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Society for Pediatric Radiology – Poster Archive

Boaz Karmazyn

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Showing 18 Abstracts.

Thymic Pathology and Mimickers of Pathology in Children

The Thymus appears in a variety of sizes and shapes, and may even change in size as a response to disease process in the same patient. These underlying variations, as well as ectopic or accessory tissue, can mimic pathology and may become a source of confusion resulting in anxiety, unwarranted imaging, unnecessary biopsy, chemoradiation or even surgery. Read More

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

Authors: Osman Radya, Karmazyn Boaz

Keywords: Thymus, Ectopic thymic tissue, Thymic pathology

Chest CT in the Evaluation of Child Abuse

The aim of this exhibit is to familiarize the radiologist with low dose chest CT technique, articulate advantages of CT in detection of fractures that are occult or indeterminate on skeletal surveys, as well as discuss the limitations of chest CT. Radiologists play a central role in the detection of non-accidental trauma. After bruising and soft tissue trauma, fractures are the most common inflicted injuries seen in children. Rib fractures are one of the most common fractures identified on skeletal surveys and are one of the most specific injuries in child abuse. Chest CT has been shown to increase detection of rib fractures in child abuse and postmortem studies. In addition, new techniques such as the use of tin filter allow performance of very low dose chest CT. This has led some to advocate for increased utilization of chest CT, as head CT and abdominal CT have already well-established indications for evaluation of child abuse. Chest CT can be considered in children with negative skeletal survey and high clinical suspicion for child abuse, when the diagnosis of rib fractures is indeterminate, and when the finding of additional or more specific fractures may aid in management, such as in children with both anterolateral fractures and recent cardiopulmonary resuscitation. Chest CT has some limitations. Uncommonly CT can miss acute nondisplaced fractures demonstrated on radiographs due to lower spatial resolution. In addition, developmental variations in the costochondral junction (CCJ) can mimic healed fractures in CT. We will provide the protocol we use for low dose chest CT technique and discuss the value of axial oblique and 3-D reconstructions in detection of rib fractures. We will show examples of fractures seen on chest CT which are occult or indeterminate on radiography, such as buckle fractures or fractures in challenging locations such as the CCJ. We will further discuss the strengths of CT in the evaluation of other thoracic injuries of abuse including fractures of the sternum, scapula, and vertebral bodies. Cases of fractures found on post-mortem imaging will be included. Finally, we will also show cases demonstrating the utility of CT in identifying false positives and normal variants that may mimic fractures on radiographs. Read More

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

Authors: Mcluckey Morgan, Karmazyn Boaz, Marine Megan

Keywords: Nonaccidental Trauma, Thoracic

Management of Incidental Liver Lesions in Children: Considerations and a Suggested Approach

Management of incidentally discovered pediatric liver lesions can be challenging. As compared with adults, no formal guidelines exist on this subject. Our purpose is to suggest an approach to the management of incidental pediatric liver lesions based on review of the literature and our institutional multidisciplinary experience. Outline: - Main considerations when evaluating incidental liver lesions in children (including age, alpha fetoprotein level, lesion size, imaging characteristics differentiating benign and malignant tumors, role of contrast-enhanced US, role of hepatobiliary contrast MRI) - Suggested approach to the management of incidental liver lesions detected by US, CT, and MRI - Examples of common incidental liver lesions (cyst, hemangioma, focal nodular hyperplasia, hepatocellular adenoma, focal fatty infiltration and sparing) Read More

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

Authors: Chilukuri Sanjeev, Molleston Jean, Karmazyn Boaz

Keywords: Incidental, Liver, Lesion

Radiologic Evaluation of Costochondral Junction Fractures in Pediatric Patients and the Association with Non-Accidental Trauma

This study aimed to elucidate the imaging appearance of costochondral junction (CCJ) fractures in young children, determine the association with nonaccidental trauma (NAT), and suggest a mechanism for injury. Read More

