Anorectal malformations (ARMs) are a heterogenous group of congenital anomalies involving the distal rectum and anus that are often associated with other anomalies. Neonates with ARMs may be identified at birth or prenatally and, upon delivery, receive a myriad of imaging tests to characterize the type of ARM and associated anomalies. Recent literature supports the use of transperineal ultrasound in the initial assessment of neonates with ARMs, with the Society of Pediatric Radiology recommending its use in the imaging algorithm for ARMs. Transperineal ultrasound, if adequately performed, allows evaluation of the location of the distal rectal pouch and the anatomy and location of any rectourogenital fistulas. In this educational poster, we review the clinical presentation and classification ARMs and discuss the role of transperineal ultrasound in the initial assessment of cases. We then describe common sonographic findings of ARMs on transperineal ultrasound using examples from our own institution. Our goal is to familiarize pediatric radiologists with this heterogenous group of congenital anomalies and the clinical utility of transperineal ultrasound in characterizing this pathology. Read More

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

Authors: Martin Camden, Cassella Katharyn, Johnstone Lindsey, Leschied Jessica

Keywords: Gastrointestinal, Anorectal, Ultrasound

Scurvy (vitamin C deficiency) was largely considered to be historical until recent years. The current prevalence of scurvy in the United States is approximately 7.1% and is thought to be increasing due to growing awareness of neurodiverse populations. Neurodiverse individuals show patterns of thought or behavior that are different from those of most people, but are still considered within normal range of human behavior. Interchangeable terms include neurodivergent, neurodifferent, and neurominority. While these terms traditionally refer to individuals with autism spectrum disorder (ASD), they also include individuals with attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), Trisomy 21, dyslexia, sensory disorders, and others. In the ASD population alone, the incidence increased from 1 in 150 children in 2000 to 1 in 36 children in 2020. Neurodiverse individuals are at risk for vitamin C deficiency as a result of a tendency towards extreme restricted diets. Clinically, vitamin C deficiency causes dermatologic symptoms (hyperkeratosis, corkscrew hair, poor wound healing), hemorrhagic symptoms (petechiae, ecchymoses, gingival bleeding), and skeletal symptoms (leg swelling/pain). It is largely a clinical diagnosis that can be supplemented or confirmed by laboratory, radiographic, and MRI investigations. This case review will highlight the typical presentation of scurvy with comments on the clinical presentation, associated neurodivergent behaviors contributing to the disease, and the radiographic and clinical diagnosis. In sum, vitamin C deficiency is becoming more prevalent in children that fall within the spectrum of neurodiversity and should be considered in the appropriate clinical context. Pediatricians and pediatric radiologists should be aware of the clinical emergence of scurvy, be able to recognize the imaging manifestations of the disease, and be sensitive to the unique needs of neurodiverse children. Read More

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

Authors: Hatcher Lauren, Cassella Katharyn, Foust Alexandra, Johnstone Lindsey, Leschied Jessica

Keywords: Vitamin C deficiency, Neurodivergent, Neurodiverse

Fibrolipomatous hamartoma (FLH) of the median nerve, also known as perineural lipoma or lipomatous hamartoma, is a rare, slow-growing, benign neoplasm that arises from proliferation of fibrofatty tissue that infiltrates epineural and perineural elements and results in thickening of the axonal bundles. It is thought to be congenital, which is why many patients present in childhood, typically with painless enlargement of the distal forearm or volar wrist. Some patients may present with carpal tunnel syndrome because of median nerve compression. Macrodactyly of the involved region has been reported in rare cases. MRI is considered the preferred modality for diagnosis of FLH; however, ultrasound, computed tomography, and rarely, radiography also play important roles in diagnosis. Imaging allows for accurate differentiation of FLH from other disease processes such as peripheral nerve sheath tumor (PNST) and lipoblastoma. In symptomatic patients, treatment of FLH includes carpal tunnel decompression, fibrofatty sheath debulking, and microsurgical dissection of the neural elements. In asymptomatic patients, observation may be appropriate. This case series aims to describe multi-modality imaging manifestations of FLH presenting in children and highlight imaging features that are key to achieving a definitive diagnosis, sparing the need for surgical exploration and biopsy. Case 1 11-year-old patient found to have a nontender, palpable mass in the right wrist. Radiographs revealed no abnormalities. Ultrasound of the palpable abnormality demonstrated an ovoid echogenic mass with internal hypoechoic fascicles contiguous with the median nerve, consistent with fibrolipomatous hamartoma of the median nerve. Patient has remained asymptomatic since diagnosis. Case 2 12-year-old patient with numbness and tingling in the median nerve distribution. Ultrasound demonstrated an indeterminate heterogenous lesion in the wrist. MRI revealed a collection of enlarged cylindrical fascicles surrounded by fat along the course of the median nerve. The patient underwent carpal tunnel release with symptomatic relief. The patient developed enlargement of her thumb and soft tissue hypertrophy along the ulnar aspect from the thumb tip down into the webspace. Most recent MRI demonstrated stability of hamartoma; however, the patient has developed recurrent carpal tunnel syndrome and is scheduled to undergo neurolysis of the median nerve and debulking of the thumb tumor. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Rullan Varela Valeria, Woodruff Ronald, Johnstone Lindsey, Sarma Asha, Leschied Jessica

