Acosta-izquierdo Laura

Final Pr. ID: Poster #: EDU-006

Abdominal aortic pathology is uncommon in the pediatric population. It is a complex clinical condition that can range from aneurysms to stenosis and can present in the emergency department as a life-threatening condition or as an incidental finding in elective studies. As radiologists, knowing the underlying conditions of abdominal aortic pathology can help clinicians narrow the differential diagnosis and provide early and focused treatment, as most of these cases represent a therapeutic dilemma. The purpose of this educational exhibit is to overview the embryology and normal anatomy of the abdominal aorta and to provide a comprehensive review, through cases, of the different causes of abdominal aortic aneurysms and middle aortic syndrome. Read More

Authors:  Acosta-izquierdo Laura

Keywords:  Aneurysm, Stenosis, Aorta

Albertson Megan,  Powers Andria,  Beavers Angela

Final Pr. ID: Poster #: EDU-063

Background:
AVID is an acronym describing a triad of findings including 1) asymmetric ventriculomegaly, 2) interhemispheric cyst, and 3) dysgenesis of the corpus callosum. This entity accounts for one of the presentations of callosal dysgenesis along a wide spectrum. Because midline anomalies occur with many processes, including holoprosencephaly and aqueductal stenosis, it may appear to have overlapping features on initial glance. However, by focusing attention on the secondary findings, a specific diagnosis may be determined.

Objectives:
By the end of this presentation the learner will: 1) Become familiar with the imaging characteristics of AVID. 2) Describe the differential diagnosis of AVID and the important distinguishing features. 3) Understand the clinical implications of interhemispheric cysts and similar diagnoses.

Cases/Differential Diagnosis:
Through several case examples of mistaken diagnoses, we will describe key findings to differentiate brain disorders with midline anomalies including AVID, holoprosencephaly, and aqueductal stenosis. Holoprosencephaly creates a monoventricle, but may also be associated with a dorsal midline cyst which can be confused for an interhemispheric cyst. Features that differentiate holoprosencephaly from AVID are the presence of fused cerebral hemispheres, thalamic fusion, and a true monoventricle. Aqueductal stenosis may also show severe hydrocephalus, but lacks the cystic component which is seen with the other mentioned entities. Aqueduct stenosis usually causes symmetric ventriculomegaly of the lateral and 3rd ventricles as well as upward displacement of anterior cerebral arteries and inferior displacement of internal cerebral veins. The hydrocephalus from all of these entities may be treated with ventricular shunt placement, but AVID is an important diagnosis to consider because the wall of the interhemispheric cyst could be imperceptible by imaging and may not improve if the tip of the drainage catheter is not within the cyst.

Conclusion:
When evaluating cases of true ventriculomegaly it is important to consider a differential including AVID, holoprosencephaly, aqueductal stenosis, among other less common congenital syndromes. Careful attention to additional imaging findings is necessary to distinguish the correct diagnosis from look-alikes. Making an accurate diagnosis is important as there are differences in medical decision making, treatment outcomes, and long-term prognosis. Read More

Authors:  Albertson Megan , Powers Andria , Beavers Angela

Keywords:  AVID, Holoprosencephaly, Aqueductal Stenosis

Vidal Lorenna,  Guimaraes Carolina

Final Pr. ID: Poster #: EDU-040

Cerebral aqueductal stenosis remains the most common cause of congenital and acquired obstructive hydrocephalus. The objective of this educational exhibit is to interactively illustrate the imaging findings associated with aqueductal stenosis on Fetal and postnatal MRI. Causes of aqueductal stenosis and imaging protocol optimization will also be discussed.
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Authors:  Vidal Lorenna , Guimaraes Carolina

Keywords:  Aqueductal stenosis, hydrocephalus, fetal MRI

Abe Shuji,  Shimada Makoto,  Abe Yuki,  Nishikawa Masanori,  Tominaga Masahide,  Yatake Hidetoshi,  Yabunaka Koichi,  Katsuda Toshizo

