pathologies. While a comprehensive review of all possible pathologies is beyond the scope of this poster, we aim to review one particular subset of lesions, fibroblastic lesions (including myofibroblastic neoplasms), in hopes to bring these to mind when evaluating a pediatric soft tissue mass to improve diagnosis and management of these entities.
Soft tissue masses typically present clinically on the basis of history and physical examination. US and MRI are used as first- and second-line imaging modalities, with limited roles for radiographs, CT and FDG-PET. In this poster, we will review the pertinent imaging findings of these neoplasms. Read More

Authors:  Chitalkar Sachin , Shet Narendra

Keywords:  Soft Tissue Mass, Soft-Tissue Tumors, Pediatric Radiology

Sideris Georgios,  Stever Madeline,  Khubchandani Mansha,  Xian Ziyu,  Makris Joseph

Final Pr. ID: Poster #: EDU-062

Soft tissue lesions are very frequently encountered in daily clinical practice. Ultrasonography is typically the first-line modality given its ease of use and low cost. Pediatric radiologists play a crucial role in guiding further management by recommending observation, additional imaging or tissue sampling. However, characterizing lesions solely based on imaging can be challenging, as some cases lack definitive features. This image-rich educational exhibit will showcase both common and rare pediatric soft tissue entities that have been observed at our tertiary medical center from June 2015 to August 2023. Each displayed image will be accompanied by a label indicating whether the diagnosis is confirmed (via biopsy) or highly likely (based on imaging and clinical behavior). Teaching points and differential diagnostic considerations will be provided for each case. The aim of this poster is to highlight the distinguishing features of each entity and to aid in image interpretation. Read More

Authors:  Sideris Georgios , Stever Madeline , Khubchandani Mansha , Xian Ziyu , Makris Joseph

Keywords:  Soft Tissue, Ultrasound

Ziehe Luis,  Navarro Oscar

Final Pr. ID: Poster #: CR-035

Talar callosity, also known as foot pressure pad, is relatively rare in children. It is characterized by the development of a localized thickening of the skin and subcutaneous tissues on the dorsolateral aspect of the hindfoot to midfoot, most commonly at the level of the talus, navicular, or cuboid bones, and is attributed to repetitive pressure of the soft tissues against the bone. Such mechanical stress typically occurs in children who frequently maintain flexed leg positions with direct pressure on the dorsolateral foot, often in the absence of footwear.
The clinical course of talar callosity is benign, tending to remain stable over time as long as the underlying positioning persists. Clinically, talar callosity can be uni or bilateral and may present as focal skin hyperpigmentation and hyperkeratosis, which is often more obvious during foot adduction and plantar flexion. The true prevalence of this condition is likely underestimated, as it is typically asymptomatic and does not cause pain or functional impairment. The most frequent reason for medical consultation is the parental concern generated by the appearance of a painless nodule on the dorsum of the foot.
Although clinical diagnosis is usually straightforward, imaging studies may be requested when the lesion is mistaken for other entities, such as ganglion, vascular malformations, or soft tissue tumors. In such scenarios, ultrasound is the preferred initial imaging modality.
This exhibit illustrates five ultrasound-documented cases of talar callosities in children aged 4-10 years, two of which also had investigation with MRI. In each case, the ultrasound showed a partially defined, heterogeneous, hypoechoic thickening of the subcutaneous tissue, typically with an ellipsoid morphology, measuring between 1.3 cm and 1.8 cm in the maximal dimension, with absence of significant vascularity, and no involvement of tendinous or deep osseous structures, in keeping with the previously reported cases in the literature. MRI showed the lesions but did not add any further information to aid in the final diagnosis.
Recognition of this benign entity by clinicians and radiologists is crucial, as it can prevent unnecessary diagnostic procedures and invasive interventions, such as biopsy. The primary objective of this exhibit is to increase awareness of talar callosity among radiologists, thereby promoting accurate diagnosis and reducing the frequency of unwarranted investigations and decreasing parental concern. Read More

Authors:  Ziehe Luis , Navarro Oscar

Keywords:  Soft Tissue Mass, Benign

Rossel Natalia,  Pérez-marrero Lizbet,  Whittle Carolina,  Aris Ricardo,  Fuentealba Isabel

Final Pr. ID: Poster #: SCI-025

Soft tissue hemangiomas (STH) are the most common benign vascular tumors in childhood. Its diagnosis is mainly clinical. In some cases, imaging is required, US Doppler choice of preference. Less frequently, it can be complemented with complex studies such as diagnostic angiography, MRI and biopsy, or ultrasonographic follow-up.
This study aims to investigate the characteristics of STH that required imaging follow-up, complex studies or biopsies. Read More

Authors:  Rossel Natalia , Pérez-marrero Lizbet , Whittle Carolina , Aris Ricardo , Fuentealba Isabel

