Matos Rojas Irma,  Ugas Carlos,  Megue Huamani Marlin,  Katekaru Tokeshi Doris,  Lazarte Claudia,  Valdez Quintana Melissa,  Alpaca Rodriguez Larry,  Casamayor Alvina

Final Pr. ID: Poster #: EDU-08 (R)

The purpose of this exhibit is to review imagings findings of anomalous pulmonary venous return on angiotomography and describe anomalies associated.

Magnetic resonance (MR) imaging and computed tomography (CT) are used in diagnostic and follow – up the congenital vein anomalies. CT provides superior spatial resolution and short time but there is exposure to ionizing radiation. However in many hospital there are only the possibility of obtain CT imaging in neonates and infant.
The total anomalous pulmonary venous return (TAPVR) is the result of failure of the common pulmonary vein to connect to the left atrium with persistence of the primitive splanchnic connections of the pulmonary veins. There are four categories: supracardiac, cardiac, infracardiac and mixed.
The partial anomalous pulmonary venous return (PAPVR) occurs when some but not all segments of the developing lung failed to establish connections with the common pulmonary vein. Read More

Authors:  Matos Rojas Irma , Ugas Carlos , Megue Huamani Marlin , Katekaru Tokeshi Doris , Lazarte Claudia , Valdez Quintana Melissa , Alpaca Rodriguez Larry , Casamayor Alvina

Keywords:  anomalous pulmonary venous return, pulmonary veins, CT Scan

Stecher Priscilla,  Ordonez Alvaro,  Noor Abass

Final Pr. ID: Poster #: CR-023

Klippel-Trenaunay Syndrome (KTS) is a rare cutaneous vascular malformation syndrome involving capillary, venous, and lymphatic malformations often involving a unilateral lower limb. Patients with KTS can also have disease involvement of the gastrointestinal (GI) tract, predisoposing patients to GI bleeding. Here, we present a case of a 15-year-old male with known congenital Klippel-Trenaunay Syndrome involving the left lower extremity presenting with acutely worsening rectal bleeding. The patient presented with two weeks of rectal bleeding, fatigue, and weakness. On initial evaluation, the patient was found to have acute drop in hemoglobin concerning for active GI bleeding. Initial imaging included a tagged red blood cell scan, which demonstrated diffuse increased radiotracer activity along the left hemiabdomen, consistent with active bleed. However, the etiology/source of bleeding at this time could not be determined due to the extensive abdominal involvement. Further evaluation included CT angiography of the abdomen and pelvis, which revealed a large, extensive venous malformation extending throughout the wall of the descending and rectosigmoid colon, with venous malformation extending throughout the left lateral pelvic musculature. Arterial phase imaging demonstrated abnormal enhancement of the mucosa of the descending and rectosigmoid colon, and venous phase imaging demonstrated contrast blushing throughout the descending colon concerning for active bleeding, without clear identifiable source. Due to decline in clinical status and refractory anemia requiring massive transfusion, the patient was evaluated surgically and subsequently underwent emergent colectomy and left lower quadrant ostomy placement. Intraoperative findings demonstrated a massively dilated sigmoid colon with complex tangle of cavernous venous malformations involving approximately two feet of bowel. In setting of a technically challenging operation, the patient’s post-operative course has been complicated by rectal stump dehiscence, multiple pelvic abscesses, and guarded prognosis. In summary, KTS is a rare syndrome involving extensive capillary, lymphatic, and venous malformations, with gastrointestinal involvement predisposing patients to potential life-threating GI bleeding. Here we review a case of a 15-year-old male with KTS presenting with refractory GI bleeding in an extensive colonic vascular malformation necessitating emergent colectomy. Read More

Authors:  Stecher Priscilla , Ordonez Alvaro , Noor Abass

Keywords:  Klippel-Trenaunay Syndrome, Venous Malformation, Rectal Bleeding

Plut Domen,  Zupancic Ziva,  Mali Brajovic Senja,  Kljucevsek Tomaz,  Tomazic Mojca,  Glusic Mojca,  Homan Matjaz

Final Pr. ID: Poster #: CR-006

Congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities in which the portal blood drains into a systemic vein. They are results of embryogenetic alterations during the complex development of the portal system in early gestational period. Anatomically they are classified into two groups; extrahepatic and intrahepatic. Extrahepatic shunts were first described in 1793 by Abernethy and are thus also called Abernethy malformations. Presentation of CPVS can be highly variable and consequences severe.