Final Pr. ID: Poster #: SCI-01 (R)

The 320-row multidetector computed tomography (MDCT) enables the scanning of a maximum length of 160 mm by volume scanning (VS). Dynamic volume scanning (DVS) with MDCT enables the development of a 4D dynamic image.
The 3D findings of tracheobronchial imaging in children who cannot control their breathing fail to reveal the phase of breathing in which the image was taken, which affects the accuracy of the diagnosis of tracheobronchial stenosis. Imaging by 4D-DVS enables the accurate observation of the tracheal dynamics in association with the respiratory kinetics, thus revealing the mechanism of the former. Furthermore, 4D-DVS would enable the imaging of the cardiac blood vessels by a contrast study simultaneously with the imaging of the stenosed area.
We assessed the efficacy of the 4D-DVS imaging technique in the diagnosis of pediatric tracheobronchial stenosis. Read More

Authors:  Abe Shuji , Shimada Makoto , Abe Yuki , Nishikawa Masanori , Tominaga Masahide , Yatake Hidetoshi , Yabunaka Koichi , Katsuda Toshizo

Keywords:  Dynamic volume scanning, 4D dynamic image, tracheobronchial stenosis

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

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

Milla Sarah,  Cantu Cera,  Richer Edward,  Braithwaite Kiery,  Linam Leann,  Riedesel Erica,  Loewen Jonathan,  Simoneaux Stephen

Final Pr. ID: Poster #: SCI-013

Idiopathic thickening of the pyloric muscle can occur in young infants, causing projectile vomiting, electrolyte abnormalities, and necessity for surgical intervention to relieve the gastric outlet obstruction. Case reports have been published describing infants with HPS who also have portal venous gas (PVG) visualized within the liver. The presence of PVG in other clinical scenarios often indicates a severe and potentially life threatening bowel condition. The purpose of this study was to determine the incidence of infants with hypertrophic pyloric stenosis (HPS) and concurrent portal venous gas (PVG), as well as whether there are unique clinical features or different outcomes in the HPS patients with PVG versus without PVG. Read More

Authors:  Milla Sarah , Cantu Cera , Richer Edward , Braithwaite Kiery , Linam Leann , Riedesel Erica , Loewen Jonathan , Simoneaux Stephen

Keywords:  pyloric stenosis, portal venous gas, pneumatosis

Cielma Tara,  Bandarkar Anjum,  Adeyiga Adebunmi

Final Pr. ID: Poster #: EDU-001 (R)

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants in which the circular muscle layer of pylorus becomes thickened, leading to narrowing and elongation of the pyloric channel. The pyloric mucosa becomes redundant and appears hypertrophic. On ultrasound, the thickened pylorus is often seen adjacent to the gallbladder and anteromedial to the right kidney. Infants with IHPS are asymptomatic at birth but, in the first few weeks of life, develop nonbilious forceful vomiting described as “projectile emesis” and present with partial gastric outlet obstruction. Surgical pyloromyotomy is curative.
Standard sonographic criteria include measurement of pyloric muscle >3 mm and elongation of pyloric canal >14 mm. Normal pyloric muscle thickness measures <2 mm. When pyloric muscle thickness measures between 2-3 mm, the exam is called as equivocal or borderline. Factors leading to equivocal exam may include incorrect technique that involves over measuring the pyloric muscle thickness, obliquely oriented section of pylorus and transient pylorospasm.
Purpose: The goals of this exhibit are-
1. To review the sonographic anatomy of normal and abnormal pylorus.
2. To illustrate our technical approach to diagnose IHPS with specific attention on how to accurately measure the muscle thickness and channel length.
3. To describe tips and tricks to minimize equivocal exams. Read More

Authors:  Cielma Tara , Bandarkar Anjum , Adeyiga Adebunmi

Keywords:  Infantile hypertrophic pyloric stenosis, ultrasound, muscularis externa

Richer Edward,  Sanchez Ramon

Final Pr. ID: Poster #: SCI-083

Hypertrophic pyloric stenosis (HPS) is a frequent cause of vomiting in young infants, with an incidence of 1.5 – 4 per 1000 live births, depending on demographic group. The gold standard diagnostic test is abdominal ultrasound targeting the pylorus, and the measurement thresholds for determining an abnormal pylorus are well established. The objective of this study was to assess whether visual, subjective assessment of the pylorus was as accurate in diagnosing HPS as traditional formal measurements.


