Ectopia cordis is a rare congenital condition where the heart is located outside the chest cavity, often associated with midline defects like omphalocele and Pentalogy of Cantrell. This condition presents significant challenges in surgical management and has a high mortality rate due to complications related to cardiac and associated anomalies. A newborn delivered at 37 weeks gestation was admitted for surgical management of ectopia cordis and omphalocele. Prenatal imaging suggested Pentalogy of Cantrell. An echocardiogram was performed, but visualization was limited due to the heart’s external position, hindering comprehensive assessment. A follow-up CT angiogram confirmed ectopia cordis with complex cardiac and vascular findings. The left-sided superior vena cava drained into the coronary sinus, and the inferior vena cava was dilated, draining into the right atrium. The right atrium was dilated, while the left atrium was elongated with normal pulmonary venous drainage. A 4 mm atrial septal defect and a possible 2 mm perimembranous ventricular septal defect were noted. The right ventricle appeared normal, but the left ventricle was hypoplastic. The aortic root and ascending aorta were hypoplastic, with Z-scores ranging from -3.20 to -4.90, while the aortic isthmus and descending aorta were within normal limits. The pulmonary arteries were normal in size, and a large PDA was observed. 3D modeling was used to assess the feasibility of surgical repair and chest closure. The heart outside the chest measured 30.65 ml, and the total intrathoracic volume was 107.31 ml. The combined volume of the lungs and pleural effusions totaled 77.69 ml, leaving limited space for the heart within the thoracic cavity. This made the prospect of repositioning the heart into the chest highly challenging, with significant risk of compressing the lungs or other critical structures. The baby passed away during the hospital stay. This case highlights the role of CTA and 3D modeling in congenital heart disease, illustrating how these tools can assist in evaluating spatial constraints and informing surgical decisions in complex conditions like ectopia cordis. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Priya Sarv, Nagpal Prashant

Keywords: 3D Model, Pentalogy Of Cantrell, Cardiovascular

Pediatric polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting medium-sized arteries, leading to inflammation and organ damage. It often involves the skin, kidneys, and gastrointestinal tract, with symptoms such as fever, abdominal pain, and hypertension. Early diagnosis and treatment are essential to managing this condition. This report discusses renal imaging findings in two pediatric patients with PAN. A 10-year-old male presented with abdominal pain, nausea, and acute renal failure. A left renal biopsy revealed medium vessel arteritis, raising suspicion for polyarteritis nodosa. Renal Doppler ultrasound showed normal renal arteries but increased echogenicity of the kidneys. CTA demonstrated patent renal arteries without beading, but bilateral cortical hypoenhancement was observed, indicating cortical necrosis consistent with vasculitis. MRA further confirmed the suspicion of PAN by revealing minimal contrast blushing and nodularity at the corticomedullary junction, suggestive of microaneurysms. Imaging played a key role in confirming the diagnosis of PAN in this patient. A 16-year-old male presented with a six-month history of abdominal pain, fatigue, weight loss, chills, and hypertension. Laboratory results showed elevated inflammatory markers. MRA of the chest, abdomen, and pelvis revealed numerous bilateral arterial enhancing foci within the renal parenchyma, measuring 2 to 5 mm, suggestive of microaneurysms. A renal biopsy confirmed secondary focal segmental glomerulosclerosis. CT and MR imaging are essential for diagnosing pediatric polyarteritis nodosa by identifying key vascular abnormalities such as microaneurysms and ischemic damage. These imaging techniques not only confirm the diagnosis but also guide timely intervention, improving the management of this rare condition in pediatric patients. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Priya Sarv, Nagpal Prashant

Keywords: Renovascular Hypertension, Vasculitis, Abdominal Imaging

This exhibit explores the microbolus injection technique in pediatric cardiac CT angiography, providing a comparison to traditional bolus and test bolus methods. The microbolus technique involves delivering multiple small, precisely timed boluses of contrast media, each followed by saline flushes, using a dual-head power injector. Unlike the standard bolus injection, which administers a single large volume of contrast, the microbolus technique dispenses several smaller doses of contrast at regular intervals, interspersed with saline. This approach synchronizes the contrast circulation with the patient’s cardiac output and vascular dynamics, ensuring enhanced opacification of key heart structures, particularly in pediatric patients. The saline flushes help maintain a steady flow and promote even distribution of the contrast, preventing pooling. The primary aim is to achieve simultaneous, uniform opacification of both right and left heart structures, including coronary arteries, pulmonary arteries, and systemic veins, all within a single scan. This precise timing and contrast distribution have the potential to reduce the need for repeat imaging caused by suboptimal visualization, thus potentially lowering radiation exposure and contrast volume. This educational exhibit will address the following: A comprehensive overview of the microbolus injection technique, highlighting its distinction from traditional bolus and test bolus injections. An explanation of injector requirements and how the precise timing of contrast and saline boluses is achieved. Potential advantages of achieving simultaneous opacification of both right and left heart structures. The possibility of reducing the need for repeat or delayed scans, potentially decreasing radiation exposure. A discussion of the technique's limitations and practical considerations for clinical implementation. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Priya Sarv, Nagpal Prashant

Keywords: Cardiovascular, CT Angiography, Teaching

Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially. A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal. The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion. The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification. On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised. This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiac CTA, Cardiovascular, Congenital

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description. A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting. This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning. This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiac CTA, Complex Congenital Heart Disease, Cardiovascular

Pulmonary embolism (PE) is a potentially life-threatening condition, and accurate imaging is critical for timely diagnosis. While CT pulmonary angiography is the gold standard, MR angiography (MRA) offers a radiation-free alternative, particularly important in younger patients. However, MRA is prone to artifacts that can mimic pathology and lead to false-positive interpretations. We present two cases of 15-year-old patients who presented to the emergency department with acute chest pain and underwent MRA as part of the diagnostic workup to avoid radiation exposure. In both cases, imaging demonstrated central dark signal voids within the pulmonary arteries, raising concern for thrombus. Closer review revealed these findings were attributable to Gibbs ringing artifact, which occurs due to undersampling and edge effects, producing alternating bright and dark bands that may simulate intraluminal filling defects. In one patient, additional challenges were posed by timing-related artifacts during k-space acquisition, where misalignment of contrast bolus and central k-space filling resulted in a “maki roll” appearance, further complicating interpretation. Strategies to differentiate artifact from true thrombus include correlating with multiple imaging planes, and importantly, reviewing second or delayed angiographic runs to determine whether a defect persists or resolves. In both cases, the absence of persistent findings and awareness of artifact patterns prevented misdiagnosis of PE. These cases underscore the importance of recognizing Gibbs ringing and timing-related artifacts in MRA of the pulmonary arteries. Careful image review and knowledge of common pitfalls are essential to avoid false-positive diagnoses and ensure appropriate patient management. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Priya Sarv, Narayanasamy Sabarish, Nagpal Prashant

Keywords: Cardiovascular MRA, Magnetic Resonance Imaging, Pulmonary Embolism