Murphy Ryan,  Murati Michael,  Holm Tara,  Dietz Kelly

Final Pr. ID: Poster #: EDU-012

The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist.

Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More

Authors:  Murphy Ryan , Murati Michael , Holm Tara , Dietz Kelly

Keywords:  anterior meningocele, low flow vascular malformation, enteric cyst

Karani Kunal,  Teli Radhika,  Shah Jay,  Cornish Nathan,  Singh Manu,  Honig Shaun,  Stein Evan

Final Pr. ID: Poster #: EDU-005

Recognize the clinical features of vascular lesions of the orbit that occur in children.
Describe classification schemes of vascular lesions of the orbit that occur in children.
Identify the imaging features that permit differentiation among lesions.
Highlight new treatment modalities in which interventional radiologists can intercede. Read More

Authors:  Karani Kunal , Teli Radhika , Shah Jay , Cornish Nathan , Singh Manu , Honig Shaun , Stein Evan

Keywords:  Orbital, Vascular, Pediatric

Blagdon Ryan,  Thompson Deborah,  Schmit Pierre

Final Pr. ID: Poster #: EDU-014

The ductus venosus is a part of the fetal circulation that permits oxygenated blood in the umbilical vein to bypass the liver and provide oxygenated blood to the fetal brain and heart. Absence of the ductus venosus is a rare anomaly associated with a number of serious, life-threatening and often deadly conditions. Studies have evaluated the use of ultrasound for prenatal evaluation and detection of absent ductus venosus; however, no studies have reported non-ultrasound postnatal radiological findings of absent ductus venosus. Here, we describe the expected anatomy in those with absent ductus venosus and present abdominal x-rays of 3 infants to illustrate an expected but abnormal course of umbilical venous lines in these patients. As many as 15.6% of patients with absent ductus venosus have it in isolation and with 67-100% postnatal survival when occurring in isolation. Thus, the postnatal incidental identification of absent ductus venosus is a clinical possibility for pediatric radiologists that review abdominal x-rays to check catheter/line placement. Familiarity with this abnormal course of umbilical venous lines may assist in making this rare postnatal diagnosis and avoid potentially life-threatening complications secondary to line malposition/repositioning. Read More

Authors:  Blagdon Ryan , Thompson Deborah , Schmit Pierre

Keywords:  Ductus venosus, Vascular, Congenital

Ugas Charcape Carlos,  Matos-rojas Irma,  Sanchez-navarro Juan P.,  Fernández-ochoa Diana,  Conilla-arispe José M.

Final Pr. ID: Paper #: 001 (S)

Describir los hallazgos más frecuentes en tomografía computarizada del anillo vascular en un centro de referencia nacional y proponer un algoritmo lógico de diagnóstico para ayudar a los informes del radiólogo pediátrico. Read More

Authors:  Ugas Charcape Carlos , Matos-rojas Irma , Sanchez-navarro Juan P. , Fernández-ochoa Diana , Conilla-arispe José M.

Keywords:  vascular ring, children, ct

Bellew Elizabeth,  Sonstegard Anna Marie,  Finelt Nika,  Goldfisher Rachelle

Final Pr. ID: Poster #: CR-004

A full-term male was born with a 7 x 7 cm subcutaneous mass with central dark blue discoloration and peripheral erythema on the right flank/buttock. Initial hip and pelvis radiograph at one day old did not show evidence of calcifications. An ultrasound demonstrated an ill-defined, heterogeneous mass with internal vascularity with invasion of underlying muscle. MRI of the abdomen and pelvis with contrast at two days of age showed a T2 hyperintense mass with mild postcontrast enhancement within the right flank with infiltration of the underlying muscles including the right psoas, iliacus, gluteal, and the left erector spinae. The differential diagnosis included: kaposiform hemangioendothelioma, rhabdomyosarcoma (RMS), tufted angioma and neuroblastoma.