Read More

Authors:  Richer Edward , Sanchez Ramon

Keywords:  Pyloric stenosis, Ultrasound, Vomiting

Elma Alexander,  Bates Alister,  Xiao Qiwei,  De Alarcon Alessandro,  Fleck Robert

Final Pr. ID: Poster #: CR-046

Large airway obstruction, subglottic stenosis, tracheal narrowing, and tracheomalacia are common morbidities associated with prematurity secondary to prolonged intubation. Laryngotracheoplasty is often required to alleviate subglottic stenosis and allow a patient to be decannulated from their tracheostomy. Patients will often have continued airway and voice issues despite being able to live without a tracheostomy. The clinical conundrum in treating this patient is whether vocal folds can be surgically moved closer together to improve vocalization without compromising the airway further and increasing resistance. Here we demonstrate how this clinical conundrum can be informed by CT-derived CFD modeling in a 15-year-old male former 31-week preterm infant with dysphonia and subglottic airway narrowing at the cervical trachea and narrow vocal cords. Read More

Authors:  Elma Alexander , Bates Alister , Xiao Qiwei , De Alarcon Alessandro , Fleck Robert

Keywords:  compurtational fluid dynamics, airway modeling, subglottic stenosis

Burns Madisen,  Cao Joseph,  Carrico Caroline

Final Pr. ID: Poster #: CR-001

Aortic calcifications are an uncommon finding in the pediatric population and when present are often reflective of underlying congenital heart or metabolic disease. Intraluminal polypoid calcified lesions (coral reef aorta) causing flow limiting stenosis are exceedingly rare in even the congenital heart disease population.
A 15-year-old patient with a history of hypoplastic left heart syndrome (HLHS) with mitral and aortic atresia. She was found to have significant flow limiting stenosis of the augmented neo-aorta under catheter hemodynamic assessment. CT angiography was performed showing a 4.4 cm partially calcified mass in the ascending aorta extending into the proximal arch causing an 80% narrowing of the aortic lumen. The intrinsic multi-energy capabilities of the first-generation photon counting CT (PCCT) scanner used permitted retrospective material decomposition and thus more definitive characterization of the mass. The patient underwent open ascending aorta replacement and arch repair where densely calcified ascending aorta and base of the arch were removed en bloc along with a large intraluminal mass component without complication. Pathologic assessment revealed PTFE conduit material, thrombus, and extensive calcification with fibrous incorporation of graft and arterial wall. Read More

Authors:  Burns Madisen , Cao Joseph , Carrico Caroline

Keywords:  Aorta, Calcifications, Stenosis

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

Qiu Cecil,  Donaldson James,  Rajeswaran Shankar,  Kim Stanley,  Superina Riccardo,  Mohammad Saeed,  Whitehead Bridget,  Green Jared

Final Pr. ID: Poster #: SCI-033

Biliary stenosis continues to be an important source of morbidity in pediatric liver transplantation. Percutaneous transhepatic cholangiography (PTC) with cholangioplasty and placement of an internal/external biliary drainage catheter has been the standard of care for biliary stenosis at our institution for over twenty years. The purpose of this article is to present the largest and most comprehensive pediatric series to date detailing the percutaneous management of liver transplants complicated by biliary stenosis. Read More

Authors:  Qiu Cecil , Donaldson James , Rajeswaran Shankar , Kim Stanley , Superina Riccardo , Mohammad Saeed , Whitehead Bridget , Green Jared

