Ileocolic intussusception is a common diagnosis routinely treated by air or contrast enema in the pediatric setting. Cases become less common into the second decade of life with an inverse relationship with pathologic lead points as the inciting culprit. Idiopathic ileocolic intussusception in young pediatric patients has been correlated with seasonality and viral infections, leading to the hypothesis that lymphoid hypertrophy in the terminal ileum acts as the primary lead point in that patient population. Pediatric radiologists are vigilant in evaluation of underlying pathologic lead points in the older population including mechanical causes (Meckel diverticula, polyps, duplication cysts), lymphoma, or hematomas from bleeding disorders (IgA vasculitis, hereditary coagulopathies). Adult surgeons often operate on patients with ileocolic intussusception given the much higher propensity for pathologic lead points. A 20-year-old patient presented to the emergency room with acute onset severe colicky abdominal pain that awoke her from sleep. CT of the abdomen and pelvis was performed showing a right lower quadrant ileocolic intussusception. Patient was otherwise stable and referred to pediatric radiology for successful air enema reduction and planned for further outpatient work up of possible lead points. The patient experienced recurrence of symptoms 1 day later and was taken to the operating room where recurrent ileocolic intussusception was confirmed and ileocecetomy was performed. Pathologic examination of the specimen obtained during surgery revealed reactive lymphoid hyperplasia and multiple reactive mesenteric lymph nodes. Read More

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

Authors: Burns Madisen, Cao Joseph

Keywords: Intussusception

Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels derived from the splanchnic vascular plexus connecting the systemic circulation to the pulmonary arterial vasculature. These abnormal collateral vessels persist after birth when there is disruption of normal antegrade flow through the pulmonary arteries. MAPCAs are most commonly seen in patients with Tetralogy of Fallot with pulmonary atresia (TOF/PA). Our patient was prenatally diagnosed with hypoplastic left heart syndrome (HLH) and anomalous pulmonary venous return. She was born at term with an initial CT angiogram showing obstructive supracardiac total anomalous pulmonary venous return (TAPVR) and a small sub-millimeter MAPCA. The patient underwent immediate vertical vein stenting and subsequently underwent Norwood and open TAPVR repair on day of life 16. She continued to clinically deteriorate due to elevated pulmonary arterial pressures and was eventually diagnosed with occlusion of her left pulmonary veins, confirmed on repeat CT angiography where the small MAPCA had increased to over 2 mm in size. The patient continued to experience pulmonary hypertension resulting in respiratory failure requiring intubation and eventual extracorporeal membranous oxygenation. She became hypoxic and bradycardic during operative tracheostomy placement and was unable to be resuscitated. Read More

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

Authors: Burns Madisen, Cao Joseph

Keywords: Pulmonary, Congenital, Cardiac

This exhibit reviews the major congenital heart lesions affecting the right ventricular outflow tract (RVOT) and the surgical techniques performed in correcting these lesions. We explore the immediate post-surgical appearance of these cases through ultrasound echocardiography, CT angiography, and cardiac MR angiography. The final section reviews the more common complications seen with RVOT intervention. Read More

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

Authors: Burns Madisen, Cao Joseph

Keywords: Congenital, RVOT, Cardiac

Aortic calcifications are an uncommon finding in the pediatric population and when present are often reflective of underlying congenital heart or metabolic disease. Intraluminal polypoid calcified lesions (coral reef aorta) causing flow limiting stenosis are exceedingly rare in even the congenital heart disease population. A 15-year-old patient with a history of hypoplastic left heart syndrome (HLHS) with mitral and aortic atresia. She was found to have significant flow limiting stenosis of the augmented neo-aorta under catheter hemodynamic assessment. CT angiography was performed showing a 4.4 cm partially calcified mass in the ascending aorta extending into the proximal arch causing an 80% narrowing of the aortic lumen. The intrinsic multi-energy capabilities of the first-generation photon counting CT (PCCT) scanner used permitted retrospective material decomposition and thus more definitive characterization of the mass. The patient underwent open ascending aorta replacement and arch repair where densely calcified ascending aorta and base of the arch were removed en bloc along with a large intraluminal mass component without complication. Pathologic assessment revealed PTFE conduit material, thrombus, and extensive calcification with fibrous incorporation of graft and arterial wall. Read More

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

Authors: Burns Madisen, Cao Joseph, Carrico Caroline

Keywords: Aorta, Calcifications, Stenosis

Photon-counting detector (PCD) CT utilizes a charged semiconductor element directly paired with a high-resolution detector panel. The direct conversion of detected photons into electrical signal represents the most recent generational advance in CT technology. Changes to detector technology achieved with PCDs has the potential to reduce image noise, improve spatial resolution, improve contrast resolution, and provide multispectral imaging capability. Importantly, these gains may be achieved with an overall decrease in radiation and iodinated contrast dose. This exhibit reviews the underlying technology of the PCD using clinical scans of pediatric patients performed on the first commercially available PCCT. We present examples of (1) PCD noise reduction capability; (2) improvements in spatial resolution; (3) improvements in contrast resolution; and (4) uses of multispectral capability. These are presented in comparison to the latest generation energy integrating detector (EID) CTs to highlight reductions in radiation dose and contrast media dose. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Cao Joseph, El-ali Alexander, Siegel Marilyn

Keywords: photon counting, CT, ALARA