Given the broad list of differential diagnoses, a core biopsy of the right buttocks was obtained at 6 days of age to further characterize the lesion. Hematoxylin and eosin stained sections demonstrated highly collagenized and sclerotic spindle cells involving the adipose tissues extending into the dermis. Immunohistochemical stained sections showed positivity to desmin, myogenin and MyoD1. Fluorescence in situ hybridization studies indicated the presence of a VGLL2 gene rearrangement. These pathologic findings were consistent with sclerosing spindle cell RMS. At 13 days old, a PET scan showed the right flank lesion with minimal to no FDG uptake, a finding which is consistent with sclerosing RMS given that this sub-type consists mainly of collagen. There were no pulmonary nodules. After multiple chemotherapy cycles, subsequent MRIs of the abdomen and pelvis showed no residual enhancing lesion. The patient will be closely followed for local recurrence.

RMS, the most common soft tissue tumor seen in children, are mesenchymal tumors of skeletal muscle and are most often seen in head and neck, but are less commonly noted on the flank. Sclerosing spindle cell RMS is a subtype often seen in childhood, but exceedingly rare in newborns. Cutaneous RMS should be considered in the differential diagnosis of a large subcutaneous lesion in a newborn. Read More

Authors:  Bellew Elizabeth , Sonstegard Anna Marie , Finelt Nika , Goldfisher Rachelle

Keywords:  Rhabdomyosarcoma, Sclerosing Spindle Cell Rhabdomyosarcoma, Vascular Malformation

Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Final Pr. ID: Poster #: EDU-065

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

Authors:  Gual Fabiana , Lima Natalia , Matsuoka Marcia , Sameshima Yoshino

Keywords:  vascular anomalies, hemangioma, vascular malformations

Gaballah Marian,  Goldfisher Rachelle

Final Pr. ID: Poster #: EDU-096

Lymphatic malformations (LMs) are low-flow vascular malformations which are composed of dilated lymphatic channels, forming septated cyst-like structures (2). LMs are the second most common type of vascular malformation, second to venous malformations (1). The most common locations are in the neck, followed by the axillary region. On MRI, LMs are multiloculated, T2 hyperintense lesions, which may have fluid-fluid levels, and are without flow voids (1, 2). They can involve multiple tissue planes and do not regard anatomical and fascial boundaries (2). Cystic lymphatic malformations are further divided into microcystic, macrocystic, or mixed, based on the size of their cystic components. Macrocystic LMs are composed of larger cysts, while microcystic LMs are composed of smaller cysts and may appear solid on imaging.

We present ten cases of microcystic, macrocystic, and mixed lymphatic malformations in a variety of anatomical locations. In addition to demonstrating the imaging findings, we present a review of the literature in regards to each anatomical region. Lymphatic malformations in this presentation include right orbit (n=1), mediastinum (n=2), pulmonary bronchovascular bundles/pleural space (n=1), retroperitoneum (n=1), mesentery (n=2), perirectal and scrotal (n=1), lower extremity (n=2). 6 of these children also had additional sites of T2 hyperintense disease involving the bones or spleen, suggestive of additional lymphangiomas.

This presentation summarizes ten cases of lymphatic malformations in a variety of less common anatomical locations and a review of the pertinent literature.

References:

1. Flors L, Leiva-Salinas C, Maged IM et al. (2011) MR Imaging of Soft-Tissue Vascular Malformations: Diagnosis, Classification, and Therapy Follow-up. Radiographics 31:1321-1340.
2. White CL, Olivieri B, Restrepo R et al. (2016) Low-flow vascular malformation pitfalls: from clinical examination to practical imaging evaluation- part 1, lymphatic malformation mimickers. AJR 206: 940 – 951. Read More

Authors:  Gaballah Marian , Goldfisher Rachelle

Keywords:  Lymphatic malformation, Vascular Malformation

Kinariwala Dhara,  Daugherty Reza,  Park Auh Whan

Final Pr. ID: Poster #: EDU-009 (S)

Comprehensive radiologic evaluation and accurate diagnosis of vascular malformations is vital to guide optimal treatment. Technical approaches and sclerotic agents used by interventional radiology vary by the type of malformation, anatomic location, and architecture of the malformation. Proper pre-procedural characterization of hard-to-treat lesions impacts procedural success and long-term outcomes.

