Myers Ross,  Dietsche Eric,  Gnerre Jeffrey,  Lecompte Leslie,  Gilet Anthony

Final Pr. ID: Poster #: EDU-011

The pediatric population is not immune to the various types of cancer encountered by the adult population in terms of the organs and organ systems affected. Despite advances in treatments and detection, cancer is still the number 2 cause of death within the pediatric population. The types of tumors encountered in the younger population are often composed of more uniquely immature cellular lineages and only a small percentage have preventable causes. The goal of our single institution presentation is to provide the interested viewer with a comprehensive review of several uniquely encountered immature pediatric tumors. Our presentation will include imaging examples utilizing multiple modalities demonstrating examples of pancreaticoblastoma , immature lipoblastoma, neuroblastoma, hepatoblastoma, a case of biopsy confirmed small cell undifferentiated renal rhabdoid tumor, and a unique case of pleuropulmonary blastoma. Explanations pertaining to the key imaging features of each entity as reported in the literature will be provided to supplement the case examples from our institution. Read More

Authors:  Myers Ross , Dietsche Eric , Gnerre Jeffrey , Lecompte Leslie , Gilet Anthony

Keywords:  Oncology, Gastrointestinal, Thoracic

Semple Thomas,  Ashworth Michael,  Aurora Paul,  Owens Catherine

Final Pr. ID: Poster #: EDU-008

To review the CT features of childhood interstitial lung diseases (ChILD). Read More

Authors:  Semple Thomas , Ashworth Michael , Aurora Paul , Owens Catherine

Keywords:  Interstitial, Lung, Pulmonary, Thoracic, CT

Wallace Andrew,  Raptis Demetrios,  Bhalla Sanjeev

Final Pr. ID: Poster #: EDU-001

This case-based, pictorial, educational exhibit will:
1. Examine the predisposing conditions of thoracic aortic aneurysm (TAA) in children
2. Illustrate the histopathologic and imaging features of these conditions
3. Demonstrate proper technique for measuring and reporting aortic dimensions in children
4. Review treatment options for TAA and how treatment depnds on the underlying disease and imaging findings Read More

Authors:  Wallace Andrew , Raptis Demetrios , Bhalla Sanjeev

Keywords:  Aneurysm, Aorta, Thoracic

Mcluckey Morgan,  Karmazyn Boaz,  Marine Megan

Final Pr. ID: Poster #: EDU-095

The aim of this exhibit is to familiarize the radiologist with low dose chest CT technique, articulate advantages of CT in detection of fractures that are occult or indeterminate on skeletal surveys, as well as discuss the limitations of chest CT.

Radiologists play a central role in the detection of non-accidental trauma. After bruising and soft tissue trauma, fractures are the most common inflicted injuries seen in children. Rib fractures are one of the most common fractures identified on skeletal surveys and are one of the most specific injuries in child abuse. Chest CT has been shown to increase detection of rib fractures in child abuse and postmortem studies. In addition, new techniques such as the use of tin filter allow performance of very low dose chest CT. This has led some to advocate for increased utilization of chest CT, as head CT and abdominal CT have already well-established indications for evaluation of child abuse.

Chest CT can be considered in children with negative skeletal survey and high clinical suspicion for child abuse, when the diagnosis of rib fractures is indeterminate, and when the finding of additional or more specific fractures may aid in management, such as in children with both anterolateral fractures and recent cardiopulmonary resuscitation.

Chest CT has some limitations. Uncommonly CT can miss acute nondisplaced fractures demonstrated on radiographs due to lower spatial resolution. In addition, developmental variations in the costochondral junction (CCJ) can mimic healed fractures in CT.

We will provide the protocol we use for low dose chest CT technique and discuss the value of axial oblique and 3-D reconstructions in detection of rib fractures. We will show examples of fractures seen on chest CT which are occult or indeterminate on radiography, such as buckle fractures or fractures in challenging locations such as the CCJ. We will further discuss the strengths of CT in the evaluation of other thoracic injuries of abuse including fractures of the sternum, scapula, and vertebral bodies. Cases of fractures found on post-mortem imaging will be included. Finally, we will also show cases demonstrating the utility of CT in identifying false positives and normal variants that may mimic fractures on radiographs. Read More

Authors:  Mcluckey Morgan , Karmazyn Boaz , Marine Megan

Keywords:  Nonaccidental Trauma, Thoracic

Kinariwala Dhara,  Daugherty Reza

Final Pr. ID: Poster #: EDU-078

Although rare, CLOVES syndrome, a PIK3CA-related congenital overgrowth disorder, presents radiologists with opportunity for vital diagnostic and treatment planning. CLOVES syndrome is characterized by Congenital Lipomatous Overgrowth of the trunk, Vascular malformations, Epidermal naevi, and Skeletal and Spinal anomalies. Multimodal imaging findings can help distinguish CLOVES from other overgrowth syndromes such as Proteus syndrome and Klippel-Trenauny syndrome. We present multimodal imaging of four patients with CLOVES syndrome which demonstrate characteristic findings:

