Pediatric and childbirth-related traumatic head injuries (THI) are frequent and responsible for a high rate of hospital admissions, in addition to significant rates of morbidity and mortality. Children under one year of age are at greater risk of skull fractures with intracranial complications The radiologist plays a fundamental role in identifying and characterizing these injuries using the imaging methods available in emergency care. Transfontanellar or cranial ultrasound is the method of choice for the initial evaluation of THI in babies with an open fontanel, as it is free from ionizing radiation, very useful due to its portability, allowing the patient to be evaluated at the bedside with diagnosis in real time. The objectives of this work is to propose a flowchart to guide imaging assessment and management in these pediatric and childbirth-related THI based on 248 patients (babies and children under 2 years of age) seen in our pediatric emergency service in the period from 2010 to 2022, who presented with THI, focusing on the role of ultrasound as an initial diagnostic tool. As teaching points, we will address the ultrasound assessment of different types of extra and intracranial hemorrhages, showing the techniques and main images and the main pitfalls. Read More

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

Authors: Sameshima Yoshino, Gual Fabiana

Keywords: pediatric head trauma, ultrasound, childbirth-related traumatic head injuries

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

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

Authors: Gual Fabiana, Lima Natalia, Matsuoka Marcia, Sameshima Yoshino

Keywords: vascular anomalies, hemangioma, vascular malformations

Ultrasound is a valuable tool for evaluating lymph nodes in the context of an inflammatory response. Lymph nodes are crucial in the body's immune system, and changes in their size, shape, and echogenicity can provide valuable information about the underlying pathology. What is expected in the inflammatory response is the maintenance of its typical characteristics such as dimension, fatty hilum, thin cortex and hilar flow, however, some pathologies may present atypical lymph node enlargement. These findings are not considered pathognomonic manifestations but they can give us very important tips to direct us to the correct diagnosis as we describe in our case series: 1. Cat-scratch disease: male patient, 10-year-old, with painful epitrochlear, cervical and axillary lymph nodes for 3 months. Ultrasound (US) showed enlarged hypoechogenic lymph nodes (local lymph nodes in the same region as the cat scratch). Serological test confirmed cat scratch disease diagnosis. 2. Bacille Calmette–Guérin lymphadenitis: male patient, 7-months-old, with post vaccination right axillary lymphadenopathy. US revealed right enlarged axillary lymph node, hypoechogenic, containing tiny hyperechoic foci. 3. Lymphomatous lymph nodes: male patient, 17 years old, with painless cervical node for 4 months. US showed enlarged, heterogeneous lymph node, with loss of fatty hilum and well-defined walls, with typical findings by color Doppler study, as we will show. Immunophenotyping: non-Hodgkin's lymphoma. 4. Streptococcus Lymphadenitis: 6-year-old female patient with cervical lymph nodes. US showed Streptococcus lymphadenitis common findings: enlarged hypoechoic lymph nodes, oval-shaped, with thick capsule and hyperechogenicity of adjacent tissue. Increased central and peripheral blood flow by color Doppler. Swab test confirmed Streptococcus. 5. Thyroid tumor metastasis: 17-year-old male patient with a palpable cervical nodule. US showed a solid hypoechoic thyroid nodule and local lymph node with calcifications. Biopsy confirmed papillary thyroid carcinoma with secondary involvement of lymph node. Learning points: 1. Anatomical review of the cervical lymph node chains by ultrasound. 2. Learn typical sonographic features of atypical lymph nodes; 3. Value the importance of correlation of imaging findings with clinical data, tests and biopsy; 4. Assess the pediatric cases from our pediatric radiology group that will be useful for your future atypical cases. Read More

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

Authors: Carvalho Yago, Sameshima Yoshino, Lima Natalia, Gual Fabiana

Keywords: atypical lymph nodes, ultrasound evaluation

Girls with congenital adrenal hyperplasia can present with a wide variety of urogenital malformations. Understanding these malformations and the anatomical relations between the pelvic structures is paramount for surgical planning. Imaging of these patients can be done by various methods such as genitography, magnetic resonance or endoscopy. More recently some authors have begun to propose perineal ultrasound as an alternative for imaging of these patients for pre-operative planning. In this educational poster we will use perineal ultrasound images and detailed illustrations to: 1) Review the spectrum of genital and lower urinary tract malformations related to congenital adrenal hyperplasia in girls. 2) Explain the transperineal ultrasound technique and normal anatomy. 3) Explain the transperineal ultrasound findings and utility in girls with congenital adrenal hyperplasia. Contents: Normal anatomy Pathologic changes in congenital adrenal hyperplasia Review of what is relevant to the referring surgeon. Ultrasound technique Ultrasound findings in normal patients Ultrasound findings in congenital adrenal hyperplasia. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Takahashi Marcelo, Moreira Marcia, Motta Giovanna, Gual Fabiana, Soares Juliana, Davaus Taisa

Keywords: congenital adrenal hyperplasia, ultrasound, perineum

Ultrasonography is a very powerful non-invasive diagnostic tool widely employed for examining multiple organs and systems located both superficially and deeply. This is possible thanks to a wide range of transducers that work on different frequencies and sound lengths to explore all layers of anatomical structures. Nowadays, the reduction of exposure to ionizing radiation in children is advocated by the “as low as reasonably achievable” (ALARA) principle, and therefore, ultrasound (US) has become the main investigation tool in many assessments of lung pediatric disorders. The purpose of this educational exhibit is to describe the normal artefacts produced by LUS in a healthy lung to distinguish them from pathologic patterns and the application of LUS in pediatric diseases and procedures (ultrasound-Guided Lung Recruitment). Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Gual Fabiana, Sameshima Yoshino, Otto Debora, Braga Fernanda, Cardoso Mariana, Fernandes-ferreira Rafael, Souza Antonio

Keywords: Ultrasonography, Lung Diseases, ALARA

The purposes of this exhibit are: - review the peculiarities of the immature skeleton; - illustrate the bone fractures that are exclusively found in children; - alert to the imaging findings that should raise the suspicion to non-accidental traumas. Read More

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

Authors: Karam Izabel, Yamachira Viviane, Silva Camila, De Paula Vitor, Urbanetz Almir Antonio, Gual Fabiana, Takahashi Marcelo, Santos Durval, Rosemberg Laercio Alberto, Sameshima Yoshino, Francelino Rebeca, Kuhn Gabriel, Moura Fe Taila, Yoshimura Fabio, Castro Adham, Baptista Eduardo, Grando Paulo Eduardo, Nagaya Erina

Keywords: Fractures