CASE1:
An 8 year old boy was admitted to our hospital due to severe abdominal pain. Doppler ultrasound (US) revealed an abnormal intrahepatic tubular vascular structure. The computed tomography angiography (CTA) confirmed a direct vascular connection between the left portal vein and the dilated left hepatic vein. The right portal vein was small in size, indicating main portal blood flow through the left side bypassing the liver. The treatment for this intrahepatic CPVS was embolization of the shunt. The boy has been well since the procedure.

CASE2:
A routine medical check-up in a 14 year old girl discovered abnormal liver function tests. Abdominal US showed a huge mass in the right lobe of the liver and a big mass of similar structure in the epigastrium. Portal vein was not identified. CTA showed a short main portal vein connected directly to the inferior vena cava, consistent with the Abernethy malformation. The big mass in the epigastrium was shown to be a tumor in the caudate lobe of the liver. Focal nodular hyperplasia (FNH) was considered for liver lesions due to the imaging findings and known association with the Abernethy malformation. Biopsy confirmed the diagnosis. The girl is currently waiting for liver transplantation, as it is the treatment of choice for this extrahepatic CPVS. Read More

Authors:  Plut Domen , Zupancic Ziva , Mali Brajovic Senja , Kljucevsek Tomaz , Tomazic Mojca , Glusic Mojca , Homan Matjaz

Keywords:  Congenital portosystemic venous shunt, Abernethy malformation, Intrahepatic shunt, Extrahepatic shunt

Jordan Gregory,  Hampton Erica,  Stence Nicholas,  Milla Sarah,  Callen Andrew

Final Pr. ID: Poster #: EDU-078

Intracranial hypotension is a condition caused by the loss of cerebrospinal fluid through either a dural defect, ruptured meningeal diverticulum, or CSF-venous fistula. In the past decade, this condition has been increasingly diagnosed in individuals suffering from orthostatic headaches. In adults, CSF leaks are commonly caused by dural defects due to a degenerative disc osteophyte violating the ventral dura. In the pediatric population, spontaneous leaks may occur in individuals with underlying connective tissue disease, or from venous/lymphatic malformations which approximate the spinal subarachnoid space. Most commonly, a CSF leak results in an “orthostatic headache” characterized by head pain which worsens upon sitting or standing and improves when lying flat. In addition to headache, patients can experience vestibulocochlear symptoms, changes in vision, forgetfulness, or personality changes. CSF leak localization usually requires dynamic myelography, performed using either digital subtraction or CT techniques. However, specific tailored MRI protocols can aid in the detection and characterization of leaks. Treatment options include percutaneous injection of autologous blood or fibrin sealant into the epidural space, embolization of draining veins, or primary surgical repair. The goal of this exhibit is to provide an illustrative review of the various pathologies that can cause CSF leak in the pediatric population. A review of anatomy and pathophysiology followed by a case-based presentation including congenital, iatrogenic, traumatic, and idiopathic causes will be presented. Both noninvasive and invasive imaging protocols will be discussed with a focus on minimizing radiation dose in the pediatric population. Read More

Authors:  Jordan Gregory , Hampton Erica , Stence Nicholas , Milla Sarah , Callen Andrew

Keywords:  CSF Leak, Intracranial hypotension, CSF-venous fistula

Woon Tian Kai,  Fuad Alkhatib Rugaiyah,  Fortier Marielle

Final Pr. ID: Poster #: EDU-011

Partial anomalous pulmonary venous return (PAPVR) consists of a wide spectrum of uncommon congenital anomalies in which one or more pulmonary veins drain directly or indirectly into the right atrium as a result of abnormalities during pulmonary venous embryogenesis. Thus, keen understanding of the underlying embryological origins of the pulmonary venous system is essential to recognize the variations in PAPVR, and radiological assessment is imperative to elucidate the complex anomalous cardiovascular anatomy for subsequent clinical and surgical management. The purpose of this educational exhibit is to provide a brief discussion of the embryological development of pulmonary veins and a detailed review of the diverse array of PAPVR variations with the aid of various case studies and CT imaging findings including sinus venosus atrial septal defect, Scimitar syndrome and anomalous left pulmonary veins. Read More