- Thoracic lipomatous hyperplasia, a key sign of CLOVES syndrome in which predominantly thoracic lipomatous masses grow in the subcutaneous tissues and invade the pleura, mediastinum, and upper abdomen, often with superficial vascular malformations
- Renal anomalies, including agenesis, hypoplasia, hydronephrosis, and cysts.
- Vascular malformations, including venous, venolymphatic, and lymphatic malformations
- Spinal cord defects, including spina bifida, medullary arteriovenous shunts, and congestive myopathy of the paravertebral venous plexus

Management of CLOVES syndrome focuses on debulking of lipomatous masses, treatment of clinically significant vascular malformations, and medical management of renal and neurologic sequelae. To that end, the role of the radiologist is accurate diagnosis of the syndromic pattern, isolation of the extent of lipomatous masses for pre-operative planning, and identification of renal and spinal cord anomalies.

The purpose of the poster is to:

1. Briefly review the types of congenital overgrowth disorders as demonstrated in various imaging modalities.
2. Focus on characteristic imaging findings of CLOVES syndrome.
3. Review the benefits and disadvantages of various imaging modalities.
4. Identify the most relevant radiologic findings for surgical, interventional and medical management.


Read More

Authors:  Kinariwala Dhara , Daugherty Reza

Keywords:  Congenital, Thoracic, Vascular Malformations

Rapp Jordan,  Saul David,  Kaplan Summer,  Barrera Christian,  Otero Hansel

Final Pr. ID: Poster #: EDU-099

Background: Dual source dual-energy CT scanners (DECT) has allowed for the collection of two data sets with a single scan, opening the potential for functional data acquisition. The technique combines two energy beams at distinct voltages applied concurrently during a single scanning phase. The source data can be combined to generate a single mixed composite image, or iodine can be subtracted to create a contrast map or a virtual non-contrast image. The result is functional information in the setting of decreased radiation dose when replacing a biphasic scan, or dose neutral when compared to conventional single source CT. Post processing lung perfusion software allows for imaging display (qualification) and quantification of iodinated contrast volumes in the lungs, a surrogate for lung perfusion.
Purpose:
This educational exhibit will demonstrate: 1. How to perform DECT in children, 2. How to use postprocessing software, and 3. How to interpret lung perfusion results through clinical examples of current pediatric clinical indications including pulmonary embolism, lung hypoplasia, pulmonary AV malformation, and pulmonary hypertension.
Conclusion:
Through this exhibit, readers will gain familiarity with technical aspects of DECT of the lungs in children, understand the basics of post processing and recognize focal or regional perfusion defects, segmented perfusion analysis, and focal lesion perfusion characteristics as well as identify future applications. Read More

Authors:  Rapp Jordan , Saul David , Kaplan Summer , Barrera Christian , Otero Hansel

Keywords:  dual energy, thoracic, perfusion

Lillis Anna,  Krishnamurthy Ramkumar,  Boe Brian,  Setty Bhuvana,  Sena Laureen,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 018

Dynamic Contrast Enhanced MR Lymphangiography (DCMRL) allows evaluation of the central conducting lymphatics in patients with central lymphatic flow dysfunction. Direct injection of gadolinium contrast into inguinal lymph nodes followed by serial imaging allows visualization of lymphatic channels and lymphodynamics. This study reviews the DCMRLs performed at our institution over a 2 year period including indications, findings and impact on clinical management. Read More

Authors:  Lillis Anna , Krishnamurthy Ramkumar , Boe Brian , Setty Bhuvana , Sena Laureen , Krishnamurthy Rajesh

Keywords:  MR Lymphangiography, Thoracic Duct, Lymphatic

Sodhi Kushaljit,  Gupta Pankaj,  Saxena Akshay,  Mathew Joseph,  Agarwal Ritesh

Final Pr. ID: Poster #: SCI-066

To evaluate the diagnostic performance of 3 Tesla lung magnetic resonance imaging (MRI) in children with allergic bronchopulmonary aspergillosis (ABPA). Read More

Authors:  Sodhi Kushaljit , Gupta Pankaj , Saxena Akshay , Mathew Joseph , Agarwal Ritesh

Keywords:  MRI, THORACIC, ABPA

Pfeifer Cory

Final Pr. ID: Poster #: SCI-003

Given the relative sensitivity of pediatric patients to radiation, the need to limit exposure to the region of interest is of the utmost importance in pediatric radiography. This study assesses the practice of acquiring pediatric chest radiographs at a community hospital in which the imaging contract was acquired by a radiology practice with subspecialty-certified pediatric radiologists. Pediatric radiologists in the new radiology practice saw a need for improved collimation of pediatric chest radiographs at the community hospital. Many radiographs exhibited poor collimation and included much of the abdomen. This study examines an initiative to measure and improve radiograph quality. Read More

