Park Halley,  Burgos Daylen Sire

Final Pr. ID: Poster #: CR-025

Pulmonary vein thrombosis is an exceedingly rare occurrence but should be considered in the differentials in evaluation for opacity seen on the chest radiograph, in a coagulopathic pediatric patient. Read More

Authors:  Park Halley , Burgos Daylen Sire

Keywords:  Pulmonary vein thrombosis, coagulopathic, pulmonary embolism

Crido Silvina,  Bravo Monica,  Lipsich Jose,  Cermeño Claudia,  Dardanelli Esteban,  Moguillanky Slvia

Final Pr. ID: Poster #: EDU-029

To present a series of patients with pylephlebitis without a significant past medical history Read More

Authors:  Crido Silvina , Bravo Monica , Lipsich Jose , Cermeño Claudia , Dardanelli Esteban , Moguillanky Slvia

Keywords:  Pylephlebitis, portal vein thrombosis, omphalitis, appendicitis, ultrasonography

Cielma Tara,  Hill Cara,  Mirza Sobia,  Sanchez Ramon

Final Pr. ID: Poster #: EDU-004

Venous thromboembolism (VTE) is a multifactorial disease and a significant source of morbidity. Though the incidence of VTE, composed of deep venous thrombosis (DVT) and pulmonary emobolism (PE), is more common in adults, an increasing number of children are being diagnosed. Children who are critically ill are at greatest risk of developing VTE.

Duplex sonography is a critical front line tool in the detection and evaluation of venous thrombosis. Serial surveillance examinations allow real-time assessment of thrombosis including propagation and progression.

Recognizing the presentation and sonographic appearance of venous thrombosis assists the clinician in timely therapeutic decision-making and clinical management.

The goals of this exhibit are:

1. Describe the technical approach of performing duplex vascular ultrasound, including tips and technology that assist in optimizing studies.
2. Discuss the incidence, risk factors, and clinical characteristics of pediatric VTE.
3. Depict the sonographic appearance of thrombosis with emphasis on correlation to other modalities.
4. Discuss prognosis and long-term outcomes of VTE in children.
5. Describe future techniques and applications. Read More

Authors:  Cielma Tara , Hill Cara , Mirza Sobia , Sanchez Ramon

Keywords:  Deep venous thrombosis, Venous thromboembolism, Pulmonary embolism

Khan Hasan,  Hernandez Alberto,  Chau Alex,  Akhtar Zahra,  Upton Ashley

Final Pr. ID: Poster #: SCI-027

This study aims to evaluate the efficacy and impact of portal vein interventions in pediatric patients; which includes recanalization with venoplasty or stenting and their effects on hepatic and splenic hemodynamics through pre- and post-procedural liver and spleen elastography. Read More

Authors:  Khan Hasan , Hernandez Alberto , Chau Alex , Akhtar Zahra , Upton Ashley

Keywords:  Elastography, Portal Hypertension, Portal Vein Thrombosis

Bharde Pravinkumar,  Kinariwala Dhara,  Venkatakrishna Shyam Sunder Billapura,  Bale Christina,  Acord Michael

