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Society for Pediatric Radiology – Poster Archive


Trauma
Showing Results from 1 to 30 of 44.

Infante Juan

Final Pr. ID: Poster #: CR-014


Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.

The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.

Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma.
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Authors:  Infante Juan

Keywords:  trauma, bladder, pelvic anatomy

Cornish Nathan,  Cornish Anna,  Shah Jay,  Sarkar Debkumar,  Honig Shaun,  Sobolevsky Sergei

Final Pr. ID: Poster #: EDU-114

The role of transarterial embolization has been well studied in adults but data is lacking in the pediatric population. As a newly designated level 1 trauma center we present our institutional experience of the efficacy and safety of transarterial embolization for pediatric abdominal and pelvic trauma as well as a review of the current literature. We discuss the multidisciplinary approach to management and the role of the interventionalist as a clinician. Read More

Authors:  Cornish Nathan , Cornish Anna , Shah Jay , Sarkar Debkumar , Honig Shaun , Sobolevsky Sergei

Keywords:  Arterial Embolization, Trauma, Splenic Artery Embolization

Lish James,  Richardson Randy,  Lin Alice

Final Pr. ID: Poster #: CR-015

Traumatic laryngotracheal transection is an uncommon occurrence most often secondary to blunt trauma to the neck. The most commonly described mechanism is a “clothesline” injury or strangulation, involving high speed impact of the neck across a chain, rope, chord, or strap, usually associated with the use of a motor or recreational vehicle. It is often instantaneously fatal, and those who survive may have severe respiratory compromise requiring immediate advanced airway placement, or astonishingly, they may be asymptomatic. Tracheal transection may be identified when laryngoscopic intubation fails, during the placement of a surgical airway, or during initial CT or bronchoscopic evaluation.

We describe an 8-year-old male who experienced blunt neck trauma and was intubated successfully in the pre-hospital setting. Initial radiographic evaluation was significant for severe subcutaneous emphysema and pneumomediastinum. Bilateral thoracostomy tubes were placed. Initial CT evaluation again showed extensive pneumomediastinum without pneumothorax. Four days after initial hospitalization the patient was extubated without difficulty. Post-extubation chest x-ray showed irregular tracheal borders with focal hyperlucency adjacent the mid-cervical trachea in the former position of the endotracheal tube cuff. Repeat CT of the chest showed complete tracheal transection of the mid-cervical trachea. The patient subsequently underwent surgical repair and was discharged without complication. This is the first reported case of traumatic tracheal transection not identified on initial CT examination secondary to the position of the endotracheal balloon, with subsequent discovery of the complete transection on the post-extubation radiograph.

There is 1 reported case of tracheal transection identified on initial CT evaluation in the presence of a well-positioned endotracheal tube. Additionally, there is 1 reported case of tracheal transection not identified on initial CT evaluation, however the patient was not intubated and had minimal symptoms. Tracheal transection was confirmed via bronchoscopy in that case.

Tracheal transection is rare traumatic injury that can be difficult to identify. High clinical suspicion and careful examination with multiple modalities is often necessary to make a definitive diagnosis.
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Authors:  Lish James , Richardson Randy , Lin Alice

Keywords:  tracheal resection, neck trauma, airway

Martinez-sicari Jorge,  Eller Madeline,  Mahdi Eman,  Elbich Jeff,  Jones Kathryn,  Mishra Chakradhar,  Vorona Gregory

