Showing 4 Abstracts.
Recently JACHO proposed to address double scanning in pediatric chest CT, yet there are no data to determine whether this takes place; similarly, there is discussion regarding validity of sending pediatric patients to adult-focused practices for routine imaging by third party payors. Our purpose is to review the technical factors that impact upon radiation dose and image quality in CT scans of children referred from adult-focused practices to a children’s hospital, referenced to pre-Image Gently values. To our knowledge this is the first such review that includes body and neuro scans and extensive technique and exposure data Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Parikh Ashishkumar, Pruthi Sumit, Hernanz-schulman Marta
Keywords: ALARA, Image Gently, Radiation
Before the germinal matrix (GM) begins to recede at approximately 26 weeks gestational age (GA), it extends along the floor of the lateral ventricles far posterior to the thalamocaudate grooves. As extremely premature infants (EPIs) as young as 23 weeks GA survive with current advances in neonatology support, germinal matrix hemorrhage (GMH) can occur along these sites from which the GM has not yet involuted and should be recognized. Further, such Grade I posterior GMH may be mistakenly diagnosed as an intraparenchymal grade IV event, particularly on coronal US or other axial images, with parasagittal images demonstrating the correct diagnosis. The aim of this study is to document and describe this phenomenon, differentiate it from traditional GMH findings, and assess its prevalence in this population. Read More
Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020
Authors: Snyder Elizabeth, Pruthi Sumit, Hernanz-schulman Marta
Keywords: Ultrasound, Germinal Matrix Hemorrhage, prematurity
<b>Introduction</b> Scimitar syndrome and subdiaphragmatic total anomalous pulmonary venous connections (TAPVC) are congenital pulmonary vascular anomalies that are not typically diagnosed on routine abdominal sonography. We present three cases of ultrasound diagnosis of neonates with subdiaphragmatic pulmonary veins diagnosed on abdominal ultrasound; to the best of our knowledge, this is the first reported case of abdominal ultrasound diagnosis of previously unknown scimitar syndrome. <b>Case reports</b> Case 1: 16 day old girl born at term with cardiac dextroposition and right lung hypoplasia. On abdominal ultrasound, a large vascular structure was seen draining into the inferior vena cava (IVC) near the hepatic confluence, arising in lung above the diaphragm. Doppler confirms venous flow into the IVC (Figure 1); an arterial aortic branch with pulmonary spectral Doppler signature, extended into the base of the right lung. The diagnosis of scimitar syndrome was made, confirmed several weeks later with CT angiography. Case 2: One day old girl born at 29 weeks gestation had a prenatal diagnosis of complex congenital heart disease. Abdominal ultrasound demonstrated asplenia. As part of the complex, the examination demonstrated the common pulmonary vein draining into the left portal vein, decompressing into the heart via the ductus venosus, with color and spectral demonstration of flow direction and velocity. (Figure 2) Closure of the ductus venosus contributed to the demise of this child who was inoperable due to her extreme prematurity and her other congenital cardiac lesions. Case 3: Eight day old term infant with multiple congenital anomalies. An abdominal ultrasound for heterotaxy evaluation demonstrated a large anomalous vessel arising in the chest between the descending aorta and esophagus posteriorly, and the atrium anteriorly, descending into the abdomen draining into the portal vein, with a partially obstructing membrane near the insertion point. (Figure 3). The TAPVC was repaired on day 9 of life with direct anastomosis to the left atrium. <b>Conclusion</b>: In conclusion, subdiaphragmatic vascular components of thoracic anomalies should be recognized at abdominal sonography by pediatric radiologists, who may be the first to both recognize and diagnose these conditions. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Ndolo Josephine, Crane Gabriella, Hernanz-schulman Marta
Keywords: total anomalous pulmonary venous connection (TAPVC), Scimitar syndrome, ultrasound
<b>Introduction</b> Torsion or volvulus of upper abdominal viscera is rare and related to incomplete development and laxity of suspensory ligaments, or to poorly developed supernumerary accessory lobes. Clinical symptoms at presentation can be confusing and nonspecific, yet prompt recognition is essential to avoid life-threatening complications. Radiologists play an essential role in prompt recognition of these conditions. Our exhibit will review congenital anomalies of upper abdominal solid viscera that can lead to volvulus within an embryologic and anatomic framework. As examples, we include cases of mesenteroaxial gastric volvulus (Figure 1), torsion of an accessory hepatic lobe (Figure 2), and splenic torsion in the setting of polysplenia (Figure 3). Our cases include radiologic-pathologic correlations and therapeutic implications of solid visceral torsions. <b>Table of Contents/Outline:</b> Review of the embryology and anatomy of upper abdominal organs including a detailed pictorial of suspensory and anchoring ligaments. Review and examples of types of gastric volvulus and treatment. Review of variants of liver anatomy and of incidence and location of accessory hepatic lobes, with examples. Review of splenic anatomy and normal variants, splenic torsion and gross malformations including variants seen in heterotaxy, with review of treatment options in splenic torsion, including observation, surgical pexy or resection. Review of associated congenital anomalies (e.g. omphalocele, diaphragmatic hernia, and malrotation, etc.) Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Sundaram Karthik, Singh Sudha, Hernanz-schulman Marta