Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees. We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance. Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup. Read More

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

Authors: Eliades Sarah, Pomeranz Christy, Baad Michael, Roytman Michelle, Kovanlikaya Arzu

Keywords: Soft tissue mass, Ultrasound, Superficial

Congenital portosystemic shunts represent a rare congenital malformation which diverts portal blood to the systemic circulatory system. These malformations can either be intrahepatic or extrahepatic. The intrahepatic portosystemic shunts have been classified into four types. Intrahepatic congenital portosystemic shunts demonstrates a persistent communication between the portal and hepatic venous structures, which were derived from the embryonic vitelline veins or between the vitelline and subcardinal veins. A ductus venosus, a normal structure in neonates, represents an intrahepatic congenital portosystemic shunt between the left portal vein and left hepatic vein. It typically closes between 2-17 days of postnatal life. In our institution, since April 2020, there have been five separate cases of intrahepatic congenital portosystemic shunts in newborns. We will review the imaging for each of these cases, as well as review the current literature and classification of portosystemic shunts. Read More

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

Authors: Collins Lee, Pomeranz Christy, Cohen Sara, Baad Michael, Kovanlikaya Arzu

Keywords: Portosystem Shunt, Liver, Ultrasound

Langerhans cell histiocytosis (LCH) is rare in the neonatal period and has a different distribution of disease and prognosis compared to older cohorts, requiring extensive imaging evaluation and familiarity of the radiologist with potential sites of involvement. Treatment and prognosis is dependent on accurate pretreatment evaluation. In this educational poster, we first describe histiocystic disorders, the current and prior classification schema, and the role of imaging in pretreatment evaluation of LCH. Utiliziing cases at our institution, we explore the imaging findings in neonatal LCH organized by organ system and the role of imaging in risk organ identification. We discuss the affect on treatment and prognosis, and the differences in imaging and prognosis between neonatal presentation and other age groups. Finally, we review current guidelines for posttreatment imaging follow up. Read More

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

Authors: Kennedy Patrick, Baad Michael, Kovanlikaya Arzu, Cohen Sara, Collins Lee, Pomeranz Christy

Keywords: Neonatal, lymphoproliferative, neoplasia

A palpable finding along the chest wall is a frequent indication for pediatric ultrasound. Accurate identification of benign lesions can reassure families and appropriately triage patients who need follow-up, cross sectional imaging, or biopsy. The purpose of this exhibit is to review chest wall anatomy, illustrate ultrasound techniques, and discuss key ultrasound imaging features of common benign lesions and normal variants. Cases will include but are not limited to: accessory breast tissue, gynecomastia, sternalis muscle, angulated costal cartilage, rib fracture, chondral injury, ganglion cyst arising from the sternoclavicular joint, osteochondroma, neurofibroma, lipoma, myofibroma, pilomatrixoma, dermoid and epidermoid cysts, fibrous hamartoma of infancy, hemangioma, lymphatic malformation, and abscess. Each case will include the clinical presentation of the patient, classic ultrasound imaging features, and subsequent management. Read More

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

Authors: Colucci Philip, Cohen Sara, Baad Michael, Pomeranz Christy, Collins Lee, Kovanlikaya Arzu

Keywords: chest wall, ultrasound, pediatric

Congenital urethral polyps are a rare benign fibroepithelial lesion, typically arising from the verumontanum. We present a case of a 2 day old neonate undergoing renal ultrasound for follow up of prenatally diagnosed urinary tract dilation. Ultrasound demonstrated severe bilateral central and peripheral caliyectasis with parenchymal thinning, bilateral distal ureterectasis and marked bladder wall thickening. An echogenic soft tissue nodule was visualized at the bladder outlet. Subsequent VCUG showed a rounded filling defect intermittently located in the posterior urethra and bladder neck, suspicious for a diving mobile polyp. Transurethral resection of the polyp was performed. This case highlights an unusual cause of bladder outlet obstruction in neonates which can mimic the presentation and imaging appearance of posterior urethral valves. Read More

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

Authors: Collins Lee, Cohen Sara, Pomeranz Christy, Jarrett Delma, Baad Michael, Akhavan Ardavan, Kovanlikaya Arzu

Keywords: congenital urethral polyp, urinary tract dilation