Recurrent pneumonia in pediatrics is diagnosed when a child develops 2 or more episodes in a year or 3 or more episodes in total, with radiographic clearing of densities in between episodes. It accounts for 7-9% of childhood pneumonia and is the one of leading causes of preventable childhood mortality worldwide. It presents a diagnostic challenge, and management relies on clinical judgement, careful history and physical examination, and features suggestive of underlying conditions. Identifying the cause of recurrent pneumonia is crucial for early diagnosis and treatment and reducing morbidity and mortality. It can occur due to localized pathology of the respiratory tract or from complications of systemic disease. Chest radiography is one of the most commonly performed imaging studies in pediatric care. It is easy to perform, readily available even in low-resource settings, and is often the first modality of imaging utilized for investigating pneumonia. We present a case series highlighting the clinical presentations of various pathologies implicated in recurrent pneumonia and the diagnostic role of radiographs and follow up computed tomography (CT) in its management. We finally present a diagnostic algorithm for recurrent pneumonia and emphasize the importance of following a thorough checklist to ensure precise delivery of care. Readers of this exhibit can expect to learn about the significance of imaging in the diagnosis of recurrent pneumonia due to: - Foreign bodies - Tumors - Congenital malformations - Immunodeficiency Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Amiruddin Raisa, Noor Abass, Sherwani Poonam

Keywords: Radiographic Findings, Pulmonary, CT Chest

The differential diagnoses of pulmonary asymmetry beyond pleural effusion and lobar pneumonia are broad. Diseases that manifest uniquely in the pediatric population, such as congenital diaphragmatic hernia and unilateral pulmonary agenesis, may have remarkably similar radiographic findings, with Computed Tomography (CT) reliably distinguishing the two. Readers of this exhibit will gain a comprehensive understanding of ● Common and uncommon pediatric conditions resulting in pulmonary asymmetry on radiography, with CT correlation, ● Epidemiology, embryological origins, and clinical management of these cases. Table of Contents/Outline: ● Introduction ● Goals and objectives ● Review of cases demonstrating pulmonary asymmetry on radiography with CT correlate in the pediatric population ● Key teaching points in identifying radiograph and CT abnormalities in each case ● Epidemiology, embryological origins, and clinical management of the cases presented. Conditions discussed include: ● Pulmonary agenesis ● Congenital diaphragmatic hernia ● Foregut duplication cyst ● Congenital pulmonary airway malformation ● Bronchial atresia ● Foreign body aspiration ● Swyer-James Syndrome ● Scimitar syndrome ● Bronchopulmonary sequestration ● Congenital lobar emphysema ● Unilateral absence of pulmonary artery ● Poland syndrome Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Amiruddin Raisa, Noor Abass, Alizai Hamza

Keywords: Pulmonary asymmetry

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events. At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment. 18F-FDG PET/MRI representative cases from clinical practice: Case 1. 18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner. Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases. Case2. 4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation. Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Maleki Nazanin, Amiruddin Raisa, States Lisa, Aboian Mariam

Keywords: PET-MRI, Pediatric Imaging, Brain Tumors

Current guidelines for initial cross-sectional imaging in pediatric lymphomas involves CT (Computed Tomography) of the chest, abdomen, and pelvis, ensuring that the radiation dose is As Low As Reasonably Achievable (ALARA). Whole-body MRI is favored over CT in this regard for diagnosing and staging the disease given its additional advantage of maximizing contrast resolution. Imaging characteristics of lymphoid tissue on MRI includes high T2 and STIR signal. Low and intermediate signal of lymphadenopathy on T2 and STIR is an unexpected finding noted anecdotally in nodular sclerosing Hodgkin’s lymphoma. These signal characteristics may be characteristic of histological subtype of the disease and may in future be used to avoid a biopsy diagnosis. In this study we aimed to review signal characteristics of lymphadenopathy in biopsy-confirmed nodular sclerosing Hodgkin’s lymphoma. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Venkatakrishna Shyam Sunder, Rigsby Devyn, Amiruddin Raisa, Schoeman Sean, Jalloul Mohammad, Andronikou Savvas

Keywords: MRI, Nodular Sclerosing Hodgkin Lymphoma

Despite the global surge in adoption of Positron Emission Tomography Magnetic Resonance Imaging (PET/MRI) in healthcare, a formal educational framework for pediatric PET/MRI is lacking. The study aimed to conduct and report a needs assessment of pediatric radiology fellows, informing the development and implementation of a peer-reviewed pediatric PET/MRI curriculum and library. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Lopez-rippe Julian, Alkhulaifat Dana, Sompayrac Anne, Amiruddin Raisa, Hamel Eva, States Lisa, Reid Janet

Keywords: Radiology education, Radiology curriculum, Positron Emission Tomography Magnetic Resonance Imaging