Showing 5 Abstracts.
An otherwise healthy 37 day old male presented to dermatology with a pedunculated, friable red glabellar mass. First noticed as a flat, bluish lesion at 10 days, its subsequent rapid growth led to an emergency department visit where dermatology diagnosed a hemangioma and initiated propranolol treatment. Despite this, the mass continued to grow rapidly, encroaching upon the patient’s right eye. The patient was admitted for further workup. Ultrasound findings were consistent with hemangioma while MRI findings were atypical, contributing to a decision to obtain percutaneous biopsy. Pathology was consistent with choriocarcinoma. PET/CT found FDG-avid glabellar, liver and lung lesions. The infant's therapy and clinical course will be briefly described. Clinical photos, ultrasound, MR, and PET/CT before and after therapy will be included. Discussion The unusual predilection of infantile malignancies for cutaneous metastases allows their early discovery and creates vivid clinical stigmata not easily forgotten. While relatively common in infancy, such presentations are exceedingly rare in children and adults. In a series of 208 infants with cutaneous metastases, numerous bluish skin nodules created the so-called “blueberry muffin” baby appearance in 82% of cases. The following diseases presented with cutaneous involvement (ordered most to least common): leukemia, Langerhans cell histiocytosis, neuroblastoma, rhabdoid tumor, rhabdomyosarcoma, primitive neuroectodermal tumor, choriocarcinoma, and adrenocortical carcinoma. Etiology and epidemiology will be discussed. Imaging findings and a companion case in which choriocarcinoma was also misdiagnosed initially as infantile hemangioma will be discussed. Considered one of the fastest growing tumors, infantile choriocarcinoma classically presents with hepatomegaly, anemia, failure to thrive, and precocious puberty between 0 days and 5 months of life. Left untreated, the disease is usually fatal within 3 weeks of presentation. Chemotherapy and delayed surgical excision of metastases can be curative with long-term survival rates of around 80%. Conclusion A solitary cutaneous metastasis can be mistaken for infantile hemangioma both clinically and radiographically. Atypical MRI appearance is one important clue that can suggest an alternative diagnosis. Early diagnosis and treatment of infantile choriocarcinoma is critical for survival. PET/CT may be useful for staging and follow-up. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Dance Logan, Patel Mittun
Keywords: choriocarcinoma, cutaneous metastases, infantile
The objective of this work was to determine whether a 3D gradient echo-based mDIXON T1-weighted sequence can replace a TSE-based mDIXON sequence in the evaluation of bone and musculoskeletal soft tissue lesions. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Peterson Michael, Patel Mittun, Dance Logan, Keehn Brian, Pokorney Amber, Barnes Craig
Keywords: mDixon, Gradient Echo, MRI Techniques, mDixon FFE, mDixon TSE
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
3D mDIXON Gradient Echo (GRE) technical superiority has already been established: improved fat saturation, faster acquisition time, high spatial resolution, and volumetric data acquisition allowing for a comprehensive multiplanar and 3D post-contrast evaluation of vessels and soft tissue lesions. Vascular malformation imaging requires large field of view images that can adversely affect fat saturation, is frequently performed with a non-sedated patient resulting in motion artifact, and requires higher spatial resolution to better characterize a lesion and evaluate lesion extent. Additionally the interventional radiologists at our institution prefer 3D post-contrast imaging to assist in treatment planning. We believe that this sequence is well suited for vascular malformation MRI imaging. The primary purpose is to illustrate the clinical utility and superior image quality of the 3D mDIXON GRE sequence over more conventional mDIXON TSE sequence through a series of cases of a variety of vascular malformations in different body regions. The secondary purpose of this presentation is to validate the clinical superiority of this sequence through a blinded reviewer comparison to the more conventional mDIXON TSE sequence. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Dance Logan, Keehn Brian, Patel Mittun, Pokorney Amber, Peterson Michael, Aria David, Barnes Craig, Bailey Smita
Keywords: vascular malformation, MRI, water fat imaging