Final Pr. ID: Poster #: EDU-006

Pediatric esophageal varices almost uniformly occur as a consequence of portal hypertension in children with chronic liver disease or extrahepatic portal vein obstruction. Varices in these cases typically evolve in the distal esophagus at the intersection of the left gastric and esophageal veins. We report a rare case of “downhill” varices that developed in the proximal esophagus due to extensive chronic thrombosis of the SVC and brachiocephalic veins in a child with intestinal failure requiring lifelong central venous access for parenteral nutrition. We report a case of downhill varices associated with thrombosis of the SVC and brachiocephalic veins, secondary to a central line.
A 14-year-old boy with an ACTG2 (actin gene) mutation-related history of parenteral nutrition dependent chronic intestinal pseudo-obstruction and central venous catheter-associated thrombi on prophylactic anticoagulation presented with new onset dysphagia. On endoscopy, Grade II esophageal varices without stigmata of recent bleeding were unexpectedly identified in the upper and middle esophagus. Imaging was then performed to assess for advanced liver disease or abnormal portal flow. CT of the abdomen and pelvis showed no splenomegaly, ascites, or radiographic signs of cirrhosis. There was, however, partial visualization of dilated para-esophageal vessels coursing from the chest.
Subsequent chest CT demonstrated chronic occlusion of the right internal jugular and brachiocephalic veins, along with severe narrowing of the SVC. There were extensive venous collateral pathways through the azygos and para-esophageal venous system and engorged submucosal veins were present in the esophagus. Echocardiography confirmed a stable chronic thrombus in the SVC.
Given the high risk of intervention, the decision was made to forgo immediate SVC balloon dilation and stenting and to continue active surveillance.
This case highlights the important role of imaging in differentiating “downhill” esophageal varices from their “uphill” counterpart. This distinction is critical, as each entity necessitates a different treatment approach. Definitive management of downhill varices is aimed at alleviating SVC obstruction but carries significant risk and was deferred in this case. Read More

Authors:  Bharde Pravinkumar , Kinariwala Dhara , Venkatakrishna Shyam Sunder Billapura , Bale Christina , Acord Michael

Keywords:  Venous Recanalization, PICC, Thrombosis

Durand Rachelle,  Acord Michael,  Srinivasan Abhay,  Krishnamurthy Ganesh,  Saade-lemus Sandra,  Cahill Anne Marie,  Kaplan Summer

Final Pr. ID: Paper #: 120

Neonates with prolonged hospitalization often require PICCs. The concern for PICC-related complications, including venous thrombosis, infection, catheter migration and breakage, often prompts Doppler ultrasound (US) evaluation. However, peri-catheter thrombus in a neonate can be challenging to evaluate, as the accessed peripheral veins in neonates are small, some less than 1mm in luminal diameter. Small-bore catheters may occupy the entirety of the vessel lumen, which can produce absence of peri-catheter flow, which is confounding for thrombus. This distinction has implications for hematologic management. Read More

Authors:  Durand Rachelle , Acord Michael , Srinivasan Abhay , Krishnamurthy Ganesh , Saade-lemus Sandra , Cahill Anne Marie , Kaplan Summer

Keywords:  PICC, Thrombosis, Neonate

Stein Nina,  Ahmed Fahran

Final Pr. ID: Poster #: CR-066

We present a radiologic case of a teenager with portal, inferior mesenteric, superior mesenteric, and splenic vein thromboses presenting with acute abdominal pain and treated conservatively with anticoagulation therapy. Ultrasound and computed tomography were done at the acute presentation and follow up magnetic resonance images were performed. One year of anticoagulation therapy correlated with almost complete resolution of splanchnic thrombosis; however, the superior mesenteric vein continues to remain severely dilated close to the confluence on subsequent annual imaging. The initial imaging also diagnosed multiple phlebolith in the pelvis. We suspect this is a congenital malformation of the porto-splanchnic circulation presenting with acute thrombosis. Differential is variceal dilatation as sequela of extensive thrombosis. Read More

Authors:  Stein Nina , Ahmed Fahran

Keywords:  Splanchnic Venous Thrombosis, Portal Venous Aneurysm, Mesenteric Vein Thrombosis, Portal Vein Thrombosis, Anticoagulation

