CT with 4D cine imaging can non-invasively and dynamically characterize airways for various pathologies, such as airway caliber fluctuations in tracheobronchomalacia, intermittent compression by cardiovascular or other mediastinal structures, or constriction from anatomic anomalies like those associated with craniofacial syndromes. However, optimal interpretation of dynamic airway CT studies requires an understanding of the impact of such extrinsic factors as the presence of support apparatus (e.g., endotracheal tube, enteric tube), level of required respiratory support (e.g., positive end-expiratory pressure), and differences in positioning (e.g., with jaw thrust). We have performed more than 100 pediatric cases of dynamic airway CT under a variety of conditions, in patients who range from free-breathing to ventilator-dependent, and for a variety of pathologies. In this educational exhibit, we will consider how to balance and tailor extrinsic factors when using dynamic CT for the guidance of airway management, in order to meet diagnostic considerations and supplement other cardiopulmonary investigations, including cases with bronchoscopic and surgical correlates. Read More

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

Authors: Tang Elizabeth, Menashe Sarah, Romberg Erin, Perez Francisco, Otjen Jeffrey

Keywords: Airway, Cine, CT

The purpose of this educational exhibit is to demonstrate the lower extermity manifestations of Cerebral Palsy (CP). The focus will be on plain radiographic findings, along with surgical approaches to the various abnormalities. Conditions presented will include the following: equinus, equinocavovarus, equinoplanovalgus, oblique talus, vertical talus, ankle valgus and hallux valgus. In addition, a thorough and systematic approach on how to evaluate pediatric foot abnormalities will also be discussed. CP is caused by abnormalities of the developing fetal or infant brain that result in permanent central motor dysfunction. The prevalence of CP is about 2 in 1000 live births. Although this is higher in pre-term and low birthweight infants. The proposed underlying causes are many and include infection, hypoxia, structural changes, ischemia, and hemorrhage. The underying neural damage is nonprogressive, but the clinical manifestations can change and magnify. Gross Motor Function Classification System (GMFCS) is used to grade the severity of disease. Affecting about 93% of patients with CP, foot and ankle deformities have a huge impact on patient ambulation and GMFCS score. Such lower extremity abnormalities are classified using three “levels” of severity which influnce treatment options. Level I is mild, flexible deformity; level II manifests as soft tissue contracture; and level III causes skeletal remodeling and bony deformity. Only by apprecaiting the clinical and radiological manifestations of CP can we attain a more thorough understanding of the condition and its multitude of presentations. Read More

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

Authors: Thapa Mahesh, Maloney Ezekiel, Menashe Sarah, Otjen Jeffrey, Ngo Anh-vu, Iyer Ramesh

Keywords: Cerebral Palsy, equinus, cavus

Faulty fetal packing is a concave depression of the skull caused in utero by external pressure (such as by the maternal pelvic bone, a fetal limb, or uterine fibroid). It has an incidence of approximately 1 in 10,000 births. Its main differential diagnosis is acquired ping-pong-type fracture of the malleable neonatal skull, which can raise suspicion for nonaccidental trauma if there is no history of accidental trauma. Most recent literature on faulty fetal packing describes only single case reports. This educational exhibit reviews a series of faulty fetal packing and neonatal calvarial fracture cases. After reviewing this educational exhibit, readers will be able to 1) describe the mechanism of faulty fetal packing, 2) describe the appearance of faulty fetal packing on multiple modalities including radiographs and CT, and 3) distinguish between prenatal faulty fetal packing, perinatal skull trauma, and neonatal accidental and non-accidental trauma. Read More

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

Authors: Noda Sakura, Otjen Jeffrey, Koti Ajay, Schlatter Adrienne, Blessing Matthew, Feldman Ken, Menashe Sarah

Keywords: nonaccidental trauma, Skull, child abuse