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Society for Pediatric Radiology – Poster Archive

Devasenathipathy Kandasamy

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Showing 4 Abstracts.

Introduction Hepatic visceral larva migrans (VLM) is an increasingly recognized parasitic manifestation wherein migratory nematode larvae get lodged in hepatic parenchyma leading to inflammatory granuloma or abscess formation. In this report, we describe a case of VLM presenting with upper gastrointestinal (GI) bleed secondary to a rare complication, a hepatic artery pseudoaneurysm. On literature search, only one such case is reported. Case Report A 13-year-old girl presented with abdominal pain and progressively increasing jaundice for the last 2 weeks. The patient had multiple episodes of hematemesis and melaena requiring 2 units of blood transfusion during this time. Ultrasound (USG) abdomen showed multiple ill-defined hyperechoic lesions in the right lobe of liver with presence of anechoic cystic areas within. A dual phase Computed Tomography (CT) scan of the abdomen revealed multiple confluent and discrete hypodense lesions in the right lobe of liver more apparent on portal venous phase, along with presence of a 1.5 cm pseudoaneurysm arising from posterior branch of right hepatic artery. A differential diagnosis of pyogenic liver abscesses, hepatic VLM, disseminated tuberculosis and immunodeficiency with invasive fungal infection was kept along with hepatic artery pseudoaneurysm leading to hemobilia. Lab investigations revealed peripheral eosinophilia (54%) and raised serum IgE (1600 IU/mL). Hydatid serology was negative. Based on these findings, a diagnosis of hepatic VLM was made and the patient was started on Albendazole (400 mg BD). The patient underwent Digital Subtraction Angiography and managed with successful embolization of the pseudoaneurysm using microcoils. There was significant improvement in jaundice and no recurrence of hematemesis over the next ten days along with rapid drop in peripheral eosinophilia. The patient subsequently remained asymptomatic over a follow-up period of 18 months. The inflammation caused by cytotoxic eosinophil-derived proteins associated with helminthic parasites may lead to vascular complications. Conclusion Hepatic VLM can be rarely associated with hepatic artery pseudoaneurysm presenting in the form of acute upper GI bleed in the background of progressive abdominal symptoms secondary to hepatic lesions. Prompt diagnosis and management with percutaneous angio-embolization for the aneurysm and anti-helminthic therapy for the underlying parasitic infestation is of paramount importance for a good clinical outcome. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Gupta Amit, Naranje Priyanka, Kandasamy Devasenathipathy, Jana Manisha

Keywords: Visceral larva migrans, Pseudoaneurysm, GI bleed

Children with ambiguous genitalia form a major subset of children with Disorders of sexual differentiation (DSD). Genital ambiguity invariably results in significant parental anxiety and social issues. Management requires involvement of multiple medical specialties. Accurate delineation of anatomy on imaging is a very important step in clinical decision making. The imaging tools consist of conventional genitogram, pelvic ultrasound and magnetic resonance imaging (MRI). Drawback of MRI lies in the lengthy acquisition process; whereas conventional fluoroscopic genitogram is an invasive procedure, and bears the hazards of ionizing radiation. Pelvic ultrasound is good for visualization of the gonads, and internal genital organs. However, the details of lower genital tract anatomy can not be well evaluated in a pelvic ultrasound. Trans-Perineal ultrasound (TPUS) is a technique where high resolution transducers are placed on the perineum of the child; and detailed imaging of the lower genital tract and anorectum can be performed. It has the advantages of easy availability and portability, lack of radiation exposure and avoidance of general anesthesia/ sedation. This educational exhibit will describe normal male and female lower genital tract anatomy. Various anomalies, namely, urogenital sinus, hypospadias, hypertrophied clitoris, aphallia, will be described. Technique and pitfalls will also be discussed. Normal ossification of the pubic symphysis is variable, depending on the age of the child. Selection of suitable acoustic windows in subpubic and perineal positioning of transducers is crucial. Performed by trained radiologist, TPUS can be useful adjunct imaging modality, both useful and acceptable. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Jana Manisha, Jain Rupali, Gupta Amit, Kandasamy Devasenathipathy

Keywords: DSD, Ultrasound

Chest radiograph (CXR) is a valuable tool, especially in children owing to its low cost, availability, portability and easy disinfection along with less radiation as compared to Computed Tomography (CT). In this study, we evaluate the spectrum of CXR findings and patterns in pediatric COVID-19 patients. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Gupta Amit, Bansal Abhinav, Naranje Priyanka, Jana Manisha, Bhalla Ashu, Kabra Sushil, Kandasamy Devasenathipathy

Keywords: COVID, Radiograph

Brachial plexus is a relatively common site of pediatric nerve pathology. This study was aimed at evaluation of utility of MRI and USG in the localization of brachial plexus injury in infants Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Ramachandran Anupama, Pandey R M, Jana Manisha, Kumar Atin, Kandasamy Devasenathipathy, Naranje Priyanka, Gupta Arun, Gulati Sheffali, Chakrabarty Biswaroop, Singhal Maneesh

Keywords: Brachial, Plexus, Infantile