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

Authors: Gensel Anna, Karmazyn Boaz, Forbes-amrhein Monica

Keywords: Child Abuse, CCJ fracture, NAT

The Unique Patterns of Classic Metaphyseal Lesion Healing

The Classic Metaphyseal Lesion (CML) is one of the most specific findings on skeletal surveys indicating child abuse. While there have been multiple studies to show the prevalence and specificity of the CML, very little has been published on the characteristic healing patterns. The child protective team in our tertiary children’s hospital reviews approximately 6,000 cases from all over the state every year. Many children with a positive skeletal survey will undergo a 14-day follow up survey. The purpose of this study is to share our experience on patterns of CML healing by comparing the primary survey with its follow up. We have identified a few distinct patterns: Bone formation and sclerosis along the proximal metaphyseal zone, angular deformity of the metaphyseal corner, and subchondral metaphyseal lucencies. These patterns are represented by the accompanying supplemental figures and are described below. <b>Figure 1 </b>is the 14-day follow up radiograph of an acute distal tibial CML diagnosed on the primary skeletal survey. This radiograph reveals increased sclerosis along the entire length of the metaphyseal zone, a common pattern of CML healing. <b>Figure 2</b> is 14-day follow up of a different patient who sustained a CML of the distal tibia. Healing in this case is denoted by the angular deformity and periosteal reaction along the metaphyseal corner. <b>Figure 3</b> is a radiograph of the left wrist from a patient’s primary skeletal survey. The subchondral lucency identified along the lateral metaphysis is another common pattern indicative of a healing CML. Interestingly, the 14-day follow up skeletal survey of this patient demonstrated complete resolution of this finding with no signs of prior injury. In several other cases, the metaphysis on follow up exam appeared completely normal. In summary, knowledge of the radiographic patterns of CML healing can help to identify these lesions as their classic imaging characteristics change. It is also important to recognize that if the first radiograph demonstrates CML, a normal 14-day follow up radiograph does not exclude the diagnosis. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Shields Jared, Marine Megan, Karmazyn Boaz

Keywords: CML, Child Abuse

Do we need to differentiate between different types of intestinal rotational abnormalities in asymptomatic children?

Intestinal rotation abnormality (IRA) can lead to catastrophic events from midgut volvulus. In a child that presents with bilious vomiting, urgent surgery should be performed. Ladd’s surgery is associated with complications in 10% to 20% of the patients. In this review we will show that in selected asymptomatic children with IRA, imaging can help decide if observation should be considered rather than surgery. Read More

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

Authors: Karmazyn Boaz, Marine Megan, Wanner Matthew, Billmire Deborah

Keywords: Malrotation, Nonrotation, Atypical malrotation

Neonatal bowel obstruction in Cystic Fibrosis: Findings, Pitfalls and Mimickers

To summarize our experience in diagnosis neonatal bowel obstruction in cystic fibrosis (CF) patient using contrast enema study. This pictorial review will illustrate and discuss several aspects of imaging findings in non-complicated and complicated meconium ileus as well as the mimicker. Key imaging findings, pearls and pitfalls in diagnosis and guided treatment will be made, emphasizing what radiologists need to know. Correlation with intraoperative findings and follow-up images will also be provided.<b> </b> Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Supakul Nucharin, Wanner Matthew, Marine Megan, Karmazyn Boaz

Keywords: microcolon, cystic fibrosis, delayed pass meconium

Can ultrasound differentiate between right diaphragmatic hernia and eventration?

Radiographic findings of right diaphragmatic eventration may overlap with true hernia if only liver herniates without bowel. We thus wanted to know the accuracy of ultrasonography (US) in the diagnosis of right diaphragmatic hernia. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Schold Andrew, Marine Megan, Brown Brandon, Gray Brian, Karmazyn Boaz