Keywords:  Liver transplant, PTC, Biliary stenosis

Fenlon Edward

Final Pr. ID: Poster #: EDU-007

Hypertrophic pyloric stenosis (HPS) is a common surgical condition in infants characterized by idiopathic thickening of the gastric pyloric musculature that results in progressive gastric outlet obstruction and non-bilious emesis in infants between the ages of 2 weeks and 3 months. Ultrasound is the best imaging modality in the diagnosis of HPS as it allows for clear delineation of the thickened pyloric muscle and elongated pyloric channel, as well shows associated findings including gastric distention and lack of normal gastric emptying. To the untrained eye however, lack of knowledge of normal anatomy complicated by intermittent antral contraction may make it difficult to confidently exclude HPS. Several fun and helpful radiologic signs have been created to help radiologists and especially radiology trainees recognize the ultrasound findings of HPS (e.g. antral nipple sign and cervix sign). This poster discusses a new radiologic sign called the "eating duck sign" that can be helpful in distinguishing the normal gastric pylorus. In this sign, the distal stomach and antrum appear as the body and head of the duck, the normal gastric pylorus appears as the bill of the duck, and the duodenal bulb appears as the turnip or beet shaped snack of the duck. Read More

Authors:  Fenlon Edward

Keywords:  Hypertrophic Pyloric Stenoisis, Pyloric Stenosis, Radiologic Sign

Chawla Soni,  Ourfalian Raffi

Final Pr. ID: Poster #: EDU-033

IHPS has a history that is intimately related to the evolution of Ultrasound(US). US was first used to diagnose IHPS as far back as 1977 (Teele and Smith), and as US technology advanced, the diagnosis of IHPS became more refined. We can make precise measurements for the pyloric muscle wall thickness (MWT), pyloric canal length (CL), and transverse pyloric diameter (TPD), and we have highly sensitive and specific signs (i.e. target, shoulder, double-track signs, etc) to aid us in the diagnosis of IHPS (Hernanz-Schulman 1998).

Why: IHPS is the most common cause of gastric outlet obstruction and one of the most common conditions requiring surgery in infants. The exact pathogenesis of IHPS is unknown, but it is an acquired, gradual and progressive disorder.

Who: The classic picture is 5 to 8-week old Caucasian male (4:1 M:F) who presents with non-bloody, non-bilious projectile vomiting. Classic physical exam findings including visible peristalsis and palpable pyloric olive are present in less than 50% cases. Delay in diagnosis can cause serious consequences.

When: We can typically do US at any age at the time of the next feed and as the baby is being bottle fed (ideally).

How: We use a linear 12-5 or curved 8-5 transducer, with 2D and cine imaging. The baby is placed in supine position, and we begin scanning at the epigastric region. We find the gastroesophageal junction and trace the lesser curvature of the stomach medially to find the pylorus.

What: Once we find it; we measure the MWT, CL, and TDP, and look for all the signs. One way to remember the normal limits is our “Rule of 4s”. In IHPS, MWT is more than 4mm, CL is 4x4 = 16mm, and TDP is 4+4+4 = 12+mm. The signs include target sign (hypertrophied hypoechoic muscle surrounding echogenic mucosa), shoulder/nipple sign (bulging of hypertrophied pyloric muscle into the lumen of the antrum), and double-track sign (elongated pylorus with hypoechoic lumen, sandwiched between echogenic mucosa). If the measurements do not meet our “rule of 4s” and there are none of the signs, we can confidently rule out IHPS, or we may consider another differential diagnosis, like pylorospasm and mucosal hypertrophy due to other causes like prostaglandins. We’ve come a long way with refining and defining US diagnosis of IHPS until finally ultrasound is now the gold standard diagnostic modality for IHPS. Read More

Authors:  Chawla Soni , Ourfalian Raffi

Keywords:  pyloric, IHPS, stenosis

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