The purpose of this educational exhibit is to: 1.Review the embryology, classification, and imaging features of anorectal malformations (ARMs). 2.Review the indications and techniques of Contrast-enhanced colosonography (CeCS) in pediatric patients with ARMs. 3.Provide sample cases and clinical courses of patients with specific ARMs. Anorectal malformations(ARMs) are a spectrum of congenital anomalies involving abnormal development of the distal rectum and anus, leading to an interruption or misconnection of the normal passage between the rectum and the perineum. The condition occurs in about 1 in 5,000 live births and can range from mild to complex. Children with ARMs require preoperative imaging to assess the presence and location of a fistula. Identifying the location of these fistulas is crucial for surgical planning. Contrast-enhanced colosonography (ceCS) has emerged as a valuable tool in diagnosing pediatric ARMs, offering superior anatomical visualization and assessment compared to traditional imaging techniques like fluoroscopy, providing more sensitive and specific evaluation of fistula with real-time contrast filling. CeCS avoids ionizing radiation, and ultrasound contrast agents have a high safety profile with low incidence of adverse events compared to other contrast agents. Contrast-Enhanced colosonography (CeCS) technique should include survey greyscale ultrasound examination of the pelvis to assess for adequate window. Lumason, the ultrasound contrast agent, is prepared and injected into a bag of saline, with a ratio of 1:500 mL. The mucous fistula is examined, and a small Foley catheter is inserted by the radiologist, then balloon is inflated to create a seal. Contrast is then instilled by gravity drip, and perineal structures are imaged through three standard approaches- transabdominal, transperineal and posterior sagittal approaches. As well as reviewing the topics above, this review will also provide examples of ARM cases demonstrating high, intermediate, and low fistulas seen on CeCS. Overall, CeCS enhances the diagnostic accuracy and management of pediatric ARMs. By providing detailed anatomical insights and allowing for accurate classification, it plays a critical role in guiding treatment strategies and improving long-term outcomes for affected patients. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Xu Hongmin, Gagnon Marie-helene, Ali Sumera, Linam Leann

Keywords: Anorectal Malformation, Contrast Enhanced Ultrasound, Pre-Surgical Planning

Esophageal foreign bodies (FBs) are common in children and can lead to serious complications if undetected. Fluoroscopic esophagram has been standard for radiolucent FBs but involves giving oral contrast and possible poor patient tolerance. Low-dose chest CT offers further advantages of a faster workflow and possibility of remote interpretation. We hypothesized that low-dose CT is sensitive and specific for radiolucent esophageal FBs in children. We correlated these results with the gold standard, esophagogastroduodenoscopy (EGD) when available and clinical resolution when no EGD was performed. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Ali Sumera, Dennison Chelsea B, Huang Hui, Jergel Andrew, Alazraki Adina L, Parikh Ashishkumar Kanaiyalal

Keywords: Esophageal Foreign Body, Low-Dose, CT

Foreign body (FB) aspiration is a common medical emergency in children, which can be fatal. Prompt diagnosis is crucial to avoid complication. Bronchoscopy represents the gold standard for diagnosis; however, false negatives can lead to unnecessary invasive testing and exposes children to procedural risks. While lateral decubitus radiographs can assess for air trapping, this exam has low sensitivity for detecting airway foreign bodies. Thus, there is a need for a sensitive and specific diagnostic imaging test in the detection of airway FB. We developed and implemented a FB chest CT protocol that is characterized by low-dose relative to a standard chest CT and no intravenous contrast. We hypothesize that low-dose chest CT is a sensitive and specific modality for detection of airway FB in the pediatric population that may ultimately decrease the negative bronchoscopy rate. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Dennison Chelsea B, Onnis Carlotta, Ali Sumera, Huang Hui, Jergel Andrew, Alazraki Adina, Parikh Ashishkumar

Keywords: Chest Computed Tomography (CT), Foreign Body Ingestion, Low Dose Protocol