Showing 4 Abstracts.
Hypertrophic pyloric stenosis (HPS) is a common surgical condition in infants characterized by idiopathic thickening of the gastric pyloric musculature that results in progressive gastric outlet obstruction and non-bilious emesis in infants between the ages of 2 weeks and 3 months. Ultrasound is the best imaging modality in the diagnosis of HPS as it allows for clear delineation of the thickened pyloric muscle and elongated pyloric channel, as well shows associated findings including gastric distention and lack of normal gastric emptying. To the untrained eye however, lack of knowledge of normal anatomy complicated by intermittent antral contraction may make it difficult to confidently exclude HPS. Several fun and helpful radiologic signs have been created to help radiologists and especially radiology trainees recognize the ultrasound findings of HPS (e.g. antral nipple sign and cervix sign). This poster discusses a new radiologic sign called the "eating duck sign" that can be helpful in distinguishing the normal gastric pylorus. In this sign, the distal stomach and antrum appear as the body and head of the duck, the normal gastric pylorus appears as the bill of the duck, and the duodenal bulb appears as the turnip or beet shaped snack of the duck. Read More
Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022
Authors: Fenlon Edward
Keywords: Hypertrophic Pyloric Stenoisis, Pyloric Stenosis, Radiologic Sign
Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon disorder predominantly occurring in full-term and post-term neonates during the first 6 weeks of life. Clinically it presents as an area of edema followed by indurated plaques or non-tender and mobile nodules with overlying erythema, typically along the back, buttocks, extremities, or cheeks. SCFN may result from localized tissue hypoxia and mechanical pressure that further compromises the local circulation. Fetal and neonatal conditions including macrosomia, perinatal asphyxia, traumatic birth and therapeutic hypothermia; and several maternal conditions including preeclampsia, hypertension, gestational diabetes, cocaine or cigarette exposure, calcium channel blocker use during pregnancy, and familial dyslipidemia have been associated with SCFN. Although SCFN is a self-limiting condition, patients should be monitored for associated hypercalcemia and its complications such as nephrocalcinosis and nephrolithiasis. As these lesions are superficial, they are well evaluated with high resolution ultrasound imaging for initial assessment and follow-up. Findings on ultrasound and MRI include lesions confined to the subcutaneous fat sparing the dermis, with indistinct borders lacking a distinct mass. Lesions of SCFN are echogenic on US, intermediate to low signal intensity on T1-weighted sequences, intermediate to high signal on fluid sensitive sequences, and may demonstrate cystic changes. We will review the imaging findings of subcutaneous fat necrosis in over ten newborns collected from three tertiary care hospitals, with a focus on ultrasound findings. Many of the lesions were multifocal and the majority involved the patient's back. Ultrasound evaluation was performed in all cases. MRI performed in a minority of cases will also be reviewed. While only one case was biopsied for pathologic correlation, each lesion was closely followed clinically. We will also review several mimickers of fat necrosis to be aware of. Read More
Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020
Authors: Fenlon Edward, Jaramillo Diego, Restrepo Ricardo, Corral Gonzalo
Keywords: Ultrasound, Fat, Necrosis
Post-Transplant Lymphoproliferative Disease (PTLD) is a polyclonal and monoclonal lymphoid proliferation which occurs in 1-20% of solid organ transplant recipients. It is most common in multivisceral organ transplants followed by small bowel transplants, heart and lung transplants and less commonly in liver and kidney transplants. PTLD has a bimodal distribution of occurrence with the largest peak occurring within 1 year after transplantation and a second peak at approximately 4-5 years after transplantation. The Epstein Barr virus (EBV) is associated in 50-70% of cases. EBV seronegativity in the recipient at the time of transplant predicts a 2-4 times increased risk of PTLD especially if they receive a donor organ which is positive for EBV. This may explain the higher incidence in the pediatric population who tend to be seronegative for EBV. The World Health Organization (WHO) identifies four pathologic categories of PTLD: early lesions, polymorphic type, monomorphic type and classic Hodgkins lymphoma. The majority of PTLD cases are caused by B-lymphocyte proliferation in a T-cell depleted environment in the setting of immunosuppression. However, there is a subset of cases that are caused by T-cell or natural killer cells as well as cases that occur in the setting of negative EBV. Multiple clones of proliferating B-cells can be seen in a single patient. 2/3 of cases have diffuse expression of CD20 which is an important target for therapy. PTLD may be focal or diffuse and can manifest in a variety of different organ systems or even in the allograft itself. There is a higher percentage of extranodal disease in PTLD as compared to immunocompetent patients with lymphoma. The GI tract and liver are most commonly involved. Isolated lymph node involvement in comparison is less common in patients with PTLD. Central nervous system (CNS) involvement is relatively rare in PTLD. This educational exhibit will provide a pictorial review of PTLD and illustrates cases from one of the busiest transplant centers in North America to highlight the major imaging findings as well as complications seen on imaging of this disease. Extranodal and nodal disease will be demonstrated on multiple modalities as well as complications of this disease including intussusception and biliary obstruction. CNS disease will also be shown. The clinical manifestations, imaging characteristics, prognosis and treatment will be discussed and depicted. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Maddocks Alexis, Fenlon Edward, Chen Susie, Ruzal-shapiro Carrie, Jaramillo Diego
Keywords: PTLD
Proximal humeral epiphyseal fracture-separation is a rare fracture pattern in infants often associated with birth-related or non-accidental trauma, representing a Salter-Harris type I or type II fracture. Lack of a proximal humeral epiphyseal ossification center in most newborns or only subtle displacement of a small epiphyseal ossification center in older infants, makes this injury difficult to diagnose on plain radiographs, potentially leading to delayed diagnosis or misdiagnosis. Ultrasound and MRI are therefore useful imaging modalities in indeterminate cases. Clinical findings of infant proximal humeral epiphyseal fracture-separation such as shoulder swelling, tenderness, and decreased active motion, overlap with more common entities including clavicular fracture, brachial plexus injury and osteomyelitis. Radiographs are often the first diagnostic study ordered to evaluate these symptoms but are insensitive due to minimal ossification of the proximal humeral epiphysis. Radiographs may be normal or show subtle displacement of the epiphyseal ossification center, apparent joint space widening, small metaphyseal fracture fragments or displacement of the proximal humeral metaphysis in relation to the scapula. These findings can be misdiagnosed as shoulder dislocation or pseudosubluxation due to a joint effusion. Careful review of the medical record may elucidate a history of difficult delivery with shoulder dystocia or suspected shoulder trauma. Ultrasound and MRI are useful in indeterminate cases due to their ability to resolve the cartilaginous physis and proximal humeral epiphysis, and to resolve their relationship to the humeral shaft and cartilaginous labrum. Ultrasound has higher anatomic resolution and offers the flexibility to quickly image the asymptomatic contralateral shoulder and image in planes that best show the relationship between the non-ossified epiphysis and the humeral shaft. Doppler ultrasound demonstrates epiphyseal perfusion without the need for contrast administration, and serial ultrasound imaging can be used to evaluate healing and remodeling. MRI is more useful in evaluating cases where osteomyelitis and/or septic arthritis are being considered, or in cases of an inconclusive history suspicious for non-accidental trauma to evaluate for additional osseous and soft tissue injuries. Several examples of typical proximal humeral epiphyseal fracture-separations in infants will be presented and the relevant imaging findings discussed. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Fenlon Edward, Degnan Andrew, Maddocks Alexis, Chen Susie, Jaramillo Diego