Final Pr. ID: Poster #: CR-025

Hydatid cysts caused by larval infection with the tapeworm Echinococcus granulosus commonly affect the liver and lungs, although other organ systems may also be involved. Patients may be asymptomatic for years, presenting only when there is cystic rupture. We present the case of a 12-year-old male with no known prior medical history whose family immigrated from Afghanistan to the United States three years earlier. The patient arrived as a transfer to the emergency department (ED) with acute abdominal pain following blunt trauma. While playing soccer, he collided with another player, who landed on his abdomen. Upon arrival to the ED, he was febrile, tachycardic, and endorsed diffuse abdominal tenderness to palpation. He had no recent fevers, cough, congestion, nausea, vomiting, night sweats, or weight loss. He denied recent travel. Initial labs revealed mild leukocytosis with eosinophilia. Liver function tests and lipase were within normal limits. A contrast-enhanced abdominal-pelvic CT revealed a large, complex cystic structure centered in the right hepatic lobe, containing a peripheral membrane-like structure with evidence of internal hemorrhagic components extending into the peritoneum. Further interrogation with ultrasound confirmed the free-floating internal membrane, known as the “water lily” sign, which is highly specific for hydatid cysts. Using the World Health Organization classification, this was categorized as a CE 3A cyst. A follow-up MRI for drainage localization confirmed hemoperitoneum arising from the ruptured hydatid cyst, as well as peritoneal inflammation. We observed the expected MR features of a hydatid cyst with high T2 signal and low T2 internal debris, as well as overall low T1 mixed signal intensity. Ultrasound-guided percutaneous aspiration and alcohol ablation of the hepatic hydatid cyst was performed using catheter drainage. Fluid analysis demonstrated hooklets and protoscolices confirming the presence of Echinococcus spp. Morbidity and mortality related to echinococcosis is usually due to mass effect from enlarging cysts, which may result in organ disruption, or cyst rupture, potentially leading to anaphylaxis. This case highlights the incidental nature of hydatid cysts, which, although relatively easy to treat, often go undiagnosed until discovered by chance. Read More

Authors:  Martinez-sicari Jorge , Eller Madeline , Mahdi Eman , Elbich Jeff , Jones Kathryn , Mishra Chakradhar , Vorona Gregory

Keywords:  Hydatid, Abdominal Trauma

Bhatia Aashim,  Henry M.,  Feygin Tamara,  Christian Cindy

Final Pr. ID: Poster #: EDU-065

Abusive head trauma is associated with high morbidity and mortality. The evidence-based identification, care, and protection of infants and young children who are victims of AHT is critical. A diagnosis of AHT is made after careful consideration of the history provided, constellation of injuries identified, in conjunction with any additional diagnostic evaluation, as appropriate. This multidisciplinary educational module will focus on the evidence-based evaluation of intracranial findings when abusive head trauma (AHT) is a consideration, highlighting the importance of collaboration between child abuse pediatricians (CAPs) and pediatric neuroradiologists.

Framing the discussion with multiple cases, we will (1) describe the varied clinical presentations of abusive head trauma, (2) describe a general approach to the medical evaluation of abnormal intracranial findings when abuse is a concern; (3) present the differential diagnosis including traumatic and medical causes; (4) discuss appropriate imaging evaluation including neuroimaging (brain, spine) and skeletal imaging approaches; (5) report imaging findings found more commonly in AHT; (6) underscore the importance of collaboration between child abuse pediatricians and neuroradiologists; (7) highlight key literature, including the 2018 SPR-supported AHT consensus statement, to reference in practice, and, finally; (8) discuss consideration of language to include in imaging reports when abuse is a concern.

Following completion of the educational module, the learner will be familiar with the medical and imaging evaluations when AHT is considered, be able to describe imaging findings that are more commonly associated with AHT, and be familiar with references from the literature for self-study.
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Authors:  Bhatia Aashim , Henry M. , Feygin Tamara , Christian Cindy

Keywords:  Child Maltreatment, Abusive Head Trauma, Neuroradiology

Henry M Katherine,  Bennett Colleen,  Servaes Sabah

Final Pr. ID: Poster #: EDU-032

Intra-abdominal injuries are a less common manifestation of child abuse, but can be associated with high mortality. These injuries may be difficult to detect on physical exam alone, as many children do not have external cutaneous signs of abdominal injury, and symptomatology may be non-specific. Once detected, no specific intra-abdominal injury is pathognomonic for abuse, though some are more common in physical abuse. Determination of the likelihood of abuse as a mechanism relies on the plausibility of the history provided in the context of the constellation of identified injuries.

