Showing 3 Abstracts.
A 17-month-old female presented with a one-month history of abnormal soft tissue protruding from the vaginal introitus. The patient’s past medical history was significant for hemi-hypertrophy of the left lower extremity. Physical examination demonstrated normal external genitalia, with pink solid tissue protruding from the vagina posterior aspect, and mild associated white fluid discharge. Laboratory analysis revelaed a normal CBC, serum HCG and AFP. An ultrasound examination of the pelvis demonstrated a heterogeneous echogenicity soft tissue mass with scant internal vascularity centered in the vagina and cervix, measuring approximately 4.0 x 2.3 x 2.5 cm. The patient’s clinical and imaging findings were most concerning for malignancy, namely vaginal rhabdomyosarcoma, so consultation was requested from Pediatric Surgery and Oncology. As a result of these consultations, the patient was scheduled for vaginoscopy with biopsy under general anesthesia, as well as surgical port placement due to the high suspicion for malignancy. Also to be performed under the same anesthetic was a CT examination of the chest and MR examination of the pelvis. Vaginoscopy revealed a “pebbly appearance” of the vaginal walls, which also reportedly “felt thickened” on digital exam. Multiple surgical biopsy specimens were obtained from the visibly abnormal areas. MR examination immediately post biopsy showed circumferential mural thickening of the cervix and vagina, with a more prominent area of soft tissue thickening at the level of the vaginal introitus. The areas of mural thickening appeared T1 and T2 signal isointense with mild post-contrast enhancement and no evidence of abnormal restricted diffusion. No focal mass was identified. CT examination of the chest was normal. Histopathologic analysis revealed a benign lesion composed of a relatively small number of spindle cells embedded in a loose fibrous stroma. No significant numbers of mitoses or atypia were observed, including in the lining squamous epithelium. These features were most consistent with a fibroepithelial stromal polyp. In light of the pathology findings, the port implant was removed, and the patient has since undergone surveillance vaginoscopy examinations. This case illustrates MRI findings of a rare benign condition which may mimic vaginal rhabdomyosarcoma on the basis of clinical and ultrasound findings. MRI demonstrating an absence of aggressive features may help to suggest this rare differential consideration. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Green Jared, Jaju Alok, Richard Jamie
Aneurysmal bone cysts are benign expansile osseous lesions which may behave locally aggressively, leading to growth plate destruction, angular deformity, and pathologic fracture. Current treatments such as curettage and bone graft reconstruction, sclerosis, and intra-arterial embolization have high recurrence rates and morbidity. Percutaneous cryoablation is a promising new treatment modality. Three patients with ABCs underwent cryoablation at our institution and follow-up MRIs over the span of a year were obtained. This is the first study of its kind to elucidate the imaging findings post-cryoablation of ABCs, which may help the radiologist interpret response to treatment. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Weber Jonathon, Samet Jonathan, Green Jared, Donaldson James, Rajeswaran Shankar
Keywords: Cryoablation, ABC, Aneurysmal Bone Cyst
Biliary stenosis continues to be an important source of morbidity in pediatric liver transplantation. Percutaneous transhepatic cholangiography (PTC) with cholangioplasty and placement of an internal/external biliary drainage catheter has been the standard of care for biliary stenosis at our institution for over twenty years. The purpose of this article is to present the largest and most comprehensive pediatric series to date detailing the percutaneous management of liver transplants complicated by biliary stenosis. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Qiu Cecil, Donaldson James, Rajeswaran Shankar, Kim Stanley, Superina Riccardo, Mohammad Saeed, Whitehead Bridget, Green Jared
Keywords: Liver transplant, PTC, Biliary stenosis