The Median Arcuate Ligament Syndrome (MALS) is a diagnosis of exclusion. It is a condition characterized by abdominal pain due to compression of celiac artery by the median arcuate ligament. 1. The purpose of this study is to review a single institutional experience in screening and diagnosing MALS in the pediatric population with emphasis on the diagnostic accuracy of ultrasound (US) Doppler against additional imaging and follow up. 2. We also describe our technical approach of performing Doppler US in suspected MALS and various diagnostic criteria. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Bandarkar Anjum, Otero Hansel

Keywords: Median Arcuate ligament syndrome, Doppler Ultrasound, Postural Orthostatic tachycardia syndrome

The diagnosis of malrotation is heavily reliant on imaging. Upper GI series remain the gold standard with the normal position of the duodenojejunal junction lateral to the left-sided pedicles of the vertebral body, at the level of the duodenal bulb on frontal views and posterior (retroperitoneal) on lateral views. However, a variety of conditions might influence the position of the duodenojejunal junction, potentially leading to a misdiagnosis of malrotation. Such conditions include gastric over distension, splenomegaly, renal or retroperitoneal tumors, liver transplant, small bowel obstruction, the presence of properly or malpositioned enteric tubes and scoliosis. All of these may cause the duodenojejunal junction to be displaced. We present a series of cases highlighting conditions that mimic malrotation to increase the practicing radiologist awareness and help minimize interpretation errors. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Smitthimedhin Anilawan, Suarez Angela, Webb Ryan, Otero Hansel

Keywords: malrotation, Upper GI study, mimickers

The diaphragm is the major muscle used during quiet breathing and abnormalities of diaphragm motion are a source of significant morbidity, especially in infants and young children. Diaphragm motion can be either normal, decreased, absent or paradoxical. Diaphragmatic paralysis may present with unexplained respiratory distress, difficulty in weaning the patient from mechanical ventilation and persistent elevated hemidiaphragm on chest radiographs. Early diagnosis of diaphragmatic paralysis is critical to minimize prolonged ventilatory support and consider surgical plication. Objectives: 1. To discuss our experience with diaphragm ultrasound (US) in suspected diaphragmatic paralysis. 2. To illustrate sonographic technique and protocol to perform diaphragm US. 3. To present a case-based review of the spectrum of normal and abnormal diaphragmatic motion. Read More

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

Authors: Smith Benjamin, Otero Hansel, Cielma Tara, Bandarkar Anjum

Keywords: diaphragm, diaphragmatic motion, ultrasound

Background: Dual source dual-energy CT scanners (DECT) has allowed for the collection of two data sets with a single scan, opening the potential for functional data acquisition. The technique combines two energy beams at distinct voltages applied concurrently during a single scanning phase. The source data can be combined to generate a single mixed composite image, or iodine can be subtracted to create a contrast map or a virtual non-contrast image. The result is functional information in the setting of decreased radiation dose when replacing a biphasic scan, or dose neutral when compared to conventional single source CT. Post processing lung perfusion software allows for imaging display (qualification) and quantification of iodinated contrast volumes in the lungs, a surrogate for lung perfusion. Purpose: This educational exhibit will demonstrate: 1. How to perform DECT in children, 2. How to use postprocessing software, and 3. How to interpret lung perfusion results through clinical examples of current pediatric clinical indications including pulmonary embolism, lung hypoplasia, pulmonary AV malformation, and pulmonary hypertension. Conclusion: Through this exhibit, readers will gain familiarity with technical aspects of DECT of the lungs in children, understand the basics of post processing and recognize focal or regional perfusion defects, segmented perfusion analysis, and focal lesion perfusion characteristics as well as identify future applications. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Rapp Jordan, Saul David, Kaplan Summer, Barrera Christian, Otero Hansel

Keywords: dual energy, thoracic, perfusion

With advances in intensive care, increasing numbers of premature neonates with severe respiratory distress have led to major challenges related to prolonged mechanical ventilation and chronic bronchopulmonary dysplasia. Acute lung injury and acute respiratory distress syndrome in children still confer significant morbidity and mortality despite advances in ventilation and resuscitative therapies. Much of the damage attributed to mechanical ventilation in critically ill infants and children is due to surface tension and ventilation of atelectatic lung. First reported clinically in neonates in 1989, partial liquid ventilation involves the endotracheal administration of an inert volatile perfluorochemical liquid. These perfluorocarbons aid in gas exchange due to their large oxygen and carbon dioxide carrying capacity. In addition, these chemicals possess low surface tension that allows for greater alveolar recruitment and improved lung compliance through clearance of debris and secretions. Early trials in preterm neonates and neonates with congenital diaphragmatic hernia suggested a role for liquid ventilation as salvage therapy for patients not responding to conventional mechanical ventilation and extracorporeal membrane oxygenation. Currently, efforts are underway to reassess its clinical utility in bronchopulmonary dysplasia. With this renewed clinical interest, it is important for pediatric radiologists at institutions utilizing these perfluorocarbons to be familiar with the clinical use and radiographic appearance of liquid ventilation. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Degnan Andrew, Biko David, White Ammie, Servaes Sabah, Otero Hansel, Fox William, Shaffer Thomas, Zhang Huayan, Saul David

Keywords: liquid ventilation, chest radiographs