Keywords: Musculoskeletal, Wrist Ultrasound, Neurosonogram

The majority of children’s hospitals reside in urban settings, and the most common animal related injuries seen in these areas are induced by cats or dogs. However, urban medical centers serve patients from large surrounding rural areas where a more diverse array of animal or agriculture related injuries can occur. Although an altercation with an angry horse, pig, or cow could result in severe trauma in adults, animal related injuries pose an even greater danger to children given their smaller stature and growing bodies. The natural curiosity of children also increases the risk of severe injury when living or playing around industrial agricultural equipment. Even partaking in outdoor sports or leisure activities confers risk for exposure to a variety of injury mechanisms. Depending on the specifics of the surrounding ecosystem, radiologists may also care for patients exposed to envenomation from snakes, scorpions, spiders, and various other insects, resulting in local or systemic complications. When incorporating a mechanism of injury, radiologists may anticipate complications of exposure to these animals or insects and can recommend further imaging evaluation. For example, in addition to characterizing imaging findings, such as local necrosis, from a brown recluse bite injury in a patient transferred from an outlying hospital, the radiologist would anticipate the urgency with which to assess for more systemic complications such as angioedema, rhabdomyolysis, or internal hemorrhage due to disseminated intravascular coagulopathy. To best serve our patients, pediatric radiologists should exhibit familiarity with possible mechanisms of injury related to wildlife, their various imaging manifestations, and potential complications in order to help guide clinicians in managing these potentially devastating injuries. This educational exhibit aims to demonstrate key findings of such pediatric injuries through a series of cases. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Jordan Kathryn, Killerby Marie, Patel Arjun, Cassella Katharyn, Greene Elton, Johnstone Lindsey, Leschied Jessica

Keywords: Pediatric Trauma, Image Findings, Emergency/Acute

Spinal cord lipomas are rare benign tumors of adipose tissue that have a range of presentations and management based on size, location, and embryogenesis. Importantly, the intradural lipomatous tissue can act as a tethering lesion placing the cord at risk of vascular compromise, particularly during periods of growth. Since spinal lipomas cause progressive disease and symptoms, early recognition and treatment in the pediatric population is beneficial. Neurosurgical literature supports further classification of spinal lipomas as dorsal, transitional, terminal, and chaotic based on location and imaging features for risk stratification, surgical planning, and prognostication. Although categorization for the purpose of guiding surgical management is based on imaging features, there currently is lack of representation of this classification system for spinal cord lipomas in the radiology literature. The aim of this exhibit is to educate pediatric radiologists about this classification system for spinal cord lipomas. Relevant anatomy and embryogenesis will be reviewed, and case-based examples will be used to illustrate relevant imaging features of each type of spinal lipoma. Findings impacting surgical planning and prognosis will be specifically highlighted. Read More

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

Authors: Park Seungweon, Sarma Asha, Dewan Michael, Leschied Jessica, Greene Elton, Pruthi Sumit, Martin Dann, Foust Alexandra

Keywords: spinal lipoma, embryogenesis, neuroradiology