Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm presenting as a mass in the subcutis or deep dermis in the extremities of children and young adults. Although previously regarded as ‘malignant’, due to its benign microscopic appearance and favorable prognosis, this tumor was categorized as an “intermediate tumor of uncertain differentiation” in the 2013 World Health Organization classification. AFH is often misdiagnosed on imaging and pathology. We will present the unusual case of AFH with extensive lymphadenopathy and multiple episodes of anemia. The imaging findings will be illustrated with radiographic, ultrasound, MRI, and PET/CT exams. We will also present gross specimen and pathology images. Our case involves a 9 year old male presenting with asymptomatic left upper arm and left chest wall masses for two years. A previous biopsy of the mass and a lymph node had been performed, showing juvenile capillary hemangioma and benign progressive germinal transformation, respectively. The patient had several prior episodes of anemia requiring multiple blood transfusions. Coagulopathy workup was negative, and it was postulated that bleeding into the mass could be the source of the anemia. Radiographs revealed a 4.5 cm ovoid mass in the posteromedial soft tissues of the upper left arm with stable size but increasing calcific serpiginous opacifications throughout the lesion compared to two years prior. Multiple round soft tissue nodules within the left axillary region were also present. MRI revealed a heterogeneous lesion with a calcified rim with significant susceptibility artifact likely from hemosiderin. Several enlarged adjacent lymph nodes were present with additional marked lymphadenopathy filling the left axilla abutting the brachial plexus and neurovascular bundles, extending superiorly above the acromion. The largest lymph node measured 2.8 cm within a cluster of lymphadenopathy measuring 9 x 4 x 4 cm, increased compared to MRI two years prior. PET/CT revealed increased radiotracer uptake in the mass with a max SUV of 4.5 and within the left axillary lymphadenopathy with a max SUV of 6.5. The patient underwent surgical excision of the mass with dissection and removal of two adjacent palpable lymph nodes. The mass had a firm capsule with a red/myxoid appearance measuring 6.0 x 5.0 cm. Pathology of the mass was consistent with angiomatoid fibrous histiocytoma and pathology of the lymph nodes revealed reactive follicular hyperplasia. Read More

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

Authors: Laucis Nicholas, True-malhotra Aisha, Leschied Jessica

Keywords: angiomatoid fibrous histiocytoma, lymphadenopathy, mass

Hypoxic ischemic encephalopathy occurs in up to 1.5-2.5 per 1,000 live births in developed countries and can result in major neurologic deficits and mortality in the neonatal population. Currently, treatments are supportive and include moderate hypothermia which has demonstrated a significant reduction in disability and mortality in patients with moderate hypoxic ischemic encephalopathy. Despite improved mortality, morbidity in this patient population remains high with residual neurological deficits. This review will illustrate the patterns of brain injury as well as the imaging findings of neonatal hypoxic ischemic injury on ultrasound, CT, and MRI to assist with diagnosis and prognosis. By completion of this exhibit, the learner will: 1. Review the anatomy of the neonatal brain on multiple modalities include ultrasound, CT, and MRI. 2. Be familiar with the patterns of brain injury in neonates. 3. Be able to identify the sonographic, CT, and MRI findings of neonatal hypoxic ischemic encephalopathy. 4. Understand the treatments and prognosis for neonatal hypoxic encephalopathy. Read More

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

Authors: Le Phong, Leschied Jessica, Ledbetter Karyn

Keywords: HIE

To survey active members of the Society for Pediatric Radiology regarding their utilization of various cranial ultrasound techniques and reporting practices in neonates. Read More

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

Authors: Leschied Jessica, Horst Kelly, Lampl Brooke, Hwang Misun

Keywords: SPR survey, neurosonography, neonatal imaging

Sports related elbow injuries are very common in the pediatric population. Overhead throwing athletes are at particular risk for elbow injury, notably affecting the medial elbow at site of excess valgus stress applied during the overhead throw. With the increasing competitiveness and high level of training in young athletes, these injuries are commonly encountered in the pediatric sports medicine and orthopedic surgery clinics. A comprehensive knowledge of medial elbow anatomy by the radiologist is crucial to assist in both the diagnosis and management of these patients. This review will cover acute and chronic stress injuries of the medial epicondyle, ulnar collateral ligament, common flexor tendon and ulnar nerve. A full spectrum of injuries will be addressed, utilizing US and MRI to assist with diagnosis and to guide management. By completion of this exhibit, the learner will: Review the anatomy of the medial elbow joint. Be familiar with the injury patterns affecting the medial elbow in overhead throwing athletes. Understand the utility of radiographs, MRI and dynamic and static US in making a diagnosis. Visualize the technique for performing dynamic medial elbow ultrasound in the setting of ulnar collateral ligament injury and understand its implications for treatment. Read More

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

Authors: Leschied Jessica, Scher Courtney, Wood Daniel, Davis Will, Stock Lee

Keywords: Ultrasound, Elbow, Sports

Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis. Congenital syphilis can lead to severe sequelae or at worst, death. Worldwide congenital syphilis has recently seen a resurgence, with the United States alone having 9.2 cases of congenital syphilis per 100,000 live births in 2013, the first increase since 2008. Since then, it has been increasing in prevalence yearly, with most recent preliminary data showing up to 2100 cases of congenital syphilis in 2020. In addition, the number of syphilitic stillbirths in the United States has increased as well, most recently to 94 still births in 2019. Radiology plays an important role in early diagnosis of this condition which results in early treatment and prevention of long term sequelae. This electronic exhibit of a case series will review the osseous manifestations of congenital syphilis on radiographs, as well as instruct on the clinical diagnosis, treatment and expected response to therapy, with post treatment radiographic examples. Illustrative cases from our radiology department will be used to demonstrate musculoskeletal changes of congenital syphilis, ranging from nonspecific metaphyseal lucent bands and diaphyseal periostitis to more pathognomonic presentations such as “celery stalk sign” and “Wimberger sign”. Read More

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

Authors: Eteer Khalid, Collins Denise, Sabharwal Gauravi, Ledbetter Karyn, Leschied Jessica

Keywords: syphilis, Congenital

E-cigarette, or vaping, product use associated lung injury (EVALI) is a newly recognized entity that is being reported with increasing frequency in the literature and mainstream press. The aim of this case report is to radiographically illustrate the fairly rapid progression of a severe case of EVALI that ultimately required a successful bilateral lung transplant, and to describe a unique histopathology correlation. <b>Case Report:</b> Our patient is a 16-year-old, previously healthy male with a two year history of vaping who presented to an outside hospital for dyspnea and nonproductive cough. He was initially treated with antibiotics for community acquired pneumonia. Initial contrast-enhanced CT of the chest demonstrated subtle bilateral but right lower lobe predominant centrilobular nodules, ground glass opacities (GGO) and mild septal thickening. Bronchial alveolar lavage, microbiology studies and autoimmune panel were negative for an infectious or autoimmune etiology. Repeat chest CT only five days later following clinical deterioration demonstrated a dramatic worsening of bilateral nodular airspace opacities, septal thickening, GGO and dependent diffuse consolidations. Pneumomediastinum and mild bronchiectasis were also present. Our patient’s condition continued to decline requiring intubation and subsequent ECMO support. He was transferred to our tertiary care center for bilateral lung transplant. Histopathology of the explanted lungs described predominant acute necrotizing and granulomatous bronchopneumonia with areas of organizing pneumonia. Read More

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

Authors: Poyiadji Neo, Sabharwal Gauravi, Leschied Jessica, Ledbetter Karyn, Song Tom, Collins Denise, Montecalvo Joseph

Keywords: Vaping related lung injury, lung transplant