A 10-year-old female with neurofibromatosis type 1 and severe dysplastic scoliosis, presented with a two-month history of difficulty ambulating due to lower back pain. The patient did not have neurological symptoms. An MRI of the thoracolumbar spine demonstrated subluxation of the right tenth and eleventh ribs through the neural foramina, causing mass effect on the thecal sac, but at T9-T10 without abnormal cord signal or cord compression. Several clusters of neurofibromas were present along the right ribs and paravertebral soft tissues at these levels. CT evaluation was performed for greater osseous definition, which confirmed the findings. The patient underwent complex posterior spine fusion and segmental spinal instrumentation, which included T9-T10 thoracoplasty, rib resections, and multiple Ponte osteotomies. Cases of rib head protrusion into the central canal in the setting of dystrophic scoliosis have been documented in only a limited sample of case reports. The angulated short-segment curvature in dystrophic scoliosis causes vertebral body rotation, foraminal enlargement, spindling of transverse process, and penciling of the apical ribs. These changes can alter the articulation of the rib along the spinous process. The enlarged foramina also create a space into which a rib may displace. As a result, in most reported cases, the subluxed ribs were on the convex apex of the curve in the mid-to-lower thoracic region. The risk of cord injury makes complete depiction of the anatomy crucial for surgical management. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chen Alan, Kucera Jennifer

Keywords: rib head protrusion, dystrophic scoliosis, spine

Atretic cephalocele is a rare type of neural tube defect that occurs in the parietal or occipital scalp. Most cases present postnatally with a scalp nodule which may also have associated skin and hair abnormalities. We will present a case of atretic cephalocele diagnosed with fetal MRI as well as two additional cases of postnatally diagnosed atretic cephalocele in different patients. A 26 week gestational age male fetus was found to have ventriculomegaly on routine OB ultrasound and was referred to maternal fetal medicine. Further ultrasound imaging demonstrated features suspicious for a posterior fossa encephalocele. A fetal MRI was then performed which demonstrated imaging findings consistent with an atretic cephalocele. The imaging findings associated with atretic cephalocele including embryologic positioning of the straight sinus, the “spinning top” appearance of the tentorial incisura, and the “cigar shaped” CSF tract in the interhemispheric fissure will be illustrated in the exhibit using both fetal and postnatal MRI. Although the exact embryological development of atretic cephaloceles is not completely understood, the proposed mechanisms will be discussed. A brief summary of the associated syndromes and clinical outcomes reported in the literature will be presented. Atretic cephalocele is a rare condition that is usually diagnosed postnatally with several characteristic imaging findings. These same abnormalities can also be seen on fetal MRI which can lead to an earlier diagnosis and more appropriate family counseling. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Lewis Heidi, Kucera Jennifer

Keywords: atretic cephalocele, Fetal MRI

Congenital chest lesions encompass a wide array of pathology with overlapping imaging characteristics. With prenatal ultrasound and MRI, more congenital chest lesions are being detected sooner, and it is important for radiologists to be familiar with their imaging findings for both diagnostic and prognostic purposes. This educational exhibit reviews the spectrum of pediatric congenital chest lesions and their key imaging findings. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Funaro Kimberly, Kucera Jennifer

Keywords: Chest, Congenital malformations

The pediatric orbit presents a wide spectrum of possible abnormalities which differ significantly from those seen in adults. Evaluation of the various pediatric orbital abnormalities depends on radiologic assessment with different imaging techniques to aid in diagnosis. The purpose of this exhibit is to describe and differentiate the more commonly encountered pediatric orbital abnormalities using a multimodality approach. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Lewis Heidi, Kucera Jennifer

Keywords: Orbit, Neuroradiology, Head and Neck

The fishtail deformity of the distal humerus is a rare entity that most often develops as late sequela of a pediatric elbow fracture. The observed morphologic changes that define this diagnosis have been attributed to vascular compromise of the lateral trochlea and subsequent resorption or failure of development of the trochlear ossification center (dependent upon the skeletal maturity of the patient at time of initial injury). The purpose of this exhibit is to demonstrate the imaging features that will allow radiologists to confidently diagnose a fishtail deformity of the distal humerus and to understand the pathogenesis behind the morphologic appearance. We will also discuss prognosis and management, knowledge that will allow the radiologist to be of additional value in multidisciplinary discussions. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Kuppler Kevin, Warnick Drew, Kucera Jennifer

Keywords: Elbow fracture, Trochlea

Intraperitoneal focal fat infarction is an umbrella term used to describe numerous pathologies with the two most common encountered in clinical practice being epiploic appendagitis and omental infarction. The clinical presentation often mimics an acute abdomen, which can lead to inappropriate management of the patient. While there is ample literature regarding the imaging appearance of focal fat infarction in adults, little exists regarding the imaging findings in children. The purpose of this exhibit is to demonstrate the imaging features which will allow radiologists to confidently diagnose focal fat infarction and differentiate it from more emergent causes of an acute abdomen. We will also discuss the prognosis and appropriate management, usually conservative, which is a significant difference from other causes of an acute abdomen. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Gnesda Ryan, Lewis Heidi, Kucera Jennifer

Keywords: Acute Abdomen, Epiploic Appendagitis, Omental Infarct

Pediatric patients can host a variety of benign and malignant renal tumors and tumor mimics. Their clinical presentation is nonspecific as patients may be asymptomatic or present with an abdominal mass, flank pain, or hematuria. Proper patient management requires an accurate diagnosis based on a combination of radiological and pathological findings. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Gupta Ayushi, Monforte Hector, Schaaf William, Kucera Jennifer

Keywords: renal tumor, Wilms tumor, renal cell carcinoma

Neural tube defects affect approximately 1/1000 pregnancies; left untreated these defects may lead to devastating consequences. The purpose of this presentation is to: 1) familiarize the reader with the normal anatomy seen on neonatal spine ultrasound, 2) describe normal variants often encountered on spine ultrasound, 3) provide an illustrated summary of spine embryology, and 4) discuss the various pathologies/disorders that may occur during each phase of spine embryology. Read More

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

Authors: Meyer Dustin, Chandra Tushar, Hayes Laura, Neville Kucera Jennifer

Keywords: Spine, Embryology, Ultrasound