Ovarian torsion in pediatrics is challenging to diagnose, both clinically and radiologically. Ultrasound is most commonly used to evaluate for this process, though there are no sonographic findings that are pathognomonic. One sonographic finding that has been infrequently reported in the literature is medialization of the ovary (defined as the ovary at or crossing the midline of the uterus), as the adnexal structures are drawn inwards by the twisted broad ligament. Knowledge of this finding in addition to the other more classic findings of torsion can be an important clue to the diagnosis. This study evaluates the presence of ovarian medialization in a large number of cases of known torsion. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Otjen Jeffrey, Stanescu A. Luana, Parisi Marguerite

Keywords: Medialization, Ovary, Torsion, Ultrasound

Purpose Ovarian torsion is rare in neonates and infants. Clinical diagnosis is challenging in the setting of lack of specific symptoms and the limitations in assessing pain in infants. Torsed ovaries in this patient population are also a diagnostic dilemma on imaging. In this study we reviewed the spectrum of imaging findings with pathologic correlation in a large series of patients. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Stanescu A. Luana, Otjen Jeffrey, Parisi Marguerite

Keywords: Neonatal, infantile, Ovarian Torsion

Fallopian tube torsion is a rare cause of acute abdominal pain in pediatric patients. Pelvic ultrasound is the first imaging modality utilized to evaluate for pelvic pathology, typically to rule out ovarian torsion. Ultrasound findings of fallopian tube torsion can be challenging, leading to delayed surgical intervention, particularly when ovaries have a normal gray scale appearance and spectral Doppler waveforms. We reviewed the ultrasound features of fallopian tube torsion in a series of surgically proven cases. Read More

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

Authors: Stanescu Arta, Otjen Jeffrey, Parisi Marguerite

Keywords: Fallopian tube, torsion, ultrasound

Pelvic ultrasound is commonly used to detect ovarian torsion, but the diagnosis remains challenging as there is no single pathognomonic feature. This retrospective case-controlled study aims to identify an algorithm to detect torsion based on common ultrasound imaging features. Read More

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

Authors: Otjen Jeffrey, Stanescu A. Luana, Ansdell David, Alessio Adam, Parisi Marguerite

Keywords: torsion, ultrasound, machine learning

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

Ultrasound has long been a readily available, noninvasive, and accurate means of evaluating the female pelvis and is widely used in the emergency setting for girls with abdominal and pelvic pain. One key element in evaluating for pathology is to measure ovarian size and compare left and right ovaries. Normative volume data stratified by age are available; however, these studies suffer from lack of numbers, and frequently older equipment. Technological advances in ultrasonic hardware and software have increased the resolution of both gray-scale and Doppler imaging. Increases in spatial resolution allow for better identification and measurement of ovaries and precise measurements and depictions of anatomic details. The purpose of this study was to re-evaluate normal pediatric ovarian volumes in relation to patient age with a larger dataset and newer technology. Read More

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

Authors: Otjen Jeffrey, Ansdell David, Stanescu A. Luana, Alessio Adam, Parisi Marguerite

Keywords: Ovary, Ultrasound

The purpose of this educational presentation is to demonstrate ultrasound technique and characteristic sonographic findings of common superficial pediatric extremity soft tissue lesions. We also offer advice on how to differentiate benign from malignant lestions. Children frequently present with unexplained “lumps and bumps” on their extremities. These lesions are often invisible on radiography; MRI might require use of sedation; and CT exposes the child to radiation and often requires iodinated contrast. Ultrasound (US) is a cost-effective, radiation-free, and dynamic method to evaluate superficial soft tissue lesions. We discuss choice of transducer based on lesion location. We explain why a multifrequency transducer, which allows for the evaluation of both superficial (higher frequency spectrum of the transducer) and deeper (lower frequency spectrum of the transducer) components of the lesion is important. The use of compound imaging is explained, as multiple angles of insonation are combined to provide a more complete image of the structure being interrogated. For lesions involving the hands or feet, we explain the water-bath technique. Water is an excellent medium for ultrasound waves and will minimize artifacts from air and inadequate surface contact that plague evaluation of the distal extremities. We then discuss characteristic sonographic appearance of the following conditions: vascular anomalies, osteomyelitis and subperiosteal abscess, hematoma, subcutaneous granuloma annulare, Pilomatricoma, lipoma, ganglion and Baker cyst, muscle hernia, osteochondroma, foreign bodies, and malignant conditions. Read More

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

Authors: Thapa Mahesh, Ojeda Patricia, Otjen Jeffrey, Ngo Anh-vu, Callahan Michael

Keywords: ultrasound, benigh, malignant

Pediatric head CT examinations remain a mainstay imaging modality, frequently utilized to evaluate a wide spectrum of pediatric pathology. Current pediatric head CT protocols aim to use the least amount of radiation while providing imaging of diagnostic quality. Lower radiation doses, along with other factors, can occasionally cause CT artifacts that can affect the quality and the interpretation of images. In this exhibit, we review examples of physics-based, patient-based and scanner-based CT artifacts on head CT exams, while also providing a brief explanation of the underlying physics and ways to mitigate the artifact. Imaging examples include among others: apparent posterior fossa masses due to beam hardening, apparent extra-axial fluid collections due to cupping artifact, apparent brain parenchymal hypodensities concerning for infarct, and apparent beading of intracranial vessels due to lower radiation doses administered. Awareness of these artifacts is critical for radiologists, as they can potentially lead to misdiagnosis. Read More

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

Authors: Otjen Jeffrey, Phillips Grace, Khatri Garvit, Kanal Kalpana, Kim Helen Hr, Stanescu A. Luana

Keywords: Artifacts, CT, Head

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