Keywords:  Soft Tissue Hemangioma, Infantile hemangioma, Congenital hemangioma

Hameed Shema,  Lloyd Claire,  Carmichael James,  Navarro Oscar

Final Pr. ID: Poster #: EDU-029

Soft-tissue tumors provide a significant part of a pediatric radiologists’ work. Using the World Health Organization (WHO) soft-tissue tumor classification system, those most relevant to pediatric imaging can be broadly categorized into tumors of adipocytic, fibroblastic/myofibroblastic, so-called fibrohistiocytic, vascular, nerve sheath, uncertain differentiation, smooth and skeletal muscle origin. Ultrasound remains the primary modality of choice as it is quick, provides excellent soft-tissue resolution, allows assessment of vascularity, is cost-effective and does not require sedation in young children. With rapidly advancing technology, exquisite soft-tissue detail can now be achieved, and along with additional knowledge of the natural history and imaging characteristics of soft-tissue tumors in recent years, the diagnostic accuracy of US has significantly increased.
The objectives of this exhibit are to review the sonographic imaging findings of benign and malignant pediatric soft-tissue tumors and present specific features that aid diagnosis using illustrative examples from our institutions. Read More

Authors:  Hameed Shema , Lloyd Claire , Carmichael James , Navarro Oscar

Keywords:  Soft-tissue tumors, Ultrasound, World Health Organization

Whittle Carolina,  Schild Wenzel Isabel,  Andrews Anita,  Pérez-marrero Lizbet

Final Pr. ID: Poster #: EDU-061

Ultrasound is a valuable and noninvasive tool for the evaluation of the nail unit. With the availability of high-frequency transducers, it is now possible to obtain detailed images of normal nail anatomy, including the dorsal and ventral plates, nail bed and matrix, periungual folds, and underlying structures such as the bony surface and extensor tendons. These technological advances have enabled imaging-based diagnosis of nail disorders that were previously dependent solely on clinical or histopathological assessment.
Objectives:
To describe the normal ultrasonographic anatomy of the nail unit through representative images and illustrative diagrams.
To present the main ultrasound findings of common inflammatory-infectious, traumatic, and tumoral pediatric nail disorders, with schematic drawings of the diseases.
To encourage the integration of key sonographic criteria into the daily practice of general radiologists for the evaluation of nail pathology. Read More

Authors:  Whittle Carolina , Schild Wenzel Isabel , Andrews Anita , Pérez-marrero Lizbet

Keywords:  Ultrasound, Soft Tissue

Obringer Samuel,  Englert Thao,  Kowal Daniel

Final Pr. ID: Poster #: EDU-097

Palpable masses of the scalp and neck are a common indication for imaging in children. Ultrasound serves as the first-line modality with high spatial resolution and the ability to assess vascularity without the need for ionizing radiation or sedation/anesthesia, rendering it very effective at differentiating between the many possible pathologies. This educational exhibit will outline the appropriate scanning technique, followed by a case-based review of the ultrasound appearance of some of the most common entities presenting as palpable neck and scalp masses in the pediatric population. Pathologies covered in this review include thyroglossal duct cysts, branchial cleft cysts, ectopic thymus, fibromatosis, epidermal inclusion cysts, pilar cysts, dermoid/epidermoid cysts, ranula, vascular malformations, and pseudomasses such as parotitis. This exhibit will discuss atypical features that may require further assessment with additional modalities. Lastly, relevant ultrasound anatomy, including midline neck and floor-of-mouth structures, will be reviewed as it pertains to surgical planning. Read More

Authors:  Obringer Samuel , Englert Thao , Kowal Daniel

Keywords:  Ultrasound, Soft Tissue, Scanning

Leite Igor,  Santos Luiz,  Gedeon Barbara,  Nogueira Renata,  Daltro Pedro,  Fazecas Tatiana

Final Pr. ID: Poster #: EDU-062

This educational exhibit introduces a layer-based framework for evaluating pediatric superficial soft-tissue lesions using high-frequency ultrasound. The goal is to help radiologists and sonographers determine the anatomic layer of origin (epidermis, dermis, subcutaneous fat, or superficial fascia) and demonstrate how this topographic information guides lesion characterization and differential diagnosis. By emphasizing an anatomy-oriented approach rather than a purely echogenicity-based one, the exhibit aims to support diagnostic reasoning and strengthen communication with referring clinicians in daily pediatric imaging practice. Read More

Authors:  Leite Igor , Santos Luiz , Gedeon Barbara , Nogueira Renata , Daltro Pedro , Fazecas Tatiana

Keywords:  Soft Tissue, Ultrasonography, Diagnostic

Smyth Anna,  Aboagye Rosemond,  Lee Anna,  Bray Heather

Final Pr. ID: Poster #: EDU-052

The purpose of this educational exhibit is to illustrate the radiological appearance of various ossified soft tissue lesions. The differential diagnosis is wide, with entities ranging from benign to malignant. Using instructive and interesting cases encountered at our department, this presentation will outline an approach to forming a differential diagnosis. Various teaching points will be highlighted. Pathological correlation will be included where available.

The cases to be presented include:
Myositis ossificans
Fibrodysplasia ossificans progressiva
Tenosynovial osteochondromatosis
Dysplasia Epiphysealis Hemimelica
Pseudohypoparathyroidism - Albright’s hereditary osteodystrophy
Phlebolith in a vascular malformation
Pilomatrixoma
Heterotopic ossification
Synovial Sarcoma

This presentation will highlight the distinguishing imaging characteristics of each entity and help narrow the differential diagnosis for a radiologist when faced with a pediatric ossified soft tissue lesion. Read More

Authors:  Smyth Anna , Aboagye Rosemond , Lee Anna , Bray Heather

Keywords:  Ossified soft tissue