Thomas Aby,  Steiner Michael,  Teague Clint

Final Pr. ID: Poster #: EDU-032

Congenital infections or in utero infections results from a wide variety of pathogens. The most common ones are referred by the mnemonic TORCH infections. The manifestations of congenital infections are diverse, ranging from asymptomatic cases to severe, life-threatening conditions. Common presentations include neurological abnormalities, hearing and vision impairments, developmental delays, and growth problems.

This review aims to discuss the radiological manifestations of the TORCH infections with emphasis on the resurgence of syphilis as a significant concern within the realm of congenital infections. And in by doing so, underscore the critical role of radiology in facilitating early detection and enabling timely intervention. Read More

Authors:  Thomas Aby , Steiner Michael , Teague Clint

Keywords:  TORCH, Syphilis, congenital infection

Huang Jennifer,  Hernanz-schulman Marta,  Luo Yu

Final Pr. ID: Poster #: CR-021

Congenital syphilis (CS) results from transplacental or intrapartum infection by the spirochete bacterium Treponema pallidum. After a nadir in 2005, its incidence has been rising since 2013, currently affecting 48.5 infants per 100,000 live births; this represents a nearly 300% increase since 2015. However, CS remains infrequent, and may not receive appropriate consideration in the differential diagnosis. We report such a case in which the differential diagnosis was not initially entertained. Recognition of the imaging findings of this congenital infection by the pediatric radiologist can be critical in the timely management of this condition.

Case: A 4-month old boy had wrist swelling noted by his grandmother who took him to the local ED where he was found to have a right distal radial fracture. The infant was transferred to our tertiary referral pediatric institution with concern for non-accidental trauma. Skeletal survey at our institution demonstrated multiple variable-shaped and sized lytic lesions in bilateral femurs, tibias, right fibula, bilateral humeri, radii, ulnas, right scapula and multiple vertebrae. Suggested differential diagnosis included metastatic disease, LCH, leukemia or infantile myofibromatosis, which prompted oncological evalution. CS was added late to the differential diagnosis. Further questioning then revealed that patient's mother had had syphilis during pregnancy with unknown treatment history. Further physical examination revealed multiple skin lesions and mucosal ulcers, rash, and blisters. Patient's treponemal Ig G was positive and he was treated with penicillin with RPR(Rapid Plasma Reagin) titer follow-up.

CS has a high fetal or perinatal mortality rate approaching 40%. However, most live infected newborns are asymptomatic. The common clinical presentation includes fever, rash, rhinitis, hepatosplenomegaly, anemia, jaundice and elevated liver enzymes. The common skeletal findings include periosteal reaction, metaphyseal lucent bands, widespread metaphyseal erosions; particularly characteristic (although not specific) is the Wimberger sign, which irefers to the bilateral destruction of the proximal medial tibial metaphyses with sparing of a few medial millimeters (Laval-Jeantet collar). Differential diagnosis of CS includes osteomyelitis, neuroblastoma/metastases, leukemia, infantile fibromatosis, NAT. Characteristic radiographic and clinical lesions will be presented with discussion of differential diagnoses. Read More

Authors:  Huang Jennifer , Hernanz-schulman Marta , Luo Yu

Keywords:  syphilis, Congenital

Eteer Khalid,  Collins Denise,  Sabharwal Gauravi,  Ledbetter Karyn,  Leschied Jessica

Final Pr. ID: Poster #: EDU-032

Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis. Congenital syphilis can lead to severe sequelae or at worst, death. Worldwide congenital syphilis has recently seen a resurgence, with the United States alone having 9.2 cases of congenital syphilis per 100,000 live births in 2013, the first increase since 2008. Since then, it has been increasing in prevalence yearly, with most recent preliminary data showing up to 2100 cases of congenital syphilis in 2020. In addition, the number of syphilitic stillbirths in the United States has increased as well, most recently to 94 still births in 2019. Radiology plays an important role in early diagnosis of this condition which results in early treatment and prevention of long term sequelae.

This electronic exhibit of a case series will review the osseous manifestations of congenital syphilis on radiographs, as well as instruct on the clinical diagnosis, treatment and expected response to therapy, with post treatment radiographic examples. Illustrative cases from our radiology department will be used to demonstrate musculoskeletal changes of congenital syphilis, ranging from nonspecific metaphyseal lucent bands and diaphyseal periostitis to more pathognomonic presentations such as “celery stalk sign” and “Wimberger sign”. Read More

Authors:  Eteer Khalid , Collins Denise , Sabharwal Gauravi , Ledbetter Karyn , Leschied Jessica

Keywords:  syphilis, Congenital