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

Hydatid cysts caused by larval infection with the tapeworm Echinococcus granulosus commonly affect the liver and lungs, although other organ systems may also be involved. Patients may be asymptomatic for years, presenting only when there is cystic rupture. We present the case of a 12-year-old male with no known prior medical history whose family immigrated from Afghanistan to the United States three years earlier. The patient arrived as a transfer to the emergency department (ED) with acute abdominal pain following blunt trauma. While playing soccer, he collided with another player, who landed on his abdomen. Upon arrival to the ED, he was febrile, tachycardic, and endorsed diffuse abdominal tenderness to palpation. He had no recent fevers, cough, congestion, nausea, vomiting, night sweats, or weight loss. He denied recent travel. Initial labs revealed mild leukocytosis with eosinophilia. Liver function tests and lipase were within normal limits. A contrast-enhanced abdominal-pelvic CT revealed a large, complex cystic structure centered in the right hepatic lobe, containing a peripheral membrane-like structure with evidence of internal hemorrhagic components extending into the peritoneum. Further interrogation with ultrasound confirmed the free-floating internal membrane, known as the “water lily” sign, which is highly specific for hydatid cysts. Using the World Health Organization classification, this was categorized as a CE 3A cyst. A follow-up MRI for drainage localization confirmed hemoperitoneum arising from the ruptured hydatid cyst, as well as peritoneal inflammation. We observed the expected MR features of a hydatid cyst with high T2 signal and low T2 internal debris, as well as overall low T1 mixed signal intensity. Ultrasound-guided percutaneous aspiration and alcohol ablation of the hepatic hydatid cyst was performed using catheter drainage. Fluid analysis demonstrated hooklets and protoscolices confirming the presence of Echinococcus spp. Morbidity and mortality related to echinococcosis is usually due to mass effect from enlarging cysts, which may result in organ disruption, or cyst rupture, potentially leading to anaphylaxis. This case highlights the incidental nature of hydatid cysts, which, although relatively easy to treat, often go undiagnosed until discovered by chance. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Martinez-sicari Jorge, Eller Madeline, Mahdi Eman, Elbich Jeff, Jones Kathryn, Mishra Chakradhar, Vorona Gregory

Keywords: Hydatid, Abdominal Trauma

Crohn’s disease is a common form of granulomatous inflammation affecting the gastrointestinal tract. Takayasu arteritis, a rare large-vessel vasculitis also known as pulseless disease, involves the inflammation, thickening, and narrowing of major arteries such as the aorta and its branches. There is evidence of a higher prevalence of Crohn's disease in patients with Takayasu arteritis, suggesting a potential link between these conditions. This case report highlights the presentation of Takayasu arteritis in a pediatric patient with Crohn’s disease, emphasizing the role of imaging in diagnosis. An 8-year-old female with a history of Crohn’s colitis was referred to nephrology for hypertensive emergency workup. Her blood pressure was recorded at 158/97 mmHg, prompting an echocardiogram that revealed elevated left ventricular (LV) mass, LV dilatation, eccentric hypertrophy, abnormal diastolic function, and moderate aortic insufficiency—all consistent with hypertensive emergency. A CT angiogram of the chest and abdomen with IV contrast identified infrarenal aortic stenosis, a retroperitoneal soft tissue encasing the stenotic segment, and thickening of the right common carotid artery. These findings were further validated by a Carotid Doppler ultrasound, which showed right common carotid artery wall thickening (0.41cm) with less than 50% stenosis, indicative of vasculitis consistent with Takayasu arteritis. Additionally, MRI revealed diffuse mural thickening, enhancement, and diffusion restriction of the abdominal aorta, with extension to the mesenteric, renal arteries, and left common iliac artery, confirming active arteritis. Laboratory results showed elevated inflammatory markers, including CRP (2.7), ESR (120), and IgG1 (1658). Normal IgG4 levels ruled out IgG4-related disease. The patient was started on amlodipine and atenolol for hypertension, along with solumedrol for vasculitis. Infliximab, azathioprine, aspirin, and Bactrim were also initiated for Crohn’s and vasculitis management. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Patel Shivani, Lecrone Natalie, Mahdi Eman, Vorona Gregory, Jones Kathryn, Mishra Chakradhar, Taha Khalid

Keywords: Crohn's Disease, Vasculitis, Takayusu

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

Keywords: Hypoxic, Brain, Neonate

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

Fanconi anemia (FA) is a rare genetic disorder characterized by impaired DNA repair, leading to bone marrow failure, physical abnormalities, and a heightened cancer risk. A severe neurological complication, Fanconi anemia neuroinflammatory syndrome (FANS), involves progressive neuroinflammation and brain lesions, resulting in cognitive and motor impairments. We present the case of a 12-year-old male with FANS and its neuroimaging findings over an 8-year period. The patient, with a history of stem cell transplant and graft-versus-host disease, initially presented with developmental delays at age 10, progressing to slurred speech and diplopia by age 12. Serial brain MRIs from 2016 to 2024 revealed the evolving features of FANS, but initially posed significant diagnostic challenges due to the rarity of this entity. Key imaging findings included multiple scattered foci of abnormal T2/FLAIR hyperintensity and enhancement throughout the brain, progressing to numerous ring-enhancing lesions with associated calcifications. Late-stage imaging showed large destructive lesions with significant mass effect, including a 3.6 cm rim-enhancing lesion causing 1.2 cm midline shift and ventricular entrapment. Early radiological differentials included infection, neurological manifestations of chronic graft-versus-host disease, cerebrovascular disease, and even aggressive brain tumors. Biopsy revealed necro-inflammation, with tumor analysis identifying a significant ESR1/CCDC170 gene variant. The clinical course was marked by relentless progression including cognitive decline, weakness, imbalance, and seizures. Multiple immunosuppressive therapies were attempted with limited success. This case emphasizes the importance of recognizing FANS imaging patterns, which progress from small enhancing lesions to large, destructive ones. The distinctive imaging features, combined with a history of Fanconi anemia, should prompt consideration of FANS in the differential diagnosis, even when other causes may seem more likely. Awareness of FANS as a complication in Fanconi anemia patients is crucial for timely diagnosis and management. Emphasis needs to be placed on researching effective treatments, as current options have limited success in halting progression. Recognizing FANS is essential to prevent unnecessary and harmful treatments for misdiagnosed conditions. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Martinez-sicari Jorge, Shahid Mehreen, Mahdi Eman, Canissario Ryan, Richard Hope, Sisler India, Jones Kathryn, Mishra Chakradhar, Vorona Gregory

Keywords: Genetics, Brain, Inflammation

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