Most vascular malformations located superficially on the extremities and trunk, and can be evaluated with ultrasound and color Doppler. However, evaluation can be complicated by unusual locations and difficulty in characterization, requiring MRI and/or MRA. We present interesting pediatric vascular malformations challenging for both imaging diagnosis and treatment.

The objectives of this poster include:
1. To review the classification and nomenclature of vascular malformations.
2. To present multimodal imaging findings of vascular malformations.
3. To discuss diagnostic imaging approaches of vascular malformations.modalities used.
4. To describe the treatment approaches for these malformations and outcomes including technical considerations and follow up. Read More

Authors:  Kinariwala Dhara , Daugherty Reza , Park Auh Whan

Keywords:  Vascular Malformations

Lacroix Caroline,  Ahyad Rayan,  Gupta Abha,  Chavhan Govind

Final Pr. ID: Poster #: CR-065

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor, of low malignant potential. It is typically seen in adults, but it can also less frequently affect children.

Because of its multisystem involvement, it can present in various ways both clinically and on imaging. It can present with multiple hepatic lesions and/or with multinodular lung disease simulating interstitial lung disease, infectious disease and metastatic disease among others. Multifocal bone involvement is another presentation of EHE.

One of the radiologist's daily practice challenges is that rare diseases can have significant overlap of imaging features with more frequent diagnoses (that sometimes present with atypical features). It is therefore of high relevance to know the classical and unique imaging features and signature of rare entities such as epithelioid hemangioendothelioma, in order to raise clinical suspicion when needed to direct appropriate diagnostic work-up. Our goal is to present a case of EHE, discuss possible clinical presentations and illustrate classical imaging findings. An overview of clinical implications of this diagnosis and of the available treatment options will also be provided.

Combining multisystem affection and characteristic imaging features, especially MRI features of liver lesions, radiologist can help to make early diagnosis of EHE that is rarely seen in children. Read More

Authors:  Lacroix Caroline , Ahyad Rayan , Gupta Abha , Chavhan Govind

Keywords:  epithelioid, hemangioendothelioma, vascular, tumor, multisystem

Bhalla Deeksha,  Jana Manisha,  Manchanda Smita,  Bhalla Ashu,  Naranje Priyanka

Final Pr. ID: Poster #: EDU-069

Teaching points:

The spectrum of neck masses in neonates and infants (< 2 years) differs considerably from those in older children
Understand characteristic imaging appearances, particularly recognise entities that do not require sampling for diagnosis
Learn algorithmic approach to differential diagnosis based on age and lesion morphology with case based examples

Table of contents:
Introduction: Incidence, clinical considerations
Classification:
Age: Neonate
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst
Solid:
Germ cell tumor
Congenital hemangioma
Neuroblastoma
Mixed
Primitive myxoid mesenchymal tumor (PMMT)
Teratoma

Age: Older infants
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst

Solid:
Lymphoma
Granulocytic sarcoma
Rhabdomyosarcoma
Multinodular vacuolating tumor of infancy (MNTI)
Solitary fibrous tumor (SFT)
Fibrous tumors: Fibrous hamartoma of infancy, infantile fibrosarcoma

Vascular malformation (microcystic lymphatic, venolymphatic, arteriovenous)

Infections
Ludwig angina
Zygomycosis

Practical diagnostic algorithms based on age, location (involved neck space) and morphology
Conclusion Read More

Authors:  Bhalla Deeksha , Jana Manisha , Manchanda Smita , Bhalla Ashu , Naranje Priyanka

Keywords:  Neck tumor, congenital, vascular malformation

Kinariwala Dhara,  Daugherty Reza

Final Pr. ID: Poster #: EDU-078

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

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

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

The purpose of the poster is to:

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


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Authors:  Kinariwala Dhara , Daugherty Reza

Keywords:  Congenital, Thoracic, Vascular Malformations

Defendi Larissa,  Yokoo Patricia,  Shoji Hamilton,  Balancin Marcelo,  Chate Rodrigo

Final Pr. ID: Poster #: EDU-079

Congenital lung malformations are a heterogeneous group of developmental disorders whose etiology is not well stablished. Since they represent a spectrum of anomalies, diverse imaging appearance and clinical manifestations can be found. Although rare, their clinical importance is remarkable. Some of them can be a source of important morbidity and mortality in infants and children. Others, however, remain asymptomatic and may be incidentally detected in adulthood. Nowadays, these malformations are usually diagnosed in utero by prenatal imaging. In order to optimize diagnostic accuracy and disease management, it is imperative for radiologists to be familiar with the imaging characteristics of each lesion and the proper methods employed in their evaluation.

