Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

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

Authors: Gual Fabiana, Lima Natalia, Matsuoka Marcia, Sameshima Yoshino

Keywords: vascular anomalies, hemangioma, vascular malformations

Ultrasound is a valuable tool for evaluating lymph nodes in the context of an inflammatory response. Lymph nodes are crucial in the body's immune system, and changes in their size, shape, and echogenicity can provide valuable information about the underlying pathology. What is expected in the inflammatory response is the maintenance of its typical characteristics such as dimension, fatty hilum, thin cortex and hilar flow, however, some pathologies may present atypical lymph node enlargement. These findings are not considered pathognomonic manifestations but they can give us very important tips to direct us to the correct diagnosis as we describe in our case series: 1. Cat-scratch disease: male patient, 10-year-old, with painful epitrochlear, cervical and axillary lymph nodes for 3 months. Ultrasound (US) showed enlarged hypoechogenic lymph nodes (local lymph nodes in the same region as the cat scratch). Serological test confirmed cat scratch disease diagnosis. 2. Bacille Calmette–Guérin lymphadenitis: male patient, 7-months-old, with post vaccination right axillary lymphadenopathy. US revealed right enlarged axillary lymph node, hypoechogenic, containing tiny hyperechoic foci. 3. Lymphomatous lymph nodes: male patient, 17 years old, with painless cervical node for 4 months. US showed enlarged, heterogeneous lymph node, with loss of fatty hilum and well-defined walls, with typical findings by color Doppler study, as we will show. Immunophenotyping: non-Hodgkin's lymphoma. 4. Streptococcus Lymphadenitis: 6-year-old female patient with cervical lymph nodes. US showed Streptococcus lymphadenitis common findings: enlarged hypoechoic lymph nodes, oval-shaped, with thick capsule and hyperechogenicity of adjacent tissue. Increased central and peripheral blood flow by color Doppler. Swab test confirmed Streptococcus. 5. Thyroid tumor metastasis: 17-year-old male patient with a palpable cervical nodule. US showed a solid hypoechoic thyroid nodule and local lymph node with calcifications. Biopsy confirmed papillary thyroid carcinoma with secondary involvement of lymph node. Learning points: 1. Anatomical review of the cervical lymph node chains by ultrasound. 2. Learn typical sonographic features of atypical lymph nodes; 3. Value the importance of correlation of imaging findings with clinical data, tests and biopsy; 4. Assess the pediatric cases from our pediatric radiology group that will be useful for your future atypical cases. Read More

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

Authors: Carvalho Yago, Sameshima Yoshino, Lima Natalia, Gual Fabiana

Keywords: atypical lymph nodes, ultrasound evaluation