In this multidisciplinary educational presentation made in collaboration with pediatric radiologists and child abuse pediatricians, we will: (1) review physical exam and laboratory indicators to obtain abdominal imaging; (2) review imaging examples of intra-abdominal solid organ injuries; (3) review imaging examples of hollow viscus injuries; (4) discuss the types of trauma that causes solid organ and hollow viscus injuries; (5) review imaging modalities available, and (6) briefly discuss medical management.
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Authors:  Henry M Katherine , Bennett Colleen , Servaes Sabah

Keywords:  Child Abuse, Trauma, Abdominal

Germaine Colton,  Richards Allyson,  Tocchio Shannon

Final Pr. ID: Poster #: CR-035

Congenital insensitivity to pain (CIP) is a rare genetic condition in which patients are born with the absence of nociception at birth. These patients do not feel painful or noxious stimuli including pain from infection, inflammation or heat. The inability to feel and respond to painful stimuli leads to repeated injuries and infections, as well as poor wound healing. Children born with CIP are often misdiagnosed as being victims of abuse due to the nature and repetitiveness of their injuries. While rare, it is essential to understand the distinguishing features of CIP and how it differs from non-accidental trauma (NAT). In this case presentation, we provide an overview of the types of fractures and injuries common in patients with CIP, review characteristic imaging findings of CIP and discuss pitfalls specific to radiology.

CONTENT ORGANIZATION:
1) Overview and epidemiology of CIP.
2) Imaging findings characteristic of CIP.
3) Other clinical findings and injuries specific for CIP.
4) Differentiating CIP from NAT.
5) Review follow-up imaging considerations and discuss a radiologist’s role in managing a patient with CIP.

SUMMARY:
1) The major teaching points of this case presentation include:
2) Understanding the clinical presentation and distinguishing imaging findings common in CIP.
3) Recognizing CIP and differentiating it from other types of accidental vs non-accidental trauma is an essential component in patients receiving appropriate care.
4) Providing the correct recommendations for imaging follow-up helps provide improved care to patients with CIP.
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Authors:  Germaine Colton , Richards Allyson , Tocchio Shannon

Keywords:  Genetics, Non-Accidental Trauma, Infection

Warner Christopher,  Maguire Sabine,  Miller Angie,  Trefan Laszlo,  Fadell Michael

Final Pr. ID: Poster #: SCI-057

Fractures are a common manifestation of physical child abuse, and when present can have considerable bearing on the legal process. Although the timing of skeletal injury and healing is of great importance in forensic cases, the dating of fractures in the age group in which fractures from physical abuse most frequently occur is largely based on the radiologist’s personal experience as opposed to primary research. A full understanding of the radiological features of healing in infant fractures will enhance the assessment of fracture dating in cases where the time of injury is unknown, such as suspected abuse. The objective of this study was to describe the timing of fracture healing in infants using previously defined radiographic signs of fracture healing. Read More

Authors:  Warner Christopher , Maguire Sabine , Miller Angie , Trefan Laszlo , Fadell Michael

Keywords:  Healing Fracture, Fracture Healing, Non Accidental Trauma, Abuse, Long Bone

Akbari Yasmin,  Kralik Stephen

Final Pr. ID: Paper #: 159

Cervical spine trauma, particularly at the craniocervical junction, can produce significant morbidity and mortality in the pediatric population. Although normative pediatric cervical spine CT measurements have been reported, the accuracy of these measurements for predicting ligamentous injury remains unknown. The purpose of this study is to evaluate the sensitivity and specificity of normative pediatric CT measurements for prediction of traumatic ligamentous injury at the craniocervical junction, using MRI as gold standard. Read More

Authors:  Akbari Yasmin , Kralik Stephen

Keywords:  Cervical spine, Trauma, CT

Aquino Michael,  Koberlein George

Final Pr. ID: Poster #: EDU-098

Access to timely and accurate interpretation of imaging studies is critical to ensure quality care. This has driven demand for 24/7 radiology coverage. Examples of coverage models and solutions to logistical and financial challenges of providing around-the-clock real-time radiology services can be helpful as more children's hospitals move toward meeting this demand. The purpose of this exhibit is to describe the practice model used to provide after-hours pediatric radiology coverage at Cincinnati Children's Hospital Medical Center. Read More

Authors:  Aquino Michael , Koberlein George

Keywords:  Quality, Emergency, Trauma

Xue Christine,  Nowrangi Rajeev,  Smith John,  Acharya Patricia

Final Pr. ID: Paper #: 021

To assess whether a convolutional neural network (CNN) can be trained via transfer learning to accurately diagnose metaphyseal corner fractures on long bone radiographs by comparing its performance to that of a board-certified pediatric radiologist. Secondary endpoints will include the ability of the CNN to detect the type of long bone presented on the radiograph as well as identify the chronicity of the fracture. Read More