The purpose of this exhibit is:
- To describe the postnatal radiological appearance of some congenital lung diseases on conventional radiography, ultrasound (when available) and cross-sectional imaging methods;
- To conduct a brief review of the literature regarding etiology, epidemiology, clinical features and adequate diagnostic approach;
- To highlight the key imaging findings of each abnormality and their differential diagnoses;
- To briefly discuss management and follow-up of each condition.

Illustrative cases from our Radiology Department will be used to demonstrate the following entities:

1. Parenchymal anomalies:
- Lung hypoplasia;
- Congenital bronchial atresia;
- Congenital lobar emphysema;
- Congenital pulmonary airway malformation (previously known as congenital cystic adenomatoid malformation);
- Pulmonary bronchogenic cysts;
- Tracheal bronchus;
- Accessory cardiac bronchus.

2. Vascular anomalies:
- Interruption of a main pulmonary artery;
- Pulmonary artery stenosis;
- Anomalous pulmonary venous drainage.

3. Combined parenchymal and vascular anomalies:
- Bronchopulmonary sequestration;
- Hypogenetic lung (scimitar) syndrome. Read More

Authors:  Defendi Larissa , Yokoo Patricia , Shoji Hamilton , Balancin Marcelo , Chate Rodrigo

Keywords:  Congenital, Vascular, Lung

Bhatt Malay,  Kirsch Alyssa,  Metz Terrence

Final Pr. ID: Poster #: EDU-049

To familiarize the audience with our institution’s technique utilizing ultrasound (US) and electrocardiogram (ECG) for anatomic localization and technical guidance for PICC placement in a pediatric intensive care unit (PICU) procedure suite utilizing intravenous (IV) sedation without general anesthesia to eliminate patient and operator radiation exposure and decrease sedation specifically in a pediatric population. Read More

Authors:  Bhatt Malay , Kirsch Alyssa , Metz Terrence

Keywords:  PICC, Vascular Access

Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-064

Review the causes of cerebral hemorrhage in the pediatric patient based on clinical cases.

Stroke is a major cause of morbidity and mortality in children worldwide. The reported annual incidence ranges from 2.3 to 13 per 100,000 children per year in developed countries. In contrast to the adult, in children, diagnosis is not as straightforward, because when children present with acute neurological deficits, stroke is often not the first diagnosis considered by the medical providers.

Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly.

Stroke in children can be ischemic or hemorrhagic, referring to the term hemorrhagic stroke as a intracerebral hemorrhage that is nontraumatic and whose most common etiology is secondary to a vascular malformation (Arteriovenous Malformation (AVM), Dural/Pial Arteriovenous Fistula (Dural AVF/Pial AVF), Cavernous Malformation, Vein of Galen Aneurysmal Malformation (VGAM), Developmental Venous Anomaly (DVA), Capillary telangiectasia, Sinus Pericranii, Aneurysms).

The most commonly used classification of vascular malformation is based on angioarchitectural and histomorphological characteristics. To differentiate these classic types, in a first step, shunting lesions have to be discerned from nonshunting lesions, as well as other features of the vascular contribution that will be evaluated by image.

We cannot forget the hemorrhage associated with coagulopathy, haematological disorders, brain tumors and cerebral sinovenous thrombosis (CSVT) which in the latter case can be found as venous infarction or hemorrhage; and other less common causes of hemorraghe in pediatrics as the intracranial aneurysms, in 15% of all pediatric aneurysms are secondary to an infection (micotic aneurysm).

