Showing 8 Abstracts.
To share these uncommon but important cases of Midgut Volvulus (MGV) without malrotation. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Youssfi Mostafa, Biyyam Deepa, Bailey Smita
Keywords: VOLVULUS, MALROTATION, SMA CUT-OFF
Calcifying nested stromal epithelial tumor (CNSET) is a very rare primary liver tumor in children. To our knowledge, about 30 cases have been reported in literature. We describe the imaging appearance and histopathologic features of this tumor detected in a 2 year old girl who presented with an incidentally detected calcified liver lesion on a chest x-ray which was obtained for cough. Computed tomography (CT) demonstrated a 5.5 centimeter sized heterogeneous mass with large coarse calcifications. MRI better demonstrated the margins of the lesion, which was predominantly hyper-intense on T2-weighted images. Large areas of signal void were seen in the superior aspect of the lesion, corresponding to the calcifications seen on CT. The lesion demonstrated restricted diffusion. Post-contrast, the lesion demonstrated enhancement in the portal venous phase with washout on the delayed phase. Initial diagnosis based on imaging findings and patient’s age was hepatoblastoma. However, serum alpha- fetoprotein (AFP) was normal, which is unusual with hepatoblastoma. Patient underwent subsequent wedge biopsy, which was proven to represent calcifying nested stromal epithelial tumor of the liver. PET/CT, obtained to evaluate for metastatic disease, demonstrated increased FDG activity within the primary hepatic lesion, with SUV Max of 3.5, with no evidence of FDG avid metastatic disease. She then underwent right hepatectomy and cholecystectomy. No sign of tumor recurrence has been noted to date on the follow up abdominal ultrasound examination in the past 2.5 years. Calcifying nested stromal epithelial tumor should be considered in the differential when a large heterogeneous liver tumor with coarse/ chunky calcifications is identified at imaging in the absence of elevated serum AFP in a child. Currently the standard treatment in complete surgical excision and liver transplantation if excision is not possible. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Biyyam Deepa, Youssfi Mostafa, Mandell Gerald, Taylor Steve, Patel Mittun
Keywords: nested stromal epithelial, tumor, liver
The purpose of this case report is to alert the reader to a rare differential diagnosis for infra- as well as intradiaphragmatic lung sequestration. A 38-year-old G2P0010 pregnant patient was referred for fetal magnetic resonance imaging (MRI) due to a 14.2 x 20.2 x 18 mm left paraspinal hyperechogenic mass with no internal vascularity and no convincing systemic arterial feeding vessel concerning for neuroblastoma as seen by ultrasound (US) performed at 34 weeks. Fetal MRI performed the same week showed a homogeneous T2-hyperintense left paraspinal mass in close apposition to and associated with a small area of loss of continuity in the diaphragm. This has been previously reported by postnatal computerized tomography as the "split diaphragm" sign in a case of intradiaphragmatic lung sequestration (Meier AH, Eggli KD, Cillei RE. Intradiaphragmatic extralobar sequestration: a rare pulmonary anomaly. Pediatr Surg 200;44:e27-29). Thus, the differential diagnosis provided at the time was congenital intradiaphragmatic sequestration and neuroblastoma. The fetus delivered via uncomplicated spontaneous vaginal delivery at term. Postnatal US performed at the age of 15 days showed a left hyperechogenic mass extending from the left lower chest to the ipsilateral retroperitoneum through a small defect in the diaphragm, favored to represent an extrapulmonary lung sequestration. The left adrenal gland was normal. A follow-up CT performed at 7 months of age showed a 2.6 cm left paraspinal mass with no systemic arterial blood supply to support the diagnosis of sequestration. The differential diagnosis at the time included neurogenic tumor or a myofibroma arising from the diaphragm. Follow-up CT at 13 months of age showed similar findings. The patient underwent uneventful laparoscopic removal of the mass with a final pathological diagnosis of congenital adrenal rest. Congenital adrenal rest presenting as a diaphragmatic mass is rare and as been reported once in an adult patient with an adenoma in heterotopic adrenal tissue located in the left diaphragm, diganosed because of mass effect in the gastric fundus during an uper gastrointestinal series (Keirns MM. Two unusual tumors of the diaphragm. Radiology 1952; 52:542-547). We hope this report raises awareness of this entity as a potential differential diagnosis for prenatal masses seen in close relationship with the adrenal gland and/or diaphragm. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Goncalves Luis, Jamshidi Ramin, Biyyam Deepa, Patel Mittun, Cornejo Patricia
