Showing 6 Abstracts.
Fidget spinners (FS) have become an increasingly popular toy among children of all ages since April 2017. This toy comprises of a central bearing attached to two or more prongs made of plastic or metal and is designed to be spun between a user’s fingers. With its popularity, FS have grown diverse in design, featuring additional components including light-emitting diode units, Bluetooth speakers, and button batteries. With its multiple small components, FS pose a risk of ingestion and aspiration among young children. This may be incidental or accidental due to the rapidly spinning nature of the toy. Since May 2017, there has been a growing number of cases of FS ingestions among young children internationally. Recognition of the different components of a FS on imaging, especially plain radiography, is important in the early diagnosis and prompt and accurate management of foreign body ingestion. To date, there is no available educational resource to aid and guide radiologists and clinical providers in identifying FS as a foreign body. The purpose of this educational exhibit is to assist radiologists and clinicians to identify the imaging findings associated with FS-related foreign body ingestions. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Lin Jonathan, Chawla Soni
Keywords: Foreign Body, Fidget Spinner
IHPS has a history that is intimately related to the evolution of Ultrasound(US). US was first used to diagnose IHPS as far back as 1977 (Teele and Smith), and as US technology advanced, the diagnosis of IHPS became more refined. We can make precise measurements for the pyloric muscle wall thickness (MWT), pyloric canal length (CL), and transverse pyloric diameter (TPD), and we have highly sensitive and specific signs (i.e. target, shoulder, double-track signs, etc) to aid us in the diagnosis of IHPS (Hernanz-Schulman 1998). Why: IHPS is the most common cause of gastric outlet obstruction and one of the most common conditions requiring surgery in infants. The exact pathogenesis of IHPS is unknown, but it is an acquired, gradual and progressive disorder. Who: The classic picture is 5 to 8-week old Caucasian male (4:1 M:F) who presents with non-bloody, non-bilious projectile vomiting. Classic physical exam findings including visible peristalsis and palpable pyloric olive are present in less than 50% cases. Delay in diagnosis can cause serious consequences. When: We can typically do US at any age at the time of the next feed and as the baby is being bottle fed (ideally). How: We use a linear 12-5 or curved 8-5 transducer, with 2D and cine imaging. The baby is placed in supine position, and we begin scanning at the epigastric region. We find the gastroesophageal junction and trace the lesser curvature of the stomach medially to find the pylorus. What: Once we find it; we measure the MWT, CL, and TDP, and look for all the signs. One way to remember the normal limits is our “Rule of 4s”. In IHPS, MWT is more than 4mm, CL is 4x4 = 16mm, and TDP is 4+4+4 = 12+mm. The signs include target sign (hypertrophied hypoechoic muscle surrounding echogenic mucosa), shoulder/nipple sign (bulging of hypertrophied pyloric muscle into the lumen of the antrum), and double-track sign (elongated pylorus with hypoechoic lumen, sandwiched between echogenic mucosa). If the measurements do not meet our “rule of 4s” and there are none of the signs, we can confidently rule out IHPS, or we may consider another differential diagnosis, like pylorospasm and mucosal hypertrophy due to other causes like prostaglandins. We’ve come a long way with refining and defining US diagnosis of IHPS until finally ultrasound is now the gold standard diagnostic modality for IHPS. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Chawla Soni, Ourfalian Raffi
Chest radiographs remain the most frequently used examination in patients presenting with acute complains, adult and children alike. In many pediatric conditions, an abnormal finding on a chest radiograph may be the first clue available. In this educational exhibit, a systematic approach in the evaluation of pediatric chest radiographs is provided. With the use of mnemonic “In the <u>ER</u>, <u>L</u>ook and <u>L</u>isten for <u>M</u>ost o<u>B</u>vious <u>S</u>igns!”, the reader will navigate through the essential components of the evaluation with Exposure, Rotation, Lines, Lung fields, Mediastinum, Bones and Soft tissues. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Pan Patrick, Roth Antoinette, Chawla Soni
Keywords: Chest, Radiograph, Approach