Read More

Authors:  Rodríguez Garza Claudia , Guillen Gutierrez Cinthia , Elizondo Riojas Guillermo

Keywords:  vascular malformations, hemorrhage, pediatric stroke

Tan Timothy Shao Ern,  Teo Eu Leong Harvey James

Final Pr. ID: Poster #: EDU-060

Vascular anomalies are commonly encountered in paediatrics, often presenting as clinically palpable superficial lesions, and may be associated with an underlying syndrome or congenital disease. According to the ISSVA classification, vascular anomalies are broadly categorized into proliferating vascular tumours and vascular malformations. Vascular tumours may be benign (infantile and congenital haemangiomas), locally aggressive (kaposiform hemangioendothelioma) and malignant (angiosarcoma). Vascular malformations are further subdivided into high-flow (e.g. arterio-venous malformations or fistulas), low-flow (capillary, venous and lymphatic malformations) and complex combined malformations.

Ultrasound is usually the first-line imaging modality of choice to evaluate these lesions, particularly in children, due to its advantages such as excellent superficial spatial resolution, lack of ionizing radiation, negating any need for sedation, wide availability, low-cost and ability to assess vascularity and flow dynamics. Moreover, ultrasound is also useful in detecting complications, guiding further work-up and can be used for routine follow-up after treatment. Transducer selection is typically determined by lesion size and depth. However, mixed complex vascular malformations and deep extensive lesions, particularly those located in poorly accessible regions (e.g. near bony or air-filled structures) may not be well delineated on ultrasound and further evaluation with cross-sectional imaging, usually magnetic resonance imaging/angiography, would be warranted.

The goals of this educational exhibit are to review and familiarize radiologists with the ISSVA classification as well as clinical and imaging features of commonly encountered soft tissue vascular anomalies occurring in children, with emphasis on the utility of ultrasound as a useful diagnostic tool. Sonographic and clinical features of the above mentioned conditions will be illustrated and reviewed. Read More

Authors:  Tan Timothy Shao Ern , Teo Eu Leong Harvey James

Keywords:  Vascular Anomalies, Hemangioma, Ultrasound

Snyder Elizabeth,  Puttgen Kate,  Mitchell Sally,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-073

Vascular anomalies comprise both vascular tumors and vascular malformations which can occur anywhere in the body; the trunk and extremities being the second most common location following the head and neck. Accurate identification of these anomalies is important for proper clinical evaluation and management, particularly since these patients often require multidisciplinary care. The International Society for the Study of Vascular Anomalies (ISSVA) classification, recently updated in 2014, is widely accepted and offers comprehensive classification for all medical subspecialties involved in the care of these complex anomalies, thus providing common language among caregivers. The purpose of this educational exhibit is to highlight the most important MRI and MRA imaging findings in order to identify these lesions according to the 2014 ISSVA classification. Read More

Authors:  Snyder Elizabeth , Puttgen Kate , Mitchell Sally , Tekes-brady Aylin

Keywords:  vascular anomalies, MRI/MRA, time-resolved MRA

Dance Logan,  Keehn Brian,  Patel Mittun,  Pokorney Amber,  Peterson Michael,  Aria David,  Barnes Craig,  Bailey Smita

Final Pr. ID: Poster #: SCI-034

3D mDIXON Gradient Echo (GRE) technical superiority has already been established: improved fat saturation, faster acquisition time, high spatial resolution, and volumetric data acquisition allowing for a comprehensive multiplanar and 3D post-contrast evaluation of vessels and soft tissue lesions. Vascular malformation imaging requires large field of view images that can adversely affect fat saturation, is frequently performed with a non-sedated patient resulting in motion artifact, and requires higher spatial resolution to better characterize a lesion and evaluate lesion extent. Additionally the interventional radiologists at our institution prefer 3D post-contrast imaging to assist in treatment planning. We believe that this sequence is well suited for vascular malformation MRI imaging. The primary purpose is to illustrate the clinical utility and superior image quality of the 3D mDIXON GRE sequence over more conventional mDIXON TSE sequence through a series of cases of a variety of vascular malformations in different body regions. The secondary purpose of this presentation is to validate the clinical superiority of this sequence through a blinded reviewer comparison to the more conventional mDIXON TSE sequence. Read More

