Murari Karthi,  Reading Brenton,  Hayatghaibi Shireen,  Ashton Daniel,  Buckley Jennifer,  Robinson Amie,  Noel-macdonnell Janelle,  Rivard Douglas,  Theut Stephanie,  Cully Brent

Final Pr. ID: Paper #: 070

Gastro-Jejunostomy (GJ) tubes are commonly placed and exchanged by interventional radiologists (IR) in pediatric patients requiring transpyloric feeds. GJ tubes with slight variations are available from different manufacturers, most frequently used are Avanos Medical, Inc. (previously Halyard Medical Devices) and Applied Medical Technology (AMT). There is currently no published data available comparing complication rates between the different GJ tubes. The goal of this study is to compare complication rates at two different pediatric institutions and reasons for non-elective required exchange/replacement of GJ tubes manufactured by Avanos and AMT in pediatric patients. Read More

Authors:  Murari Karthi , Reading Brenton , Hayatghaibi Shireen , Ashton Daniel , Buckley Jennifer , Robinson Amie , Noel-macdonnell Janelle , Rivard Douglas , Theut Stephanie , Cully Brent

Keywords:  Gastrojejunostomy, G-tube, Complications

Desai Sudhen,  Steve Mccaulley,  Vaidya Vinay

Final Pr. ID: Poster #: EDU-041

Patients requiring enteral support typically have not had a primary provider for the maintenance of their enteral tubes and at many institutions are only seen on an as-needed basis. Specifically, patients with gastrojejunal feeding tubes tend to present acutely (e.g. tube occlusion, dysfunction or accidental removal) to Interventional Radiology (IR) departments with need for exchange. Standard patient presentation is via the ED or their GI offices after significant time investment on the part of the families and involved providers to arrange the IR visit. Read More

Authors:  Desai Sudhen , Steve Mccaulley , Vaidya Vinay

Keywords:  Data Management, AI, Gastrojejunal feeding tube

Basta Amaya,  Vajtai Petra,  Hopkins Katharine,  Schmitz Kelli

Final Pr. ID: Poster #: EDU-100

Cecostomy tubes are not uncommonly encountered in a busy pediatric radiology practice but can pose a challenge to the unfamiliar. These devices provide access to the colon for routine antegrade enemas to promote bowel regularity and continence, most commonly in children with spinal dysraphism. This educational exhibit will describe the typical routine for cecostomy tube exchange, characterized by the Seldinger technique, and describe interesting cases of more difficult exchanges and complications, including different scenarios of broken and malpositioned tubes, and a practical approach to management of these challenges. After viewing this exhibit, the radiologist should be armed with several strategies for approaching both routine and complicated cecostomy tube exchanges. Read More

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

Keywords:  cecostomy, tube, exchange

Lee Gregory,  Noel-macdonnell Janelle,  Robinson Amie,  Crockett Jay,  Chan Sherwin

Final Pr. ID: Poster #: SCI-010

Gastrostomy tube (GT) or gastrojejunostomy tube (GJT) checks are a frequently ordered radiographic procedure to confirm placement. The goal of this study was to evaluate the accuracy of after-hours examinations for GJ or GJT placement using abdominal radiographs after injection of contrast, as compared to traditional fluoroscopy exams, which utilize a radiologist to perform the procedure.
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Authors:  Lee Gregory , Noel-macdonnell Janelle , Robinson Amie , Crockett Jay , Chan Sherwin

Keywords:  G Tube, Fluoroscopy

Cielma Tara,  Adeyiga Adebunmi,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-022

Adnexal torsion is one of the most common gynecologic surgical emergencies. Delayed diagnosis could result in tissue necrosis, leading to loss of ovarian function and impaired fertility.

The goals of this exhibit are:
1. Review the anatomy of the female pelvis.
2. Discuss the incidence, risk factors, and clinical characteristics of adnexal torsion.
3. Describe the technical approach of performing pelvic ultrasound.
4. Illustrate the sonographic imaging spectrum of adnexal torsion.
5. Discuss diagnostic criteria of adnexal torsion. Read More

Authors:  Cielma Tara , Adeyiga Adebunmi , Bandarkar Anjum

Keywords:  adnexal torsion, ovarian torsion, fallopian tube

Majmudar Anand,  Pandey Vijay

Final Pr. ID: Poster #: EDU-130

1) To identify the correct radiographic position of pediatric support lines and tubes.
2) To review abnormal placement of the lines and tubes as well as their anatomic consideration.
3) To review potential complication of incorrectly positioned lines. Read More

Authors:  Majmudar Anand , Pandey Vijay

Keywords:  Pediatric lines and tube

Flowers Colleen,  Kaplan Summer,  Zhu Xiaowei

Final Pr. ID: Poster #: EDU-014 (T)