Cregg Allison,  Nguyen Theo,  Holm Tara,  Flanagan Siobhan

Final Pr. ID: Poster #: CR-059

Portal hypertension in pediatric patients is rare, most commonly caused by extrahepatic portal vein (PV) occlusion. Complications include gastrointestinal bleeding. If obstruction recanalization or surgical shunt is not feasible, a transjugular intrahepatic portosystemic shunt (TIPS) can be placed. Risks of TIPS include encephalopathy, shunt stenosis, or thrombosis. Tipsitis is rare, occurring in less than 1% of TIPS patients, but is serious, with a mortality of 32%. Early diagnosis and treatment are key to preventing the need for liver transplantation, and imaging plays a key role in early detection. We present a case of tipsitis identified with FDG-PET/CT imaging.
A 16 year-old-male with prematurity, umbilical vein catheter, and heterozygous prothrombin mutation presented with hematemesis. Imaging identified chronic PV thrombosis. Due to the occlusion involving both the right and left PV, TIPS was placed. 5.5 months post-TIPS, he presented with fever and body aches. Investigations revealed Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia and thrombosed TIPS. He completed a 6-week course of IV antibiotics, and the TIPS was revised.
Two weeks later, he was readmitted with recurrent MSSA bacteremia. FDG-PET/CT scan was performed, showing increased TIPS uptake, consistent with tipsitis. He completed an additional 8-week IV antibiotic course. Repeat FDG-PET/CT showed decreased but persistent TIPS uptake. IV antibiotics were extended, and he was placed on suppressive oral antibiotics with a plan for FDG-PET/CT in 3 months.
Tipsitis is rare, and early infection (<120 days) is associated with gram-positive bacteria caused by seeding during placement. In this case, later infection was suspected to be caused by Staph aureus superinfection during influenza. Low-grade symptoms include malaise, and high-grade symptoms include fever and rigors. Suspicious CT findings include peri-graft gas or fluid. Radiolabeled leukocyte uptake is specific to infection, but spatial resolution is limited. FDG-PET/CT with focal TIPS metabolic activity (SUV > 8.0) correlates with infection source (sensitivity 91-98%, specificity 64–91%).
Antibiotic therapy is successful in 53% of cases, and FDG-PET/CT can determine the degree of treatment success. Residual hypermetabolic activity signifies partial response. Aggressive antibiotics are recommended to prevent resistance and the need for liver transplant. FDG-PET/CT plays a vital role in diagnosis and management of tipsitis. Read More

Authors:  Cregg Allison , Nguyen Theo , Holm Tara , Flanagan Siobhan

Keywords:  Portal Vein Thrombosis, FDG PET, Interventional Radiology

Baker Omar,  Hernandez Alberto,  Cleveland Heather,  Justino Henri

Final Pr. ID: Paper #: 075

Portal vein thrombosis (PVT) is a major cause of pediatric portal hypertension and gastrointestinal (GI) bleeding. Recanalization with balloon angioplasty (BA) and stent placement have emerged as a minimally invasive treatment option for PVT. We sought to review the success and complication rates of transcatheter PVT therapy in pediatric patients with native liver. Read More

Authors:  Baker Omar , Hernandez Alberto , Cleveland Heather , Justino Henri

Keywords:  Portal Venous Thrombosis, Balloon Angioplasty, Stenting

Panesar Harsimran,  Beekman Alexander,  Martin Laura,  Armstrong Katherine,  Hodes Aaron

Final Pr. ID: Poster #: CR-006

Midgut volvulus in children is uncommon, but diagnosis of portal vein thrombosis in association with midgut volvulus has been rarely reported. We present a case of a 3-year old male with an unusual presentation of recurrent episodic abdominal pain suspected initially having ileocolic intussusception. Cross-sectional imaging identified extensive acute portomesenteric thrombosis in the setting of suspected midgut volvulus, which was confirmed on upper GI series and at surgery. A thrombophilia workup was negative. To our knowledge, this is the first case of acute portal vein and superior mesenteric vein thrombosis with splenic vein extension in association with midgut volvulus. When the diagnosis remains elusive and imaging demonstrates an extensive acute PVT with SMV extension in children and adolescents, radiologists should consider midgut volvulus in addition to other etiologies, such as malignancy, cirrhosis, or bowel inflammation. Read More

Authors:  Panesar Harsimran , Beekman Alexander , Martin Laura , Armstrong Katherine , Hodes Aaron

Keywords:  Portal vein thrombosis, Superior mesenteric vein thrombosis, Midgut volvulus