Authors:  Dance Logan , Keehn Brian , Patel Mittun , Pokorney Amber , Peterson Michael , Aria David , Barnes Craig , Bailey Smita

Keywords:  vascular malformation, MRI, water fat imaging

Graeber Brendon,  Silva Cicero

Final Pr. ID: Poster #: EDU-124

Umbilical catheters provide intravascular access in the neonatal period that is lifesaving and relatively easy to obtain. However, they are associated with numerous complications related to their placement and use. These may occur because of injuries to vessels and adjacent structures at the time of or following catheter placement; an example is a liver hematoma caused by focal perforation of the umbilical or portal veins during attempted passage of the catheter into the ductus venosus. Complications may also arise from the use of a malpositioned catheter. Pleural effusions and ascites composed of total parenteral nutrition solutions may result from the use of an umbilical venous catheter that terminates in the portal venous system. Complications may be caused by otherwise well positioned, normally functioning catheters, which are innately thrombogenic and may cause thrombosis of the aorta and branches, portal venous system, or caval tributaries, with potentially devastating consequences. Finally, catheter-associated blood stream infection is always a risk during placement and subsequent use. The resulting bacteremia can lead to life-threatening sepsis and additional complications such as septic thrombosis and mycotic aneurysm. This educational review presents a spectrum of complications related to umbilical catheters, organized according to the framework outlined above. The review includes images of cases illustrating both common and unusual entities and a discussion of their salient imaging and clinical features. Read More

Authors:  Graeber Brendon , Silva Cicero

Keywords:  Vascular, Catheter, Newborn

Molloy Christopher,  Merchant Michelle,  Chiang Michael,  Peng Lauryn,  Lew Wesley,  Shaul Donald

Final Pr. ID: Poster #: EDU-094

-Review causes of pediatric abdominal aortic aneurysm (AAA)
-Optimize imaging in evaluation of pediatric AAA, including imaging of complications
-Discuss medical management and definitive treatment of pediatric AAA Read More

Authors:  Molloy Christopher , Merchant Michelle , Chiang Michael , Peng Lauryn , Lew Wesley , Shaul Donald

Keywords:  Aneurysm, Aorta, Vascular

Meldrum Jaren,  Wood Jonathan,  Rooks Veronica

Final Pr. ID: Poster #: EDU-104

The purpose of this exhibit is to provide radiologists at various levels of training with a concise and comprehensive illustrated review of anomalies associated with persistence of the falcine sinus. The exhibit will rely on literature review, illustrations, and multimodality imaging from patients with persistent falcine sinus associations. Read More

Authors:  Meldrum Jaren , Wood Jonathan , Rooks Veronica

Keywords:  falcine sinus, vein of Galen, occipital meningocele, cranial vascular embryology, cranium bifidum

Lewis Paul,  Bandarkar Anjum,  Bulas Dorothy,  Kane Timothy

Final Pr. ID: Poster #: EDU-142

Background: Median Arcuate Ligament Syndrome (MALS) has a long and controversial past. Currently a diagnosis of exclusion, MALS is considered in patients suffering from functional abdominal pain who have typically had extensive prior workups. More common in slender, young women, MALS patients classically present with postprandial epigastric pain, nausea, weight loss, and occasional diarrhea. Since it was first described in 1963, debate has continued as to the pathophysiology of the disease with authors disagreeing whether symptoms are due to mesenteric ischemia and vascular steal phenomenon or compression of the celiac plexus and resulting neuropathy. The association with Postural Orthostatic Tachycardia Syndrome (POTS) in the pediatric population adds further speculation to the exact etiology.
Surgical treatment for MALS is becoming more common, particularly in the pediatric population. Recent technical advances in ultrasound and cross sectional imaging have led to an increased role of diagnostic radiologists in the diagnosis of MALS. Imaging provides an objective measurement in a sea of subjective complaints, with the results often dictating whether surgery is even considered. Read More