Keywords: Diaphragm, Hernia, Ultrasound

Role of Imaging in Management of Pediatric Testicular Tumors

Testicular tumors in children often pose diagnostic challenges. There is a bimodal age distribution and the pathology encountered is age-related. The purpose of this exhibit is to familiarize pediatric radiologists with the types of testicular tumors, the different incidence of malignant tumors among age groups, as well as benign lesions with specific characteristics on ultrasound that do not require surgery. In addition, we will discuss special situations related to specific syndromes such as Peutz-Jeghers and androgen insensitivity syndromes. We will discuss the role of imaging in guiding patient management. 1. Overview of pediatric testicular tumor types by age a. Early childhood, pre-pubertal, pubertal b. Incidence of malignant tumors in each age group 2. Imaging and lab workup of testicular tumors a. US Imaging characteristics of various tumors b. Potential role for contrast enhanced US c. Lab workups d. Indications for abdominal and pelvic CT scans e. Follow up after tumor resection 3. Lesions with specific US characteristics that do not require surgery a. Congenital Adrenal Rests b. Rete testis c. Intratesticular varicose veins 4. Management options a. Radical orchiectomy b. Testicular sparing/Enucleation c. Follow-up 5. Special situations a. Syndromes b. Microlithiasis Read More

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

Authors: Chen Paula, Marine Megan, Misseri Rosalia, Kaefer Martin, Karmazyn Boaz

Keywords: Testicular tumors, Ultrasound

Hide and Seek with Bronchopulmonary Sequestrations: A Longitudinal Perspective

Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the lower airway resulting in a mass of nonfunctional lung tissue. Our purpose is to present the prenatal and postnatal imaging findings of a spectrum of BPS cases and to correlate with pathology findings. We present a series of BPS evaluated with prenatal imaging (US and MRI) and postnatal imaging (radiographs, US, CT, and MRI). Pathology will be reviewed. Our series includes isolated BPS, hybrid BPS associated with cystic pulmonary airway malformation (CPAM), BPS associated with diaphragmatic hernia, and challenging cases of intradiaphragmatic, subdiaphragmatic, and mediastinal sequestrations that can mimic other masses. We also include a case of sequestration with an associated communication to the GI tract (bronchopulmonary foregut malformation) and a case of isolated BPS that spontaneously involutes over time. Read More

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

Authors: Chilukuri Sanjeev, Karmazyn Boaz, Wanner Matthew, Brown Brandon, Gray Brian, Marine Megan

Keywords: Sequestration, Fetal, Bronchopulmonary

Multimodality Diagnosis of Spinal Fractures in Child Abuse

The purpose of this poster is to review the imaging findings of spinal fractures in children evaluated for child abuse on radiography, CT, and MRI, and differentiate fractures from vertebral body variations. Read More

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

Authors: Steinhardt Nicole, Marine Megan, Supakol Nucharin, Radhakrishnan Rupa, Lahiri Niloy, Jennings Greg, Thompson Shannon, Karmazyn Boaz

Keywords: Child abuse, spinal fractures, Vertebral variations

Parathyroid Carcinoma: A Rare Cause of Pediatric Primary Hyperparathyroidism

An 18-year-old male initially presented to an outside hospital with acute knee pain after playing sports. MRI of the left knee demonstrated acute complete rupture of the patellar tendon and incomplete rupture of the quadriceps tendon with multiple T1 hypointense, T2 heterogenous well defined osseous lesions in the distal femur, proximal tibia, and fibula. These lesions were concerning for malignancy, so the patient was referred to orthopedic oncology at our institution. Read More

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

Authors: Lipman Monali, Imel Erik, Ackah Sarah, Chen Diane, Hunter Cynthia, Wurtz Lawrence, Zevin Erika, Karmazyn Boaz

Keywords: parathyroid carcinoma, brown tumor, hypercalcemia

Ascent of the conus medullaris level in infants less than 3 months old with borderline or low position of the conus.

Evaluate temporal change in position of the tip of the conus medullaris in infants with borderline or low position of the conus on initial spine ultrasound (US) performed at less than 3 months of age. Read More

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

Authors: Osman Radya, Karmazyn Boaz, Marine Megan, Wanner Matthew, Radhakrishnan Rupa, Supakul Nucharin, Ducis Katrina, Jennings Samuel, Jea Andrew

Keywords: Tethered cord, Ultrasound, MRI