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Society for Pediatric Radiology – Poster Archive


Trauma
Showing Results from 1 to 30 of 34.

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

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

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

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

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

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

Salinas Puente Estefany,  Blanqueto Fuentes David,  Rodríguez Garza Claudia,  Dávila Escamilla Ivan,  Montemayor Martínez Alberto

Final Pr. ID: Poster #: CR-001

Intracranial hemorrhage (ICH) and ischemic brain injury are rare in the fetus. The most common location of hemorrhage in the fetus is intraventricular and is related to prematurity. Intracranial hemorrhage in the fetus can be intra or extra-axial and its recognition is important because of its complications and poor outcome. The causes of fetal intracranial hemorrhage are idiopathic, maternal, and of the fetus; maternal causes vary, and the main is trauma. Domestic violence increases during pregnancy, placing the mother and the fetus at risk for injury.
Features of central nervous system nonaccidental trauma in pediatric patients are well established, however, there are not too many examples in the literature of these imaging findings in the fetal stage.
The purpose of this case is to demonstrate the features of intracranial hemorrhage and ischemic brain injury caused by nonaccidental trauma during pregnancy and the evolution after birth.
The subject of this case report is a 36-week gestation product referred because of severe ventriculomegaly detected during an obstetric ultrasound; a fetal MRI was performed which showed an acute to subacute hemispheric bilateral subdural hematoma, infratentorial subdural hemorrhage, retroclival hematoma, subarachnoid hemorrhage, ventriculomegaly, brain edema, and midline shift. The patient was born at 38 weeks through C-section with no respiratory effort and a 4 points APGAR score, he was intubated and spent 38 days in the NICU, during his stay a postnatal transfontanelar ultrasound and a brain MRI were performed and showed persistence of the supratentorial and infratentorial subdural hematomas bigger in size with an epidural component, retroclival hematoma, subarachnoid hemorrhage, brain edema, midline shift, uncal herniation and hemispheric ischemic vascular event. The etiology of this extensive and atypical presentation hemorrhage was inquired including coagulation and genetic disorders, and the medical background of the parents which came out normal; after thorough interrogation, the mother revealed trauma related to domestic violence.
In our case, we will show that the localization and features of nonaccidental trauma of the central nervous system in the fetal stage are similar to the pediatric stage.
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Authors:  Salinas Puente Estefany , Blanqueto Fuentes David , Rodríguez Garza Claudia , Dávila Escamilla Ivan , Montemayor Martínez Alberto

Keywords:  Fetal, Trauma, Head

Thomas Anna

Final Pr. ID: Poster #: EDU-077

1. Review frequency, relative severity, and age-related mechanisms of pediatric C-spine injuries.
2. Explore peculiarities of the pediatric cervical spine that predispose to different injury patterns than seen with adults.
3. Examine postnatal pattern of cervical spinal ossification.
4. Inspect the craniocervical junction anatomy, its ligamentous support and classic injury patterns.
5. Discuss available imaging recommendations in the workup of pediatric patients with suspected C-spine trauma.
6. Consider select patient scenarios of classic pediatric c-spine injuries.
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Authors:  Thomas Anna

Keywords:  pediatric C-spine trauma, craniocervical junction, C-spine development

Akbari Yasmin,  Subramanian Subramanian,  Furtado Andre,  Panigrahy Ashok,  Zuccoli Giulio

Final Pr. ID: Poster #: EDU-090

Pediatric cervical spine trauma, although rare with an incidence of only 1-2%, can have very high morbidity and mortality. The leading causes are motor vehicle collision, sports related injury and child abuse in infants. The incidence of upper cervical spine injury is more common in children than adults due to differences in biomechanics, with the pediatric head size being proportionally larger when compared to adults. Although conventional radiographs remain the standard initial imaging evaluation, CT has become an important modality to detect bony injury and subtle signs of underlying ligamentous injury and hemorrhage (although consideration must be made for the increased radiation exposure). The presence of ligamentous injury, dens synchondrosis fracture, spinal cord evaluation, and spinal cord injury without radiographic abnormality (SCIWORA), meanwhile, are better evaluated with MRI. We will review the normal appearance of the pediatric cervical spine including normal measurements on radiographs and CT, including the importance of the basion-dens interval, powers ratio, and atlanto-occipital distance with illustrations. The normal development of the cervical spine as well as CT and MRI anatomy of cervical spine ligaments will be reviewed with illustrations. Imaging findings of atlanto-occipital and atlanto-axial distraction and pediatric cervical spine fractures including clay shoveler's fracture and dens synchondrosis fractures will be illustrated with CT and MRI. Finally, a review of clinical decision criteria for pediatric cervical spine trauma and imaging approach will be presented. The importance of obtaining MRI in children under 5 years and appropriate use of imaging will also be discussed.