Authors:  Lewis Paul , Bandarkar Anjum , Bulas Dorothy , Kane Timothy

Keywords:  MALS, GI, Vascular

Dery Julie,  Rypens Francoise,  Garel Juliette,  Raboisson Marie-josee,  Lapierre Chantale

Final Pr. ID: Poster #: EDU-013

Prenatal screening and diagnosis of fetal anomalies rely upon ultrasound studies (US). US is generally considered safe during pregnancy. It is estimated that 1% of all neonates are born with a congenital heart defect that makes careful standardized examination of the fetal heart a mandatory step during all fetal US exams. US examination of the fetal heart requires at least analysis of the fetal situs, the four-chamber (4CH) view and the three-vessel view (3V). In the evaluation of the fetal heart, it is now worldwide accepted that the three-vessel trachea (3VT) view should be obtained, if technically feasible, in supplement of the other classical fetal cardiac views (4CH, 3V).

The relevance of adding the 3VT view is that some congenital cardiovascular abnormalities, potentially significant for fetal outcome, can only be diagnosed with this view; these malformations include vascular rings and right aortic arches. Read More

Authors:  Dery Julie , Rypens Francoise , Garel Juliette , Raboisson Marie-josee , Lapierre Chantale

Keywords:  Fetal ultrasonography, Three-vessel tracheal view, Vascular ring

Berger Jonathan,  Thomas Anna,  Teague Clint

Final Pr. ID: Poster #: CR-052

* To present a rare case of rectosigmoid venous malformation in a 15-year old male patient without Klippel Trenaunay Syndrome.
* To review common syndromic and nonsyndromic causes of pediatric lower gastrointestinal bleeding with presentation of relevant imaging.
* To discuss the classic imaging features and various treatment options for colorectal venous malformations. Read More

Authors:  Berger Jonathan , Thomas Anna , Teague Clint

Keywords:  lower gastrointestinal bleeding, vascular malformations of the lower GI tract

Farmakis Shannon,  Khanna Geetika

Final Pr. ID: Poster #: EDU-037

Located at the border between the abdomen and the groin, the inguinal region can be a cause for consternation for the practicing radiologist. The inguinal canal can be a site for pathology secondary to abdominal or scrotal pathology. Though lymphadenitis is the most common cause of an inguinal mass in a child, a variety of conditions can result in an inguinal mass.

The purpose of our poster is to review the imaging appearance and differential diagnosis of various potential causes of nonmalignant inguinal masses in children. Read More

Authors:  Farmakis Shannon , Khanna Geetika

Keywords:  inguinal, pediatric, congenital, vascular, gonadal

Lacroix Caroline,  Vossough Arastoo

Final Pr. ID: Poster #: SCI-040

Intracranial aneurysms are rare in children. The utility, yield, and effectiveness of screening for aneurysms in children and young adults with a predisposing history for aneurysms or a family history of aneurysms is not known. The purpose of this study is to assess the prevalence of positive imaging studies performed for screening of intracranial aneurysms in children with familial history of intracranial aneurysms, and determine the utility and yield of these studies. Read More

Authors:  Lacroix Caroline , Vossough Arastoo

Keywords:  MRA, Vascular Imaging, Brain

Izhar Zain

Final Pr. ID: Poster #: CR-039

An 8-week-old male, born without complication at 33 weeks gestation age, presented with an undifferentiated posterior-midline scalp mass that had been present since birth. According to the mother, the mass has progressively increased in size with subjective tenderness to palpation. The mother reported possibly relevant two seizure-like episodes around 5 weeks of age consisting of jerking leg movements and staring spells with rapid blinking. Otherwise, the infant was healthy without any documented past medical or surgical history. Based on the presentation, a dedicated sonogram of the head was ordered with the goal of visualizing the mass and underlying cranial anatomy. The mass was demonstrated to be extracranial with avid vascularity. A few images raised suspicion for a trans-osseous vascular connection between the mass to the sub-adjacent dural venous sinuses. Subsequent contrast enhanced MRI and MRV imaging was ordered to distinguish the leading differential of Sinus Pericranii and Atretic Parietal Cephalocele. On MRI, the highly vascular extracranial mass demonstrated enhancement pattern similar to the dural venous sinuses. A trans-ossoeus vascular channel was seen arising from the mass coursing intracranially and communicating with the superior sagittal sinus. No arterial channel was visualized. No evidence of a persistent falcine venous sinus, primitive falcine vein or CSF tract was visualized. Subsequently, the diagnosis of Sinus Pericranii was established.

