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Society for Pediatric Radiology – Poster Archive

Krista Birkemeier

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Showing 4 Abstracts.

We present the case of a 14 year old Asian male with a history of poorly controlled congenital adrenal hyperplasia (CAH) and growing testicular adrenal rest tumors. While on high dose steroid therapy, the lesions decreased in size from 1.1 x 1.0 cm to 0.5 x 0.8 cm. However, they subsequently increased in size, measuring 2 to 3 cm in length when the patient was not compliant with the steroid regimen due to Cushingoid side effects. The masses were bilateral, symmetric, and located at the mediastinum testis, all findings consistent with testicular adrenal rest tumors as opposed to Leydig tumor. With growth, they coalesced to form undulating masses with hyperechoic and hypoechoic layers mimicking the cerebrum, an appearance more typically seen in the adrenal glands at initial diagnosis of CAH. Current practice guidelines in much of the developed world typically result in early diagnosis and advanced therapy, making testicular adrenal rest tumors of this size and appearance unique. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Willard Scott, Birkemeier Krista

Keywords: congenital adrenal hyperplasia, CAH, testicular adrenal rest tumor, TART

Prenatal screening ultrasound at 18 weeks gestation identified homogeneous enlargement of the distal left leg. There was relative increased blood flow by Doppler, but the bone lengths were symmetric. There were no cysts and no amniotic bands. MRI was performed at 21 weeks gestation for further characterization. MRI demonstrated a lobulated, infiltrative, asymmetric soft tissue signal intensity thickening extending from the knee to the dorsum of the foot. There was no fat content appreciable on T1 or T2 fat saturated images. Given these findings, a vascular soft tissue mass such as kaposiform hemangioendothelioma was the primary differential consideration, with other fibrous tumors considered less likely. Follow up ultrasounds demonstrated commensurate growth of the lesion with the child. At scheduled cesarean delivery, the otherwise healthy female infant had a leg mass that measured 14 cm, extending from the knee to the dorsum of the foot, as seen on prenatal imaging. The skin overlying the lesion was thick and redundant with hypertrichosis. Postnatal MRI was performed on day 2, unexpectedly showing extensive fat signal, along with edema signal and enhancement of the muscle, fat, and thickened skin. There was no abnormal vascularity and no focal mass. There was mild tibial bowing. Incisional biopsy was performed on day 6, with pathologic diagnosis of spindle cell tumor suggestive of fibrous hamartoma of infancy (FHI). This apparent case of FHI is an atypical presentation, with interesting imaging implications. FHI is usually smaller (3-5 cm), more common in males (2.4:1), and only rarely involves the lower extremities distal to the knee (0.5% of cases). Only 23% of FHI are present at birth. To our knowledge, there are no case reports describing the fetal MRI appearance of this entity. Hamartomatous lesions and macrodystrophia lipomatosa had been excluded from the differential diagnosis due to the lack of fat signal intensity on fetal MRI. However, the fetus was imaged in early second trimester and normal subcutaneous fat is usually not visible on MRI until late in the second trimester. This case raises questions regarding the timing of appearance of fat in this lesion. As a result, we recommend that fat containing lesions not be excluded on the basis of absence of fat in early fetal MRI. Repeat MR imaging of musculoskeletal tumors in the third trimester to re-assess content may be useful. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Willard Scott, Birkemeier Krista

Keywords: FHI, Fibrous hamartoma of infancy, kaposiform hemangioendothelioma, fetal MRI

<b>Introduction:</b> The use of e-cigarettes, or vaping, has become increasing popular, and little is known about its long-term effects. We present a case of vaping-associated lung illness in a pediatric patient. <b>Case Presentation: </b>An 18 year-old male presented with worsening fever, chills, and vomiting over a week. He was diagnosed and treated for pneumonia. He denied smoking but endorsed vaping until developing his illness. Over the next two weeks, he lost 12-15 pounds but his cough improved and his appetite returned. He continued to feel weak, tired, and lightheaded upon standing. Labs revealed an elevated ESR and platelet count. The chest radiograph demonstrated an abnormal pattern of perihilar consolidation and ground glass opacity. Further evaluation by computed tomography demonstrated bilateral interstitial and ground glass opacities with areas of consolidation and tree-in-bud centrilobular nodules. The opacities were predominantly peripheral and peribronchiole in location with subpleural sparing. There was associated cylindrical and varicoid bronchiectasis. The overall appearance was most consistent with organizing pneumonia. <b>Discussion: </b>Little is understood about the relatively new vaping-associated lung illness. E-cigarettes were first introduced in 2007, marketed as a safer alternative to smoking cigarettes and as a method for smoking cessation. Vaping has become exceedingly popular among youth. E-cigarettes use heat to vaporize liquid into aerosol, which is then inhaled. Liquid cartridges often contain nicotine, tetrahydrocannabinol, and cannabinoid oils. Additional compounds also found in these products include diacetyl and propylene glycol for flavoring and glycerin to create visible smoke. The exact mechanism and cause for lung injury is unclear, but it is postulated that chemical irritation and potentially thermal injury lead to some of the effects seen thus far. Other ingredients can be added to cartridges, making the etiology of injury even more elusive. Based on reported cases, patients often present with a range of symptoms, including dyspnea, pleuritic chest pain, nausea, and vomiting. Work-ups often reveal lipoid pneumonia, bronchiectasis, eosinophilic pneumonia, pleural effusions, suspected hypersensitivity pneumonitis, and at least one case of diffuse alveolar hemorrhage. In our case the appearance was that of organizing pneumonia. It is unclear if damage is reversible, but some reports discuss clinical improvements with a steroid course. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Niakan Lillian, Birkemeier Krista, Santiago Jose

Keywords: Thoracic, Pulmonary

Imaging during the evaluation of suspected child abuse victims may be requested 24 hours a day, however, pediatric radiologists may not always be available to interpret these studies. Timely reporting is important for treatment and disposition in this vulnerable population. In addition, the accuracy of detection of subtle injuries is critical for patient safety. The current protocol at our institution consists of an immediate preliminary interpretation by an adult radiologist when a skeletal survey is obtained after hours, and final interpretation by one of three pediatric radiologists during normal business hours. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Birkemeier Krista, Ward Erica, Salman Sehar, Blazovic Sarah, Mallett Lea

Keywords: Skeletal Survey, Discrepancy, Child Abuse