The objective for a low dose imaging protocol was to eliminate patient risks and to reduce radiation doses. Tube placements are confirmed via imaging thereby avoiding utilization of malpositioned tubes. Reduced technical parameters lessen the absorbed skin dose. A limited field of view which includes distal espohagus and airway allows accurate assessment of feeding tube position. The new region of interest eliminates unnecessary exposure to hypersensitive organs including, thyroid and reproductive structures. This coned down view requires a lower image quality thereby allowing a lower dose approach. Read More

Authors:  Flowers Colleen , Kaplan Summer , Zhu Xiaowei

Keywords:  Low Dose Protocol, Feeding tube confirmation

Dorai Raju Anand,  Chauhan Ankita,  Cohen Harris

Final Pr. ID: Poster #: EDU-027

Adnexal torsion is the most common gynecological emergency in children and adolescents. Early diagnosis is crucial. The diagnosis of torsion requires a summation analysis of clinical, laboratory, and imaging findings. Adnexal torsion may mimic abnormalities of the gynecological (such as ectopic pregnancy and pelvic inflammatory diseases ), genito-urinary (such as renal or ureteric stones), and gastrointestinal tract abnormalities (mostly, appendicitis and inflammatory bowel disease like Crohn's). Gastrointestinal causes mimicking torsion may also include less likely abnormalities of the upper GI tract, including liver, gall bladder, pancreatic, and ulcer disease. Additionally, rare tumor masses may be a direct cause of ovarian or para-ovarian torsion or may simulate the pain.

We present a spectrum of imaging cases showing simulators of ovarian torsion as well as a spectrum of actual gynecological system torsions, including those of the ovaries and para-ovarian structures in the pediatric population. We review the fundamental potential diagnostic pitfalls that may falsely suggest an adnexal torsion as well as imaging features to help evaluate adnexal and para-adnexal torsion.

Imaging plays a critical role in the diagnosis of adnexal torsion and its simulators. We demonstrate imaging findings of those simulators as well as in adnexal torsion. Our study emphasizes primarily on the use of ultrasound to postulate key imaging points.

Adnexal torsion can take a subacute, intermittent, or chronic course, which may be challenging to diagnose. Prompt early recognition and operative management of this abnormality is essential. Correct and early diagnosis facilitates prompt surgical exploration to prevent ovarian tissue loss and the consequent effect on future fertility.
Read More

Authors:  Dorai Raju Anand , Chauhan Ankita , Cohen Harris

Keywords:  Torsion, Adnexa, ovary, fallopian tube

Dorai Raju Anand,  Chauhan Ankita,  Cohen Harris

Final Pr. ID: Poster #: CR-016

Isolated bilateral fallopian tube cyst torsion is extremely rare in the pediatric population. We have found no published reports of this entity in a child. Early diagnosis of such cases is crucial for the possibility of fallopian tube salvage surgery and the prevention of irreversible damage. Nonspecific clinical and imaging findings in a few reported unilateral cases in children often make surgical intervention mandatory for the diagnosis.

A 10-year-old girl came to the hospital for acute lower abdominal pain. Ultrasound findings demonstrated two large para-ovarian cysts, contiguous with tortuous and dilated fallopian tubes, suggesting torsion of the tubes. A clinician ordered CT did not add any new information.
The patient underwent a diagnostic laparoscopy that confirms the USG impression of the torsion of the bilateral fallopian tubes. Surgical exploration demonstrated twisting of about 1080 degrees of the hemorrhagic and necrotic right paratubal cyst and tube. The left cyst and tube were torsed at 360 degrees. Right partial salpingectomy, left paratubal cyst aspiration, and detorsion of fallopian tubes was accomplished. The uterus and ovaries were healthy.

Isolated bilateral fallopian tube torsion is extremely rare in the pediatric population with nonspecific clinical and imaging findings. Diagnosis usually requires surgery. Our study showed a case of bilateral fallopian tube torsion that occurred about bilateral paratubal cysts. Visualization of a dilated fallopian tube in the presence of normal-sized ovaries must be concerning for fallopian tube torsion, which can be secondary to a paratubal mass or cyst. Prompt early recognition and operative management of this relatively rare entity may prevent unnecessary tubal resection and improve long term fertility. Read More

Authors:  Dorai Raju Anand , Chauhan Ankita , Cohen Harris

Keywords:  Torsion, Fallopian tube, Paratubal cysts

Stanescu Arta,  Otjen Jeffrey,  Parisi Marguerite

Final Pr. ID: Paper #: 003

Fallopian tube torsion is a rare cause of acute abdominal pain in pediatric patients. Pelvic ultrasound is the first imaging modality utilized to evaluate for pelvic pathology, typically to rule out ovarian torsion. Ultrasound findings of fallopian tube torsion can be challenging, leading to delayed surgical intervention, particularly when ovaries have a normal gray scale appearance and spectral Doppler waveforms. We reviewed the ultrasound features of fallopian tube torsion in a series of surgically proven cases. Read More

Authors:  Stanescu Arta , Otjen Jeffrey , Parisi Marguerite

Keywords:  Fallopian tube, torsion, ultrasound