Authors:  Xue Christine , Nowrangi Rajeev , Smith John , Acharya Patricia

Keywords:  AI, Nonaccidental Trauma, metaphyseal corner fractures

Verma Nupur,  Patel Pratik,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-108

Accidents remain a top cause of morbidity and mortality in pediatric patient. Assessment for blunt trauma to the abdomen is difficult in the trauma patient and findings of bowel injury can be subtly or confounded by visceral injuries. The most specific finding of free air in blunt hollow visceral organ is often minimally present, or entirely unseen. The pediatric radiologist must be familiarity with the more often seen and less specific secondary signs on CT, including free fluid, bowel wall thickening, and mesenteric contusion injury. We present, by case example, bowel injuries in the traumatic pediatric patient and their management and outcomes, while addressing common pearls and pitfalls. As many of these patients do well with non-operative treatment the radiologist must also be familiar with findings that would allow such option, to appropriately advice referring providers and manage potential re-image of the pediatric patient. Read More

Authors:  Verma Nupur , Patel Pratik , Rajderkar Dhanashree

Keywords:  Trauma, Pediatrics, Dose Reduction in CT, Abdominal Injury

You Sun Kyoung,  Lee So Mi,  Cho Hyun-hae

Final Pr. ID: Poster #: SCI-005

To investigate of imaging findings of brain computed tomography (CT) and demographic findings of children with head trauma under 2 years. Read More

Authors:  You Sun Kyoung , Lee So Mi , Cho Hyun-hae

Keywords:  brain, computed tomography, brain trauma, pediatric

Garg Vasant,  Partovi Sasan,  Vasavada Pauravi,  Weinert Dayna,  Berlin Sheila,  Mcdavid Lolita,  Sivit Carlos

Final Pr. ID: Poster #: CR-040

We present a rare Case Report Exhibit of a 4-year child with myositis ossificans secondary to non-accidental trauma. The child presented to the ER complaining of a headache. Head CT was unremarkable. However, initial physical examination revealed numerous bruises over the lower abdomen and thighs including belt marks. The patient also demonstrated restricted range of motion. A skeletal survey showed multiple remote fracture deformities and myositis ossificans extending the length of both femurs. Although myositis ossificans frequently occurs in athletes who sustain blunt injury, this unfortunate case occurred secondary to non-accidental trauma and specifically the caregiver intentionally standing on the patient’s legs. Pediatric radiologists should be mindful of non-accidental trauma as a potential cause of myositis ossificans, especially in very young children and when multifocal. Read More

Authors:  Garg Vasant , Partovi Sasan , Vasavada Pauravi , Weinert Dayna , Berlin Sheila , Mcdavid Lolita , Sivit Carlos

Keywords:  myositis ossificans, non-accidental trauma, child abuse

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.
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Authors:  Mcluckey Morgan , Karmazyn Boaz , Marine Megan

Keywords:  Nonaccidental Trauma, Thoracic

Tutman Jeffrey,  Hedlund Gary

Final Pr. ID: Poster #: SCI-047

Accurate imaging characterization of chronic subdural hemorrhage (cSDH) has clinical and forensic implications, and continues to challenge the radiologist. The MRI characteristics of surgically proven cSDH were retrospectively reviewed in the context of known pathomorphology of the aging SDH. Read More

Authors:  Tutman Jeffrey , Hedlund Gary

Keywords:  Non-accidental trauma, Abusive Head Trauma

Alturkistani Tahani,  Goldwasser Bernard,  Blumfield Einat,  Liszewski Mark,  Taragin Benjamin

Final Pr. ID: Poster #: EDU-032

1) To understand penetrating injury in pediatric patients and how the child’s body habitus is more susceptible to multi organ injury than that of adult.
2) To explain the role of computed tomography (CT) in a pediatric penetrating trauma triage algorithm.
3) To discuss optimization of CT protocols in pediatric trauma patients based on the mechanism of injury with attention to radiation dose reduction.
4) To review the imaging findings in penetrating injuries to the chest, abdomen and pelvis.
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Authors:  Alturkistani Tahani , Goldwasser Bernard , Blumfield Einat , Liszewski Mark , Taragin Benjamin