Authors:  Pfeifer Cory

Keywords:  ALARA, radiography, thoracic

Tung Eric,  Nelson Benjamin,  Nimkin Katherine

Final Pr. ID: Poster #: EDU-083

Asthma is a common childhood disorder characterized by chronic reversible hyperresponsiveness in the small airways, resulting in obstructive physiology. Asthma is diagnosed either clinically or with pulmonary function tests. Imaging is often unnecessary unless there is concern for superimposed pneumonia or a complication related to an acute asthma exacerbation. However, pediatricians must maintain a high degree of suspicion for non-asthma pathologies that present similarly to asthma and may require imaging to ensure an accurate diagnosis. This pediatric case series describes these pathologies and provides case examples from our institution of children that were initially misdiagnosed as having asthma until the proper imaging study was performed. Read More

Authors:  Tung Eric , Nelson Benjamin , Nimkin Katherine

Keywords:  asthma, thoracic, Mimic

Andres Mariaem

Final Pr. ID: Poster #: EDU-004

To review and present the MDCT angiography features of the congenital aortic anomalies in a comprehensive manner with supplemental description of their association to the adjacent airway and/or esophageal structures.

Congenital thoracic aortic anomalies manifest in a wide array of imaging presentations that are enumerated in this pictorial review. Multidetector CT (MDCT) angiography in reformatted and 3D images provides noninvasive technique to visualize the aortic anomalies, in addition to assessment of the airways and esophagus.

MDCT provides comprehensive non-invasive imaging of the congenital thoracic aortic anomalies as follows:
A. Vascular Ring. This is an anomalous formation of vessels that may completely or incompletely encircle the trachea and esophagus with potential of causing airway and/or esophageal compromise [1]. Anomalies included are the left aortic arch with aberrant right subclavian artery (the most common congenital aortic arch anomaly that commonly clinically cause dysphagia lusoria), the right aortic arch with mirror-image branching (the second most common type of arch anomaly), and the double aortic arch (the most common cause of symptomatic vascular ring).

B. Interrupted Aortic Arch. Major characteristics is complete discontinuity of aortic lumen between the ascending and the descending aorta. There are three (3) types in this pictorial review: Type A- aortic interruption between the left subclavian artery and descending aorta, Type B- aortic interruption between the left subclavian artery and the left common carotid artery, and Type C- aortic interruption between the left common carotid artery and the innominate artery.

C. Coarctation of the Aorta. Focal narrowing of the aortic lumen which is located at the level of the isthmus in majority of cases. This has two classifications which are the preductal form and the other the postductal form.

Congenital anomalies of the thoracic aorta comes in many forms. MDCT has advantages of ultra short scanning time and high spatial resolution that enables this modality to become a principal imaging method that equips Radiologists to evaluate the aortic anatomy and its congenital anomalies along with its association with the adjacent airway and esophageal structures. Read More

Authors:  Andres Mariaem

Keywords:  congenital, thoracic, aortic anomalies

Niakan Lillian,  Birkemeier Krista,  Santiago Jose

Final Pr. ID: Poster #: CR-033

Introduction: The use of e-cigarettes, or vaping, has become increasing popular, and little is known about its long-term effects. We present a case of vaping-associated lung illness in a pediatric patient.

Case Presentation: An 18 year-old male presented with worsening fever, chills, and vomiting over a week. He was diagnosed and treated for pneumonia. He denied smoking but endorsed vaping until developing his illness. Over the next two weeks, he lost 12-15 pounds but his cough improved and his appetite returned. He continued to feel weak, tired, and lightheaded upon standing. Labs revealed an elevated ESR and platelet count. The chest radiograph demonstrated an abnormal pattern of perihilar consolidation and ground glass opacity. Further evaluation by computed tomography demonstrated bilateral interstitial and ground glass opacities with areas of consolidation and tree-in-bud centrilobular nodules. The opacities were predominantly peripheral and peribronchiole in location with subpleural sparing. There was associated cylindrical and varicoid bronchiectasis. The overall appearance was most consistent with organizing pneumonia.

Discussion: Little is understood about the relatively new vaping-associated lung illness. E-cigarettes were first introduced in 2007, marketed as a safer alternative to smoking cigarettes and as a method for smoking cessation. Vaping has become exceedingly popular among youth. E-cigarettes use heat to vaporize liquid into aerosol, which is then inhaled. Liquid cartridges often contain nicotine, tetrahydrocannabinol, and cannabinoid oils. Additional compounds also found in these products include diacetyl and propylene glycol for flavoring and glycerin to create visible smoke. The exact mechanism and cause for lung injury is unclear, but it is postulated that chemical irritation and potentially thermal injury lead to some of the effects seen thus far. Other ingredients can be added to cartridges, making the etiology of injury even more elusive. Based on reported cases, patients often present with a range of symptoms, including dyspnea, pleuritic chest pain, nausea, and vomiting. Work-ups often reveal lipoid pneumonia, bronchiectasis, eosinophilic pneumonia, pleural effusions, suspected hypersensitivity pneumonitis, and at least one case of diffuse alveolar hemorrhage. In our case the appearance was that of organizing pneumonia. It is unclear if damage is reversible, but some reports discuss clinical improvements with a steroid course. Read More

Authors:  Niakan Lillian , Birkemeier Krista , Santiago Jose

Keywords:  Thoracic, Pulmonary