Sinus Pericranii and Atretic Parietal Cephalocele are extracranial subscapular masses that present similarly on physical examination and overall presentation. Sinus Pericranii is a low flow vascular malformation with an abnormal connection to the dural sinuses. Atretic parietal cephaloceles are small subscapular lesions with dura, dysplastic brain and fibrous tissue associated with variant intracranial anatomy including a persistent falcine venous sinus/primitive vein and/or abnormal CSF tract. Subsequently imaging findings are essential in distinguishing between the two entities and arriving at a definitive diagnosis. The presented case demonstrates this scenario. Read More

Authors:  Izhar Zain

Keywords:  Sinus Pericranii, Atretic Parietal Cephalocele, Vascular Malformation

Chern Joshua,  Mallon Mea,  Urbine Jaqueline,  Malik Archana,  Kazmi Faaiza,  Poletto Erica,  Faerber Eric

Final Pr. ID: Poster #: EDU-095

Soft tissue vascular malformations encompass a wide variety of lesions throughout the body. Appropriate treatment for these lesions is dependant on accurate classification and diagnosis. Unfortunately, inappropriate nomenclature and description by the radiologist can lead to confusion and possibly mismanagement. Read More

Authors:  Chern Joshua , Mallon Mea , Urbine Jaqueline , Malik Archana , Kazmi Faaiza , Poletto Erica , Faerber Eric

Keywords:  Arteriovenous malformation, Vascular malformation, Lymphatic malformation, Vascular tumor

Rebolledo Signe,  Greenberg S Bruce,  Lyons Karen

Final Pr. ID: Poster #: EDU-005

The purpose of this educational presentation is to provide a pictorial review to promote recognition and understanding of the embryology, anatomy and spectrum of interruption of the aortic arch (IAA) in children. Read More

Authors:  Rebolledo Signe , Greenberg S Bruce , Lyons Karen

Keywords:  Cardiac, Vascular, Congenital

Ahn Richard,  Oatis Kristi,  Patel Anish,  Josephs Shellie

Final Pr. ID: Poster #: EDU-048

Long-term central indwelling catheters are required for multiple treatments in pediatric patients including hemodialysis, parenteral nutrition and chemotherapy. An infrequent complication of these catheters is difficulty at removal or replacement (the “stuck” catheter). Attempted removal of these “stuck” catheters can lead to catheter fracture and retained catheter fragments. These retained catheter fragments can lead to infection, venous thrombosis and ultimately venous stenosis. Given that pediatric patients often require long-term venous access, preservation of venous reserve is critical to the care of these patients. In this exhibit, published literature will be reviewed and a pictorial review of the authors’ clinical experience with “stuck” catheters will be presented. Read More

Authors:  Ahn Richard , Oatis Kristi , Patel Anish , Josephs Shellie

Keywords:  stuck catheter, vascular access

Han Brian,  Parisi Marguerite,  Ferguson Mark

Final Pr. ID: Poster #: EDU-010

Congenital vascular anomalies of the liver are rare entities that take on different physical forms and clinical presentations, with imaging being highly important in the diagnosis and follow-up of these entities. The purpose of this educational presentation is to provide a multimodality imaging review of several different congenital vascular anomalies of the liver that have been observed at a single pediatric tertiary care center. These include infantile hepatic hemangiomas, congenital portosystemic shunts, and congenital intrahepatic arterioportal shunt. The clinical course and management/treatment for each of these entities, to also include the role of imaging in follow-up, will also be briefly discussed. Read More

Authors:  Han Brian , Parisi Marguerite , Ferguson Mark

Keywords:  Vascular, Congenital, Liver