Keywords:  Trauma, Cross-sectional, penetrating trauma, Penetrating injuries, GunShot wounds

Stewart Zachary,  Elmore Kate,  Thompson Allison,  Pham Huy

Final Pr. ID: Poster #: SCI-002

Delayed phase imaging increases the sensitivity of detection of injuries to the urinary tract and also assists in characterizing solid visceral organ injuries at the expense of doubling the radiation dose to the patient. If institutions can lower the rate of these examinations, the cumulative radiation exposure reduction would be substantial. Here we evaluate the rate of delayed phase imaging in the pediatric trauma population at our Level I trauma center as well as the frequency with which these patients demonstrate an indication on portal venous imaging for delayed phase acquisition. Finally, there are minimal guidelines dictating the appropriateness of delayed imaging in pediatric trauma. We include a review of the literature in order to elucidate appropriate indications and help guide clinicians to make evidenced based decisions. Read More

Authors:  Stewart Zachary , Elmore Kate , Thompson Allison , Pham Huy

Keywords:  Trauma, ALARA, Protocol

Lodwick Daniel,  Krishnamurthy Rajesh,  Deans Katherine,  Cooper Jennifer,  Groner Jonathan,  Gonzalez Dani,  Lee Choonsik,  Kelleher Kelly,  Minneci Peter,  Shah Summit,  Stanley Rachel

Final Pr. ID: Poster #: SCI-054

Computed tomography (CT) imaging protocols and prescribing practices vary across institutions. Pediatric trauma patients treated at a pediatric trauma center (PTC) may receive less radiation if their CT imaging is performed at a PTC rather than at non-PTCs prior to transfer. The objective of the study was to determine differences in radiation exposure from CT imaging in pediatric trauma patients initially treated at a PTC center compared to non-PTCs. Read More

Authors:  Lodwick Daniel , Krishnamurthy Rajesh , Deans Katherine , Cooper Jennifer , Groner Jonathan , Gonzalez Dani , Lee Choonsik , Kelleher Kelly , Minneci Peter , Shah Summit , Stanley Rachel

Keywords:  Radiation, Computed Tomography, Trauma

Arceo Salvador,  Christopher Ross,  Milla Sarah,  Riedesel Erica

Final Pr. ID: Paper #: 165

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

Authors:  Arceo Salvador , Christopher Ross , Milla Sarah , Riedesel Erica

Keywords:  Dual Energy, Trauma, Intracranial Hemorrhage

Lucin Michael,  Faruqui Sami,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-095

Because of the consequences of missed non-accidental trauma, it is essential for pediatric radiologists to have a high index of suspicion for injuries related to non-accidental trauma. Certain patterns of fracture raise suspicion for non-accidental trauma and are often considered pathognomonic. We present several cases of fractures that are typically considered pathognomonic for non-accidental trauma that had other non-abuse etiologies. These cases include classic metaphyseal lesions, subdural hematomas and long bone fracture in non-ambulatory patients among others. While there may be non-abuse etiologies of fractures that are classically considered pathognomonic for child abuse, the illustrative cases demonstrate the severe magnitude of injury necessary to produce these findings. This is why it is essential to evaluate the patient history and identify if the resulting injuries are consistent with the history. Read More

Authors:  Lucin Michael , Faruqui Sami , Sato Yutaka , Sato T Shawn

Keywords:  Non-accidental trauma, Fracture

Noda Sakura,  Otjen Jeffrey,  Koti Ajay,  Schlatter Adrienne,  Blessing Matthew,  Feldman Ken,  Menashe Sarah

Final Pr. ID: Poster #: EDU-013

Faulty fetal packing is a concave depression of the skull caused in utero by external pressure (such as by the maternal pelvic bone, a fetal limb, or uterine fibroid). It has an incidence of approximately 1 in 10,000 births. Its main differential diagnosis is acquired ping-pong-type fracture of the malleable neonatal skull, which can raise suspicion for nonaccidental trauma if there is no history of accidental trauma. Most recent literature on faulty fetal packing describes only single case reports. This educational exhibit reviews a series of faulty fetal packing and neonatal calvarial fracture cases. After reviewing this educational exhibit, readers will be able to 1) describe the mechanism of faulty fetal packing, 2) describe the appearance of faulty fetal packing on multiple modalities including radiographs and CT, and 3) distinguish between prenatal faulty fetal packing, perinatal skull trauma, and neonatal accidental and non-accidental trauma. Read More