Keywords: lung sequestration, neuroblastoma, adrenal rest
Approximately 800 children in the United States undergo renal transplant each year. Allograft failure is driven by interstitial fibrosis often due to chronic antibody mediated rejection. Renal biopsy is the gold standard to detect allograft dysfunction but limited by sampling error and inherent procedural and anesthesia risk. Ultrasound shearwave elastography (US-SWE) is a non-invasive imaging technique that assesses the mechanical stiffness of tissue. The primary aim of this study was to examine the relationship between US-SWE values, pathologic fibrosis/rejections scores and serology in pediatric recipients of renal transplant. Read More
Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020
Authors: Riemann Monique, Bailey Smita, Angadi Siddhartha, Biyyam Deepa, Turman Martin
Keywords: ultrasound, elastography, pediatric renal transplant
Our educational exhibit will be an ultrasound pictorial review of the normal and pathologic conditions of the orbit in children. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Willard Scott, Patel Mittun, Bailey Smita, Miller Jeffrey, Plotnik James, Biyyam Deepa
After reviewing the exhibit, participants will be able to recognize suspicious and non-suspicious ultrasound (US) features of pediatric thyroid nodules which will help to triage nodules that need a biopsy. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Biyyam Deepa, Patel Mittun, Dance Logan, Dao Tuan, Youssfi Mostafa, Towbin Richard
Radiologists have classically been taught the imaging findings of skeletal “Don’t touch lesions” on radiographs. The radiologist's goal is to best characterize these boney lesions and avoid tissue biopsy, especially since some bone lesions are misleading when viewed histologically, with nonaggressive lesions appearing aggressive. Many of these classical “Don’t touch lesions” are now being further evaluated with contrast enhanced magnetic resonance imaging (MRI). MRI findings of these radiographically classical lesions are not as well understood by radiologists with less MRI experience. We will provide an education exhibit to display MRI and corresponding radiographic appearances of characteristic “Don’t touch lesions”. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Keehn Brian, Patel Mittun, Peterson Michael, Dance Logan, Biyyam Deepa, Pokorney Amber, Barnes Craig
Keywords: Don't touch lesions, benign bone lesions
Accurate tumor measurement is essential in initial assessment of solid tumors. Furthermore, it is vital when evaluating treatment response. Change in tumor size determines whether a treatment course is effective, if treatment should be prolonged, or whether a more aggressive treatment or chemotherapy drug should be administered. Currently endorsed and widely used guidelines for tumor volume measurement include response evaluation criteria in solid tumors (RECIST), a one dimensional measure (cm) of target lesions which is not routinely the longest axis; World Health Organization (WHO), a 2 dimensional measure of the long and one short tumor axis (cm2) but is not a measure of volume; and Childrens Oncology Group (COG), a 3 dimensional ‘volume’ (cm3) measurement but does not account for shape of the tumor. Pediatric oncology patients are almost exclusively cared for in major academic or community hospital settings where modern CT and MR scanners routinely produce direct or reconstructed multiplanar images. Therefore an evolution of tumor measurement, to determine tumor volume, must be forthcoming. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Willard Scott, Barnes Craig, Augustyn Robyn, Thorkelson Marrit, Chatfield Paige, Hu Harry, Towbin Richard, Bardo Dianna, Pfeifer Cory, Dance Logan, Bailey Smita, Southard Richard, Jorgensen Scott, Biyyam Deepa, Patel Mittun, Cassell Ian