Partial anomalous pulmonary venous return (PAPVR) consists of a wide spectrum of uncommon congenital anomalies in which one or more pulmonary veins drain directly or indirectly into the right atrium as a result of abnormalities during pulmonary venous embryogenesis. Thus, keen understanding of the underlying embryological origins of the pulmonary venous system is essential to recognize the variations in PAPVR, and radiological assessment is imperative to elucidate the complex anomalous cardiovascular anatomy for subsequent clinical and surgical management. The purpose of this educational exhibit is to provide a brief discussion of the embryological development of pulmonary veins and a detailed review of the diverse array of PAPVR variations with the aid of various case studies and CT imaging findings including sinus venosus atrial septal defect, Scimitar syndrome and anomalous left pulmonary veins. Read More

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

Authors: Woon Tian Kai, Fuad Alkhatib Rugaiyah, Fortier Marielle

Keywords: PAPVR, Partial anomalous pulmonary venous return, Embryology

Congenital coronary artery (CA) anomalies can be classified into abnormalities pertaining to origin, course and termination, which can serve as important prognostic factors. Some of these anomalies are asymptomatic with a benign clinical course, while others can give rise to symptoms of chest pain and even sudden death (e.g. malignant interarterial CA course). Acquired CA abnormalities such as coronary arterial aneurysms associated with Kawasaki disease may result in thrombi development, necessitating a change in patient management. Early and accurate diagnosis of these abnormalities is therefore crucial but can be technically challenging owing to the small size of the coronary arteries, rapid heart rate, and limited cooperation of children. Whilst the proximal aspect of the coronary arteries can be visualized with echocardiography, computed tomography angiography (CTA) provides a more comprehensive assessment of the coronary arteries even without ECG-triggering. Moreover, CTA offers the flexibility of customizing acquisition parameters for the individual patient. As such, CTA is rapidly becoming the imaging modality of choice for evaluating complex congenital and acquired CA abnormalities in children. The aims of this educational exhibit are to review the embryology of coronary arteries, outline congenital and acquired CA abnormalities, and discuss the utility of optimizing low-dose CTA to evaluate these abnormalities in children. Determining the origin and course of CAs is key for pre-operative planning in some types of congenital heart disease, for example, the arterial switch procedure for transposition of great arteries and in Taussig Bing anomaly. Identifying the malignant interarterial intramural CA course can be lifesaving. Evaluating for co-existing abnormalities, such as CPAM, is also an integral part of these studies. Read More

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

Authors: Tan Timothy Shao Ern, Woon Tian Kai, Fortier Marielle

Keywords: Coronary artery, Computed tomography, Aneurysm

Renal artery stenosis (RAS) causing renovascular hypertension is a common cause of secondary pediatric hypertension, accounting for approximately 5-25% of cases. RAS may be caused by underlying vascular or genetic conditions such as fibromuscular hyperplasia, Takayasu arteritis, Williams syndrome or neurofibromatosis type 1. RAS often manifests as isolated hypertension and radiological diagnosis can be challenging due to the small calibre of the involved vessels, potentially down to the intrarenal interlobar arteries. Angioplasty is a safe and efficacious intervention for patients with refractory hypertension or significant adverse effects to medical treatment. The purpose of this educational exhibit is to review the advantages and disadvantages of various imaging modalities (ultrasound, CT, MRI and angiography) in the assessment of RAS. Imaging findings in RAS will be illustrated through case examples of various underlying etiologies. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Woon Tian Kai, Chong Clarisse, Fortier Marielle

Keywords: Renal Artery Stenosis, Hypertension

In congenital heart disease (CHD), CT cardiac angiography (CTCA) has an important role in surgical planning and evaluating post-surgical complications, complementing echocardiography and cardiac magnetic resonance imaging (cMRI). Its strengths are in its high spatial resolution, rapid acquisition, and excellent 3D reconstruction capabilities for visualization of complex vascular and intracardiac relationships. However, unless radiologists tailor reconstructions and reports to address the surgeons’ needs, its full potential is underutilized. To do this, radiologists need to be aware of at least broad strokes of cardiac pathophysiology, as well as modern surgical approaches and potential post-surgical complications, for the most common CHDs. This will ensure that the utility of CTCA reports transcend volumetric and vascular measurements, and instead, anticipate technical challenges, identify hidden hazards, shape surgical strategy and pick up specific post-surgical complications. We propose structured CTCA reporting framework for CHD centred on the needs of the surgeon, by prioritising specific information surgeons find most useful across various CHD conditions. The objectives of this poster are a) to review, by consensus with paediatric cardiac surgeons, the key imaging features in CTCA based on different CHD lesions. b) To propose a reporting checklist for CTCA that emphasizes those key features. c) To demonstrate application of this surgeon centric framework via illustrative cases, focusing on the tetralogy of Fallot, transposition of great arteries, total or partial anomalous pulmonary venous return, and coarctation of the aorta. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Bee Stella, Woon Tian Kai, Yap Kok Hooi, Fortier Marielle

Keywords: Cardiac CTA, Reporting, Congenital Heart Disease

Congenital extrahepatic portosystemic shunt (CEPS), also known as Abernethy malformation, is a rare congenital vascular abnormality in which portosplenomesenteric blood drains directly into the systemic venous system, thus bypassing the liver via an extrahepatic shunt. CEPS classification is based on the shunt anatomy and presence of an intrahepatic portal venous supply, which affects the form of definitive treatment available. Complications can arise due to the metabolic abnormalities and altered hemodynamics brought about by the shunt. Imaging plays a crucial role in the initial diagnosis and surgical planning, as well as the identification and monitoring of complications. The purpose of this educational exhibit is to review the CEPS embryological origins, classification system and complications through various case examples across different imaging modalities (ultrasound, CT, MRI and angiography). Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Woon Tian Kai, Bee Stella, Rasheed Shabana, Fortier Marielle

Keywords: Abernethy Malformation, Vascular Anomalies, Shunts

Midgut volvulus (MGV) is a surgical emergency with potentially devastating risks of short gut syndrome, sepsis, and death. Timely diagnosis prevents treatment delay. Although traditionally diagnosed with an upper gastrointestinal (UGI) series, ultrasound (US) offers a rapid, radiation-free alternative when performed by trained operators. As part of our institution’s transition to an “ultrasound-first” protocol for suspected malrotation/MGV, we designed and implemented a structured training program to enhance sonographer proficiency. This study presents the framework and preliminary outcomes of this training initiative. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Belmonte Joy, Yang Yin, Chew Lay Ee, Wong Lee, Fortier Marielle, Tan Timothy Shao Ern

Keywords: Ultrasound, Gastric Volvulus, Malrotation