Authors:  Noda Sakura , Otjen Jeffrey , Koti Ajay , Schlatter Adrienne , Blessing Matthew , Feldman Ken , Menashe Sarah

Keywords:  nonaccidental trauma, Skull, child abuse

Heitzmann Mark,  Shalaby-rana Eglal,  Deye Katherine

Final Pr. ID: Poster #: SCI-077

Abdominal injuries account for a relatively small percentage of non-accidental trauma. Previous estimates range from 0.5% to 11%. Despite this, abdominal injuries are the second leading cause of death in non-accidental trauma after head injury. Our objective is to assess the prevalence of abdominal injuries in the setting of suspected non-accidental trauma within a large urban children's medical center. Read More

Authors:  Heitzmann Mark , Shalaby-rana Eglal , Deye Katherine

Keywords:  non-accidental trauma, abdominal injuries

Malkawi Ibraheem,  Bloom David,  Hryhorczuk Anastasia

Final Pr. ID: Poster #: EDU-036

Describe the normal anatomic appearance and anatomic variants of the pediatric coracoid process with representative images.
Evaluate the radiologic fracture patterns and fracture mimics of the pediatric coracoid process with representative images.
Review additional pathology of the pediatric coracoid process that can present incidentally after trauma

Included topics :
I Coracoid process anatomy
Normal pediatric development/ossification
Developmental variations
Associated anatomic structures

II. Sequelae of coracoid process trauma
Multimodality imaging—radiography, CT, MRI
Pediatric fracture patterns
Mimics of fractures

III. Incidental findings of the coracoid process
Neoplasm
Other
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Authors:  Malkawi Ibraheem , Bloom David , Hryhorczuk Anastasia

Keywords:  shoulder anatomy, coracoid process, trauma

Moore Ryan,  Basta Amaya,  Schmitz Kelli,  Hopkins Katharine,  Vajtai Petra

Final Pr. ID: Poster #: EDU-101

Renal trauma is not uncommon in the pediatric population and can be seen in a wide variety of settings, from minor sports-related injuries to serious motor vehicle accidents. The imaging appearance is as varied as the etiology of injuries, ranging from minor parenchymal defects to avulsion of the vascular pedicle. Our educational poster aims at exploring a variety of injuries of the kidney in children, including chronic subcapsular hematoma, different severities of laceration, renal rupture without and with urine extravasation, injuries to the ureter, trauma involving kidneys with congenital anomalies, and trauma in an undiagnosed Wilms' tumor. Because renal trauma can present with many different faces, we aim to highlight essential diagnostic pearls as well as some unusual factors which may predispose the kidney to injury. Read More

Authors:  Moore Ryan , Basta Amaya , Schmitz Kelli , Hopkins Katharine , Vajtai Petra

Keywords:  renal, trauma, injury, hematoma, laceration

Griffin Walter,  Simmons Curtis,  Southard Richard,  Jorgensen Scott,  Van Tassel Dane

Final Pr. ID: Poster #: SCI-002

Pediatric abdominal trauma can be challenging and often necessitates rapid and accurate identification of injuries for optimal patient care. This study aimed to assess the potential workflow improvements in diagnostic accuracy achieved with semi-automated analysis of Dual Energy CT (DECT) image reconstruction in the setting of abdominal solid organ injury, as compared to conventional Multi-Detector CT (MDCT) images. The data sets from dual energy reconstructions have superior tissue differentiation and can be used to train a simple artificial intelligence (AI) program to recognize these patterns and expedite care. Read More

Authors:  Griffin Walter , Simmons Curtis , Southard Richard , Jorgensen Scott , Van Tassel Dane

Keywords:  Dual Energy, abdominal trauma

Ritchie David,  Negrete Lindsey,  Naheedy John

Final Pr. ID: Poster #: EDU-045

Trauma poses significant challenges to the pediatric emergency provider. From 1 to 14 years of age, traumatic injuries remain the leading cause of death for children in the United States. The majority of total mortality is attributable to motor vehicle collisions followed by bicycle accidents, falls, burns, and physical assaults. While the practice of interventional radiology (IR) in adults is undergoing considerable growth and expansion, so too are the techniques in their application to children.