Acute abdomen is one of the most common presentations encountered in any pediatric emergency department. This educational exhibit refreshes reader with the most common causes of acute abdomen encountered in the pediatric population through a simple mnemonic (AIM)<sup>2</sup> which includes <u>A</u>ppendicitis, <u>A</u>dhesions, <u>I</u>ntussusception, <u>I</u>ncarcerated inguinal hernia, <u>M</u>eckel’s diverticulum and <u>M</u>al-rotation with midgut volvulus. Initial abdominal radiographs and confirmatory ultrasound and/or cross-sectional images including CT and MRI will be presented. There will be emphasis on “Image Gently” principles in keeping with minimum radiation exposure to our most vulnerable pediatric population. The best use of available diagnostic modality with the least or no radiation is suggested for given pathologies and clinical scenarios in pediatric patients. Also, appropriateness criteria for the diagnostic studies will be reviewed in our exhibit. Plain films may reveal an abnormal bowel gas pattern, which may suggest an underlying pathology. Use of ultrasound as part of the initial evaluation is advocated in many situations because it may be quickly performed at bedside and repeated as needed without harmful ionizing radiation. In certain cases, ultrasound examination may be confirmatory. CT is best used when the initial tests are unrevealing, or when the patient is acutely deteriorating. CT has proven to save lives of children by allowing prompt and accurate evaluation. Minimizing radiation exposure while maintaining diagnostic accuracy remains an ongoing effort of the entire care team, including the radiologists, radiology technologists and the referring physicians. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Pan Patrick, Roth Antoinette, Chawla Soni
Keywords: Gastrointestinal, ALARA
Children, especially toddlers, are the most frequent victims of foreign body (FB) ingestion because of their natural curiosity, tempting them to put everything into their mouths. Anything within arm’s reach is fair game, from simple coins to the more dangerous button batteries and magnets. This study aims to provide a thorough review of plain radiographic findings of a myriad of foreign bodies (FBs) and associated complications. With the “Rule of 3–5”, we aim to help radiologists and clinicians develop a rationale and systematic approach in managing FB ingestions. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Chan Alvin, Lin Jonathan, Ghahremani Shahnaz, Chawla Soni
Keywords: Foreign Body
Awareness of abdominal aorta abnormalities in pediatric patients is essential for appropriate diagnosis and management of the patients suffering from these conditions. Due to a nonspecific presentation, and sometimes being asymptomatic earlier in life, imaging has an important role in diagnosis of these abnormalities. Aneurysm and dissection are excluded, as they are not specific to children and with few exceptions mostly present in older patients. We review the clinical presentation and show imaging findings of mid aortic syndrome, Takayusu arteritis, rare entities such as idiopathic infantile arterial calcification. Also we show imaging of the anatomic variants of the distal aorta such as middle sacral artery, persistent sciatic artery, abdominal aorta coarctation and blind ending aorta, with a short review of embryologic development of abdominal aorta. These anomalies are not common, however if remain undiagnosed might have serious consequences. -Midaortic syndrome is an uncommon disease with progressive narrowing of the abdominal aorta and its major branches, typically involving interrenal segment of the aorta; it affects mostly children and young adults, the cause is not clear, might be the result of an intrauterine insult to the intima and subintimal tissues. Aside from diagnosis, imaging has a major role in endovascular treatment of mid aortic syndrome. -Takayusu arteritis, also predominantly involves aorta and its major branches of younger patients, with strong female predominance, and frequently found in Asian patients. Destruction of arterial medi leads to aneurysm formation and uncommonly rupture of the involved artery. -Idiopathic infantile arterial calcification, a rare entity presenting with extensive calcification and stenosis of large and medium sized arteries, usually leads to early death from coronary artery occlusion. -The aortoiliac variants are rare and not commonly discussed in the imaging literature. Some anomalies might be asymptomatic in young ages, but might complicate surgeries like heart, renal transplant, or hip surgery and increases the risk of morbidity and mortality. Some of these anomalies such as persistent sciatic artery need long term follow-up, given the possibility of aneurysmal degeneration. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Saadat Vandad, Chawla Soni, Chen Johnathan, Iskander Paul, Ghahremani Shahnaz