Authors:  Woon Tian Kai , Fuad Alkhatib Rugaiyah , Fortier Marielle

Keywords:  PAPVR, Partial anomalous pulmonary venous return, Embryology

Cielma Tara,  Hill Cara,  Mirza Sobia,  Sanchez Ramon

Final Pr. ID: Poster #: EDU-004

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

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

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

The goals of this exhibit are:

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

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

Keywords:  Deep venous thrombosis, Venous thromboembolism, Pulmonary embolism

Pezeshkpour Paymun,  Armstrong Nicholas,  Mahant Sanjay,  Muthusami Prakash,  Amaral Joao,  Parra Dimitri,  Temple Michael,  Connolly Bairbre

Final Pr. ID: Poster #: SCI-033

To analyze the use of implanted port-a-caths in Children with Medical Complexity (CMC), neurological impairment and difficult venous access. Read More

Authors:  Pezeshkpour Paymun , Armstrong Nicholas , Mahant Sanjay , Muthusami Prakash , Amaral Joao , Parra Dimitri , Temple Michael , Connolly Bairbre

Keywords:  Difficult venous access, Technology dependence, Reduced morbidity

Fuentealba Cargill Andrea,  Friesen Richard,  Barker Alex,  Fujiwara Takashi,  Englund Erin,  Park Sungho,  Londono Obregon Camila,  Browne Lorna

Final Pr. ID: Poster #: CR-012

A 22-year-old G2P1 female presented to our institution at 22 weeks for fetal cardiology evaluation of hypoplastic left heart syndrome (HLHS) with mitral stenosis and aortic atresia. Fetal echocardiogram confirmed the diagnosis and suggested a severely restricted atrial septum with a pulmonary venous forward/reverse time-velocity integral ratio (VTI) of 2.7.
At 29 weeks' gestation, she underwent a fetal CMR to evaluate for pulmonary lymphangiectasia and interatrial septum.
Fetal cardiac gating was obtained with an MR-compatible Doppler ultrasound device (Smartsync, Northh Medical) and imaging was performed at 3T.
In addition to the findings of HLHS, findings at fetal CMR included an intact/severely restrictive atrial septum with markedly dilated pulmonary veins. Additionally, there was an anomalous pulmonary vein connecting the right sided pulmonary veins to both the azygos vein and the SVC. 4D flow MRI quantified the distribution of blood flow, demonstrated a similar pulmonary venous forward/reverse flow ratio of 2.4 and visualized the anomalous vessel decompressing the pulmonary venous system into the systemic venous system. There was a segmental pattern of pulmonary lymphangiectasia, present in the right middle lobe and lingula.
Same day fetal echocardiography also confirmed the anatomical findings. The patient was determined not to be a candidate for fetal intervention and following counselling, the family elected for comfort care at delivery. After delivery, the baby did not demonstrate clinical signs of a restrictive atrial septum, despite an atrial septal gradient of 11mmHg by echocardiography, and following re-evaluation, underwent a staged single ventricle palliation. At surgery for stage 1 (Norwood-Sano), the atrial septum was found to be almost intact. The infant continues to do well and currently is status post stage 2 with a superior cavopulmonary anastomosis.
This case demonstrates the use of fetal CMR with an MR compatible doppler ultrasound device in the fetal evaluation of HLHS with a suspected restrictive atrial septum. In this case, fetal CMR with 4D flow was able to calculate a pulmonary venous forward/reverse flow ratio similar to echocardiography and demonstrated the anomalous pulmonary venous drainage pathway, which likely accounted for the absence of the expected severe manifestations of an intact atrial septum in addition to the relatively mild manifestations of pulmonary lymphangiectasia. Read More

