Showing 5 Abstracts.
Aspergillus species are ubiquitous environmental molds that healthy humans encounter daily without any adverse effects. However, these molds can cause a range of diseases in immunocompromised individuals, collectively known as invasive aspergillosis. These diseases can affect the sinuses, tracheobronchial tree, lungs, skin, or disseminate. The most common form of invasive aspergillosis is invasive pulmonary aspergillosis, which has high morbidity and mortality rates and requires prompt diagnosis and treatment. A severe form, known as angioinvasive pulmonary aspergillosis, occurs when mold hyphae invade the pulmonary arteries and cause necrosis and hemorrhage of the lung parenchyma. We present such a case in a 17-year old boy with acute myeloid leukemia who developed pulmonary pseudoaneurysms as a complication. The patient was initially admitted to the hospital for scheduled chemotherapy. Several complications occurred, including neutropenic fevers, cough, and pleuritic chest pain, despite broad-spectrum antibiotics. Initial imaging with CT pulmonary angiography showed multifocal nodules and masses with surrounding groundglass opacities. Serum aspergillosis galactomannan and Fungitell were strongly positive. Bronchoalveolar lavage was not performed due to profound anemia and thrombocytopenia. Initial treatment included dual-antifungal therapy with continued treatment upon discharge. Follow-up CT exams demonstrated complications with multiple pseudoaneurysms necessitating repeat hospitalizations, coil embolization, and lobectomy. This case demonstrates classic CT findings of angioinvasive pulmonary aspergillosis, including the "halo" and “air crescent” signs. In our case, the patient developed complications with pulmonary pseudoaneurysms that required multiple interventions. Prompt diagnosis and treatment of this condition is important due to the life-threatening implications. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Cristobal Alberto, Martinez-sicari Jorge, Vorona Gregory, Jones Kathryn, Austin Frances, Mahdi Eman
Keywords: Invasive aspergillosis, Pseudoaneurysm, Immunocompromised
Brain hypoxic-ischemic injury (HII) is a devastating injury that results in death or profound long-term neurologic disability in both children and adults. Treatment is mostly supportive, including hypothermia and administration of excitatory amino acid antagonists, with a limited window of effectiveness (as little as 6 hours), making early detection of injury critically important. Neuroimaging with Ultrasound, CT, and MRI has become increasingly valuable in the work-up of patients with HII. In this educational exhibit we will: a) review the pathophysiologic features and factors that influence the pattern of injury, b) discuss the specific imaging patterns in preterm and term neonates, c) review the imaging approach and highlight the role of advanced MRI techniques such as MR spectroscopy, DWI/ADC, and ASL perfusion in the evaluation process. Finally, we will briefly elaborate on the therapeutic hypothermia in HII, and the influence on imaging findings. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Aviado Randy, Clark Keaira, Mahdi Eman, Nada Ayman, Mishra Chakradhar, Jones Kathryn, Urbine Jacqueline, Vorona Gregory
Neuropathic arthropathy (Charcot arthropathy) can be a late manifestation of multiple disease processes that impair sensation and proprioception. The findings are commonly present in adults with diabetes and entities such as tertiary syphilis and syringomyelia. We present the rare manifestation of Charcot arthropathy of the hip in two pediatric patients with a history of spina bifida, myelomeningocele, and Chiari malformation. Through a case series, this presentation will review the image findings, treatment, and pathophysiology of neuropathic arthropathy in the pediatric population. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Jones Kathryn, Xie Katherine, Kuester Victoria, Woods Pace, Dao Vinh, Horstmann Joanna, Mahdi Eman, Mishra Chakradhar
Keywords: Charcot arthropathy, Spina Bifida, Myelomeningocele
The spectrum of imaging findings associated with intracranial germ cell tumors extends well beyond the typical suprasellar and/or pineal region masses. It is imperative that radiologists who interpret pediatric neuroimaging studies be familiar with the range of imaging findings associated with intracranial germ cell tumors, particularly as the appropriate suggestion of germ cell tumor as a diagnosis can have a significant impact on the initial surgical plan. In our case series we will review the typical imaging (CT and MRI) findings of both germinoma and nongerminomatous germ cell tumors, including metastasis and local invasion/extension. We will also review how intracranial germ cell tumors can be multifocal and how they can involve unusual areas such as the basal ganglia, cerebellum, and septal leaflets. MR spectroscopic findings associated with pediatric intracranial germ cell tumors will also be reviewed, including how these findings can be very helpful to differentiate from other similar-appearing pathologies. Finally, we will briefly discuss the treatment and prognosis of intracranial germ cell tumors. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Aviado Randy, Vorona Gregory, Tye Gary, Ritter Ann, Wang Zhihong, Mahdi Eman, Mishra Chakradhar, Jones Kathryn, Urbine Jacqueline
Keywords: Germ cell tumor, germinoma, teratoma
In our case series, we highlight the imaging findings of two patients with rare “neuroblastoma” tumors in which the diagnosis was not considered preoperatively, emphasizing the importance of pediatric radiologists being aware of these unusual etiologies for accurate diagnosis and management. A 17-year-old with blurry vision presented with progressive visual deterioration. MRI revealed a 5.5 cm mass in the inferior left frontal lobe, impacting the prechiasmatic optic nerve and optic chiasm. A CTA confirmed the lesion's encasement of the circle of Willis's left aspect. The patient underwent a craniotomy for tumor resection, revealing a primary CNS neuroblastoma FOXR2-activated, WHO grade 4. Another patient, a 13-year-old female, reported vomiting, abdominal pain, and diarrhea. The past medical history included Lyme disease and "cat scratch" fever. Severe hyponatremia was discovered, initially attributed to viral sequelae, necessitating prolonged hospitalization. An incidental nasal cavity/maxillary sinus "polyp" was identified and excised, diagnosed as olfactory neuroblastoma (Esthesioneuroblastoma), Hyam grade 3, Kadish stage 2. Post multiple surgeries and radiation, the hyponatremia, a result of SIADH, resolved with tumor treatment. Neuroblastomas, typically arising from the adrenal gland or retroperitoneum, are the most common extracranial solid pediatric tumors. They are usually sporadic, but sometimes associated with specific syndromes. Primary intracranial neuroblastomas are rare, with ambiguous classification and no distinct imaging characteristics or established adjuvant treatment protocols, contributing to high recurrence rates. CNS neuroblastomas more commonly affect the spine, with intracranial instances being rare but important differential diagnoses for pediatric brain tumors. Similarly, esthesioneuroblastomas, originating from olfactory neuroepithelial cells, are rare, constituting only 0.6% of all upper aerodigestive tract tumors. Ectopic cases are even rarer, with some inducing paraneoplastic syndromes like ectopic Cushing’s or SIADH. Particularly, esthesioneuroblastomas with SIADH-related euvolemic hyponatremia have a mere 2% prevalence and should be considered in atypical/refractory hyponatremia cases with incidental sinus masses. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Blundo Gianna, Jones Kathryn, Mishra Chakradhar, Vorona Gregory, Hinh Lylie, Mahdi Eman, Wang Zhihong, Tye Gary, Ritter Ann, Petersson Rajanya, Richard Hope, Al-samarraie Mohannad
Keywords: neuroblastoma, enthesioneuroblastoma