We first review techniques that are more commonly encountered in pediatric IR trauma such as minimally invasive control of hemorrhage, percutaneous stenting, and arterial embolization. We then present cases that are less commonly encountered such as: hepatic laceration with pseudoaneurysm formation, pelvic fracture with CT-guided iliofixation, and humeral contusion with pseudoanuerysm formation of the anterior humeral circumflex artery. In all cases, the initial imaging performed in the emergency department will be highlighted throughout for each patient prior to showing any of the corresponding interventions.

After reviewing this exhibit, an attendee should be familiar with frequently encountered and less commonly encountered trauma in the pediatric IR setting. We hope the learner will gain comfort in the prompt recognition of acute traumatic pediatric imaging that may go on to subsequently require the intensivist’s attention.
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Authors:  Ritchie David , Negrete Lindsey , Naheedy John

Keywords:  Interventional, Trauma, Pseudoaneurysm

Jordan Kathryn,  Killerby Marie,  Patel Arjun,  Cassella Katharyn,  Greene Elton,  Johnstone Lindsey,  Leschied Jessica

Final Pr. ID: Poster #: EDU-014

The majority of children’s hospitals reside in urban settings, and the most common animal related injuries seen in these areas are induced by cats or dogs. However, urban medical centers serve patients from large surrounding rural areas where a more diverse array of animal or agriculture related injuries can occur. Although an altercation with an angry horse, pig, or cow could result in severe trauma in adults, animal related injuries pose an even greater danger to children given their smaller stature and growing bodies. The natural curiosity of children also increases the risk of severe injury when living or playing around industrial agricultural equipment. Even partaking in outdoor sports or leisure activities confers risk for exposure to a variety of injury mechanisms. Depending on the specifics of the surrounding ecosystem, radiologists may also care for patients exposed to envenomation from snakes, scorpions, spiders, and various other insects, resulting in local or systemic complications. When incorporating a mechanism of injury, radiologists may anticipate complications of exposure to these animals or insects and can recommend further imaging evaluation. For example, in addition to characterizing imaging findings, such as local necrosis, from a brown recluse bite injury in a patient transferred from an outlying hospital, the radiologist would anticipate the urgency with which to assess for more systemic complications such as angioedema, rhabdomyolysis, or internal hemorrhage due to disseminated intravascular coagulopathy. To best serve our patients, pediatric radiologists should exhibit familiarity with possible mechanisms of injury related to wildlife, their various imaging manifestations, and potential complications in order to help guide clinicians in managing these potentially devastating injuries. This educational exhibit aims to demonstrate key findings of such pediatric injuries through a series of cases. Read More

Authors:  Jordan Kathryn , Killerby Marie , Patel Arjun , Cassella Katharyn , Greene Elton , Johnstone Lindsey , Leschied Jessica

Keywords:  Pediatric Trauma, Image Findings, Emergency/Acute

Handler Marci,  Sosin Scott,  Murphy Robyn

Final Pr. ID: Poster #: EDU-037

Teaching Points
1. To review the normal imaging appearance of the spleen on ultrasound, CT and MRI.
2. Discuss the imaging characteristics of various pediatric splenic pathology.
3. Learn the epidemiology, appropriate imaging workup, and management of congenital pediatric splenic abnormalities.

Introduction
The spleen can be involved in a wide range of pathologies, yet can be frequently overlooked on imaging. Splenic disorders can be seen in isolation or may be secondary to a systemic disease. Different imaging modalities can be utilized to evaluate the spleen and include ultrasound, CT, and MRI. We will perform a case-based review of the imaging characteristics of various types of pediatric splenic pathologies. After completing this educational exhibit, the reader will be able to recognize the various causes and imaging characteristics of pediatric splenic diseases. The following topics will be discussed:
Congenital splenic anomalies – asplenia, polysplenia, accessory spleen
Splenomegaly
Trauma
Inflammation/infection
Infarction
Hemochromatosis
Splenic cysts
Hemangiomas
Hamartomas
Lymphoma
Splenic metastasis
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Authors:  Handler Marci , Sosin Scott , Murphy Robyn

Keywords:  Splenic, Trauma, Congenital