Authors:  Fuentealba Cargill Andrea , Friesen Richard , Barker Alex , Fujiwara Takashi , Englund Erin , Park Sungho , Londono Obregon Camila , Browne Lorna

Keywords:  4D Flow, Pulmonary Venous Return, Cardiac MRI

Schaefer Carrie,  Aria David,  Beydoun Tammam,  Kaye Robin,  Towbin Richard

Final Pr. ID: Poster #: CR-071

In 2014, 3 patients including a 28-week preemie, 18 day-old neonate, and 11 month-old infant, were treated for large hepatic AVMs. Symptoms included CHF in both the 890-gram preemie and neonate and no symptoms in the infant with imaging revealing extensive shunting. Embolization of the AVMs was performed using various agents, entry sites, and arterial and venous techniques. Agents utilized included detachable and non-detachable coils and vascular plugs. Both direct puncture and intra-vascular techniques, including the use of the umbilical artery, were utilized. Immediate hospital course and short-term clinical and radiographic follow-up was conducted.

Technical success was achieved in all 3 patients without immediate complications. The two symptomatic patients improved clinically on short-term follow up with resolution of the preemie’s and neonate’s CHF, confirmed on post-embolization imaging. Conventional angiography demonstrated complete resolution of the AVM in the infant. Read More

Authors:  Schaefer Carrie , Aria David , Beydoun Tammam , Kaye Robin , Towbin Richard

Keywords:  Hepatic AVM, Venous Embolization

Patel Nimai,  Swana Hubert,  Johnson Craig

Final Pr. ID: Poster #: SCI-023

To assess the incidence, scope, clinical findings and imaging characteristics of GU pathology due to underlying KTS in pediatric patients with the goal of improved diagnosis and outcomes for children with this potentially fatal disorder. Read More

Authors:  Patel Nimai , Swana Hubert , Johnson Craig

Keywords:  Klippel-Trenaunay syndrome, lymphatic malformation, Venous malformation

Milla Sarah,  Cantu Cera,  Richer Edward,  Braithwaite Kiery,  Linam Leann,  Riedesel Erica,  Loewen Jonathan,  Simoneaux Stephen

Final Pr. ID: Poster #: SCI-013

Idiopathic thickening of the pyloric muscle can occur in young infants, causing projectile vomiting, electrolyte abnormalities, and necessity for surgical intervention to relieve the gastric outlet obstruction. Case reports have been published describing infants with HPS who also have portal venous gas (PVG) visualized within the liver. The presence of PVG in other clinical scenarios often indicates a severe and potentially life threatening bowel condition. The purpose of this study was to determine the incidence of infants with hypertrophic pyloric stenosis (HPS) and concurrent portal venous gas (PVG), as well as whether there are unique clinical features or different outcomes in the HPS patients with PVG versus without PVG. Read More

Authors:  Milla Sarah , Cantu Cera , Richer Edward , Braithwaite Kiery , Linam Leann , Riedesel Erica , Loewen Jonathan , Simoneaux Stephen

Keywords:  pyloric stenosis, portal venous gas, pneumatosis

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

Final Pr. ID: Poster #: EDU-006

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

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

Keywords:  Venous Recanalization, PICC, Thrombosis

Acord Michael,  Termine Carl,  Cahill Anne Marie,  Escobar Fernando

Final Pr. ID: Poster #: SCI-037

To assess the rate of dislodgement of posteriorly tunneled central lines, over-the-shoulder, in children. Read More

Authors:  Acord Michael , Termine Carl , Cahill Anne Marie , Escobar Fernando

Keywords:  venous access, back, interventional radiology

Ndolo Josephine,  Crane Gabriella,  Hernanz-schulman Marta

Final Pr. ID: Poster #: CR-001

Introduction
Scimitar syndrome and subdiaphragmatic total anomalous pulmonary venous connections (TAPVC) are congenital pulmonary vascular anomalies that are not typically diagnosed on routine abdominal sonography. We present three cases of ultrasound diagnosis of neonates with subdiaphragmatic pulmonary veins diagnosed on abdominal ultrasound; to the best of our knowledge, this is the first reported case of abdominal ultrasound diagnosis of previously unknown scimitar syndrome.