Image 1: Sagittal CT image demonstrates increased basion to dens distance and normal atlanto-dental interval, consistent with atlanto-occipital dissociation.
Image 2: T2-weighted sagittal MR image demonstrates injuries to the tectorial and posterior atlanto-occipital membranes with atlanto-occipital dissociation. There is associated epidural hemorrhage.
Image 3: Sagittal CT reconstruction demonstrates a powers ratio greater than 1, raising suspicion for anterior atlanto-occipital dissociation.
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Authors:  Akbari Yasmin , Subramanian Subramanian , Furtado Andre , Panigrahy Ashok , Zuccoli Giulio

Keywords:  Spine, Trauma, Pediatric

Fenlon Edward,  Degnan Andrew,  Maddocks Alexis,  Chen Susie,  Jaramillo Diego

Final Pr. ID: Poster #: EDU-062

Proximal humeral epiphyseal fracture-separation is a rare fracture pattern in infants often associated with birth-related or non-accidental trauma, representing a Salter-Harris type I or type II fracture. Lack of a proximal humeral epiphyseal ossification center in most newborns or only subtle displacement of a small epiphyseal ossification center in older infants, makes this injury difficult to diagnose on plain radiographs, potentially leading to delayed diagnosis or misdiagnosis. Ultrasound and MRI are therefore useful imaging modalities in indeterminate cases.

Clinical findings of infant proximal humeral epiphyseal fracture-separation such as shoulder swelling, tenderness, and decreased active motion, overlap with more common entities including clavicular fracture, brachial plexus injury and osteomyelitis. Radiographs are often the first diagnostic study ordered to evaluate these symptoms but are insensitive due to minimal ossification of the proximal humeral epiphysis. Radiographs may be normal or show subtle displacement of the epiphyseal ossification center, apparent joint space widening, small metaphyseal fracture fragments or displacement of the proximal humeral metaphysis in relation to the scapula. These findings can be misdiagnosed as shoulder dislocation or pseudosubluxation due to a joint effusion. Careful review of the medical record may elucidate a history of difficult delivery with shoulder dystocia or suspected shoulder trauma.

Ultrasound and MRI are useful in indeterminate cases due to their ability to resolve the cartilaginous physis and proximal humeral epiphysis, and to resolve their relationship to the humeral shaft and cartilaginous labrum. Ultrasound has higher anatomic resolution and offers the flexibility to quickly image the asymptomatic contralateral shoulder and image in planes that best show the relationship between the non-ossified epiphysis and the humeral shaft. Doppler ultrasound demonstrates epiphyseal perfusion without the need for contrast administration, and serial ultrasound imaging can be used to evaluate healing and remodeling. MRI is more useful in evaluating cases where osteomyelitis and/or septic arthritis are being considered, or in cases of an inconclusive history suspicious for non-accidental trauma to evaluate for additional osseous and soft tissue injuries.

Several examples of typical proximal humeral epiphyseal fracture-separations in infants will be presented and the relevant imaging findings discussed.
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Authors:  Fenlon Edward , Degnan Andrew , Maddocks Alexis , Chen Susie , Jaramillo Diego

Keywords:  Fracture, Infant, Trauma

Tong Jane,  Luo Yu

Final Pr. ID: Poster #: CR-007

Although acute appendicitis is thought to be result from luminal obstruction of the appendix, rarely it may develop following abdominal trauma. Traumatic appendicitis is thought to occur through direct injury to the appendix, or as a response to other abdominal organ injury. On the other hand, in patients with other organ injury, some distension of the appendix can occur with surrounding free fluid secondary to trauma, mimicking appendicitis. While the clinical presentation of traumatic appendicitis is similar to that of traditional appendicitis, differentiation between reactive appendiceal changes in the setting of traumatic injury to other intra-abdominal organs is important, as the latter will not require appendectomy. We present two pediatric patients in whom following initial suspicion of acute appendicitis, ultrasonography (US) identified mildly enlarged fluid-filled and hyperemic appendix with out of proportion complex fluid, raising the suspicion of previously unsuspected abdominal trauma. Upon further examination, injury to other abdominal solid organs was discovered as the primary cause of patient's presentation and appendiceal findings were reactive to abdominal solid organ injury. In cases of suspected appendicitis, visualization of significant free fluid with dense debris on ultrasonography (US) calls for more careful examination to assess clues of other abdominal injury.
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Authors:  Tong Jane , Luo Yu

Keywords:  reactive appendicitis, abdominal trauma, ultrasound