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

Background: Bronchopulmonary foregut malformations are defined as aberrant communications between an isolated segment of respiratory tissue and the esophagus or stomach. Based on the anatomic relationship of the fistulous connection, these rare malformations are classified into four groups (I–IV). Diagnosis typically involves a combination of cross-sectional imaging (CT or MRI) and an upper gastrointestinal series (UGI). Case: A 1-month-old infant with a history of lipomyelomeningocele was transferred from an outside hospital for neurosurgical evaluation. An incidental right lower lobe (RLL) pulmonary mass was identified on spinal MRI. Further evaluation with contrast-enhanced CT revealed a RLL lesion with a systemic arterial supply from the celiac artery. Internal cystic and branching lucencies were also present, raising concern for a hybrid lesion. The patient was discharged, and readmitted four months later for neurosurgical intervention for spinal dysraphism. The admission was complicated by intermittent oxygen desaturations, suspected to be secondary to gastroesophageal reflux. UGI revealed a communication between the lower esophagus and the isolated pulmonary segment in the right medial lung base confirming a diagnosis of group III CBPFM. Conclusions: This case highlights a hybrid lesion (sequestration and CPAM) with rare communication with the gastrointestinal tract, consistent with a communicating bronchopulmonary foregut malformation (CBPFM). Vague symptoms including recurrent pneumonia and workup for feeding intolerance often lead to delayed diagnosis. Surgical excision of CBPFMs is definitive treatment; however, identification of the communicating esophageal component is necessary prior to resection. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Madden Joseph, Joya Sosa Yocelin, Carrico Caroline, Cao Joseph

Keywords: Bronchopulmonary Malformation, Bronchopulmonary Sequestration, CPAM

Background: Conventional medullary osteosarcoma is a malignant bone-forming tumor characterized by the production of osteoid matrix by malignant mesenchymal cells. Although it is the most common primary malignant bone tumor in children, primary osteosarcoma of the spine is exceptionally rare, accounting for less than 5% of pediatric osteosarcomas. Symptoms are frequently nonspecific, and early radiographic clues may be subtle. Due to its rarity and nonspecific presentation, spinal osteosarcomas are often diagnosed late, typically after structural destruction or neurologic compromise has occurred. Case Report: A 12-year-old female presented with two months of progressive low back pain and an unintentional 15-pound weight loss. She denied weakness, sensory loss, or bowel/bladder dysfunction. Lumbar spine radiographs revealed a lucency of the left L2 pedicle, producing a “winking owl sign.” Follow-up CT demonstrated a lytic, destructive lesion with asymmetric enlargement of the left psoas and paraspinal musculature. Additionally, CT was useful in demonstrating the presence of osseous matrix within the primary tumor. MRI revealed an expansile, enhancing lesion centered in the left posterior elements of L2, with paraspinal soft-tissue extension and circumferential epidural involvement causing moderate to severe canal stenosis. Biopsy confirmed the diagnosis of conventional medullary osteosarcoma. The patient remained neurologically intact and was referred for multidisciplinary oncologic management. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Joya Sosa Yocelin, Madden Joseph, Fadell Michael, Carrico Caroline, Maxfield Charles, Cao Joseph

Keywords: Oncology, Osteosarcomas, Radiographic Findings

Pectus excavatum is the most common chest wall deformity, often causing psychosocial distress and cardiopulmonary issues when severe. The Haller Index (HI) obtained on CT remains the standard for assessing severity, despite its limitations and reproducibility on radiograph. Photon-counting detector CTs can reduce radiation dose while maintaining image quality. We hypothesize that significantly lowering radiation will not compromise presurgical evaluation of pectus excavatum. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Cao Joseph, Kuchibhatla Maragatha, Janos Sara, Gupta Ananya, Bache Steve, Solomon Justin, Kilpatrick Kayla, Fadell Michael, Gaca Ana, Maxfield Charles, Carrico Caroline

Keywords: Chest Computed Tomography (CT), Surgical Planning, Radiation Reduction

Patients with congenital cardiac disease are a vulnerable population who require early and repeat CT imaging. However, decreasing ionizing radiation dose in pediatric CT increases image noise. We evaluated a self-supervised deep learning denoising model integrating sparse coding with a modified Vision Transformer (SC-mViT) compared with a non-local means (NLM) algorithm using quantitative and qualitative metrics. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Gupta Ananya, Erkanli Alaattin, Badea Cristian, Cao Joseph, Clark Darin, Solomon Justin, Bache Steve, Janos Sara, Fadell Michael, Gaca Ana, Carrico Caroline, Morrison Samantha

Keywords: Congenital Heart, Artificial Intelligence, CT