Case reports
Case 1: 16 day old girl born at term with cardiac dextroposition and right lung hypoplasia. On abdominal ultrasound, a large vascular structure was seen draining into the inferior vena cava (IVC) near the hepatic confluence, arising in lung above the diaphragm. Doppler confirms venous flow into the IVC (Figure 1); an arterial aortic branch with pulmonary spectral Doppler signature, extended into the base of the right lung. The diagnosis of scimitar syndrome was made, confirmed several weeks later with CT angiography.

Case 2: One day old girl born at 29 weeks gestation had a prenatal diagnosis of complex congenital heart disease. Abdominal ultrasound demonstrated asplenia. As part of the complex, the examination demonstrated the common pulmonary vein draining into the left portal vein, decompressing into the heart via the ductus venosus, with color and spectral demonstration of flow direction and velocity. (Figure 2) Closure of the ductus venosus contributed to the demise of this child who was inoperable due to her extreme prematurity and her other congenital cardiac lesions.

Case 3: Eight day old term infant with multiple congenital anomalies. An abdominal ultrasound for heterotaxy evaluation demonstrated a large anomalous vessel arising in the chest between the descending aorta and esophagus posteriorly, and the atrium anteriorly, descending into the abdomen draining into the portal vein, with a partially obstructing membrane near the insertion point. (Figure 3). The TAPVC was repaired on day 9 of life with direct anastomosis to the left atrium.

Conclusion:
In conclusion, subdiaphragmatic vascular components of thoracic anomalies should be recognized at abdominal sonography by pediatric radiologists, who may be the first to both recognize and diagnose these conditions. Read More

Authors:  Ndolo Josephine , Crane Gabriella , Hernanz-schulman Marta

Keywords:  total anomalous pulmonary venous connection (TAPVC), Scimitar syndrome, ultrasound

Stein Nina,  Ahmed Fahran

Final Pr. ID: Poster #: CR-066

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

Authors:  Stein Nina , Ahmed Fahran

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

Baker Omar,  Hernandez Alberto,  Cleveland Heather,  Justino Henri

Final Pr. ID: Paper #: 075

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

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

Keywords:  Portal Venous Thrombosis, Balloon Angioplasty, Stenting

Almeky Somiah,  Castro Ilse,  Setty Bindu

Final Pr. ID: Poster #: EDU-020

Educational Objectives:
1. Recognize the utility of a UVC catheter in a neonate
2. Understand the anatomy which guides acceptable positioning of a UVC, and identify helpful radiographic and sonographic landmarks
3. Familiarize readers with common complications of UVC catheters through the use of imaging examples, including:
a. Malpositioning/coiling within normal structures
b. Hepatic complications
c. Cardiac complications
4. Learn to recognize the correlation between radiographic and sonographic appearances
5. Understand the utility of ultrasound in monitoring certain complications

Introduction:
Umbilical venous catheterization is a common bedside procedure performed in the Neonatal ICU. As with any procedure, umbilical venous catheterization does not come without risks.

Understanding the basics of fetal circulation is very important in evaluation of neonatal catheters. Because of the distinct anatomy associated with fetal circulation, there are unique complications associated with UVC placement.

The feared complication is placement within the portal venous system, as this may lead to inadvertent infusion of hypertonic fluids such as parenteral nutrition directly into the liver and cause hepatic damage. Radiographs can occasionally reveal findings such as focal lucency corresponding to the area of hepatic necrosis. Ultrasound provides much more detail however and is therefore useful for evaluating and monitoring such complications.

While not seen as frequently, cardiac complications may also result from UVC malpositioning. The catheter can sometimes extend too deep and terminate within the right atrium which can lead to perforation and subsequent pericardial effusion leading to cardiac tamponade. In patients with a patent foramen ovale or atrial septal defect, the catheter tip can even end up within the left atrium and lead to cardiac arrhythmias.

The purpose of this poster is to illustrate the normal anatomy and catheter positioning, as well as to provide a pictorial review of complications that result from UVC malpositioning. Read More

Authors:  Almeky Somiah , Castro Ilse , Setty Bindu

Keywords:  Malposition, NICU, Venous Access

Dewan Sannidhi,  Saul David,  Malik Archana

Final Pr. ID: Poster #: SCI-008

To characterize the sonographic appearances of lower extremity peripherally inserted central catheter (PICC)–associated thrombus and fibrin sheath in infants, and to identify imaging features that can aid differentiation between these two commonly overlapping entities.
Differentiating these on ultrasound is essential for accurate diagnosis, guidance of clinical management, and avoiding unnecessary anticoagulation or catheter removal. However, sonographic differentiation in this population remains challenging due to small vessel size, technical limitations, and limited published data. Read More

Authors:  Dewan Sannidhi , Saul David , Malik Archana

Keywords:  Ultrasound, Peripherally Inserted Central Catheter, Venous

Guillen Gutierrez Cinthia,  Rodriguez Garza Claudia,  De Luna Vega Raul,  Hernández Grimaldo Edgar,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-010 (S)

Vascular abnormalities are commonly observed in pediatric patients, with an estimated prevalence of at least 4.5%.
The current classification scheme for vascular anomalies was developed in 2014 by ISSVA (International Society for the Study of Vascular Abnormalities) and is based on the work of Mulliken and Glowacki of 1982.
This classification emphasizes the fundamental difference between vascular tumors and vascular malformations.
The diagnosis of vascular abnormalities is based on clinical history and physical examination.
US: Screening, proper characterization
TC: It allows assessing the extent of the lesion and the relationship with adjacent structures
MRI: It's the ideal imaging study and reflects its histological composition.

The most commons anomalies are:
Hemangiomas:
The most frequent vascular tumors are lobed and highly vascular lesions.
They have significant enhancement to the administration of contrast medium, but only moderate T2 hyperintensity that reflects their highly cellular nature.

Venous Malformation:
Malformed venous channels with slow blood flow with thrombosis and flebolite formation
Important, often heterogeneous and peripheral enhancement with central progression.
Hyperintense T2 signal reflects low cellularity

Lymphatic malformations:
Dilated lymphatic channels and cysts. They can be macro or microcystic
Macrocystic variants appear as cysts with a very bright T2 signal and minimal enhancement (if any), bleeding is a common complication with liquid-liquid level formation.

Arteriovenous Malformations:
The main finding is empty flow due to high flow, which infiltrate the tissues without evidence of a free mass.
There may be a mild enhancement and T2 hyperintensity that reflects tissue edema

Treatment:
In most cases, conservative treatment is recommended, but when a patient suffers from clinical complications sclerotherapy of the nidus becomes mandatory.
A multidisciplinary approach is needed.

Sclerosing agents
Alcohol 98%: Strong endothelial damage, high response rate, less expensive, easy to obtain. Painful during the procedure, high complication rate, penetrative effect on the deep vascular layer
Ethanolamine oleate: Excellent thrombogenic effect, chemical damage to the vascular wall, less toxic effect than absolute ethanol. It can induce acute renal failure due to hemolytic effect, less endothelial damage than absolute ethanol.
Polidocanol: Overhydration of endothelial cells, almost painless procedure. May induce reversible cardiac arrest Read More

Authors:  Guillen Gutierrez Cinthia , Rodriguez Garza Claudia , De Luna Vega Raul , Hernández Grimaldo Edgar , Elizondo Riojas Guillermo

Keywords:  Hemangioma, Lymphatic Malformation, Venous Malformation

Hughes Nicole,  Phelps Andrew,  Meyer Anna,  Courtier Jesse,  Mackenzie John,  Zapala Matthew

Final Pr. ID: Poster #: EDU-042

Accurate diagnosis of venous malformations can be challenging, and confidently diagnosing them is important for accurate treatment. A thorough understanding of the etiology, imaging appearance, and important mimickers of venous malformations is critical for the radiologist to provide an accurate assessment for the clinician. Read More

Authors:  Hughes Nicole , Phelps Andrew , Meyer Anna , Courtier Jesse , Mackenzie John , Zapala Matthew

Keywords:  MRI, venous malformation, Whole body MRI, Blood pool MRI contrast agent