Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon disorder predominantly occurring in full-term and post-term neonates during the first 6 weeks of life. Clinically it presents as an area of edema followed by indurated plaques or non-tender and mobile nodules with overlying erythema, typically along the back, buttocks, extremities, or cheeks. SCFN may result from localized tissue hypoxia and mechanical pressure that further compromises the local circulation. Fetal and neonatal conditions including macrosomia, perinatal asphyxia, traumatic birth and therapeutic hypothermia; and several maternal conditions including preeclampsia, hypertension, gestational diabetes, cocaine or cigarette exposure, calcium channel blocker use during pregnancy, and familial dyslipidemia have been associated with SCFN. Although SCFN is a self-limiting condition, patients should be monitored for associated hypercalcemia and its complications such as nephrocalcinosis and nephrolithiasis. As these lesions are superficial, they are well evaluated with high resolution ultrasound imaging for initial assessment and follow-up. Findings on ultrasound and MRI include lesions confined to the subcutaneous fat sparing the dermis, with indistinct borders lacking a distinct mass. Lesions of SCFN are echogenic on US, intermediate to low signal intensity on T1-weighted sequences, intermediate to high signal on fluid sensitive sequences, and may demonstrate cystic changes. We will review the imaging findings of subcutaneous fat necrosis in over ten newborns collected from three tertiary care hospitals, with a focus on ultrasound findings. Many of the lesions were multifocal and the majority involved the patient's back. Ultrasound evaluation was performed in all cases. MRI performed in a minority of cases will also be reviewed. While only one case was biopsied for pathologic correlation, each lesion was closely followed clinically. We will also review several mimickers of fat necrosis to be aware of. Read More

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

Authors: Fenlon Edward, Jaramillo Diego, Restrepo Ricardo, Corral Gonzalo

Keywords: Ultrasound, Fat, Necrosis

Chronic nonbacterial osteomyelitis (CNO) is an aseptic auto-inflammatory condition that affects children and presents with insidious bone pain. Children present with a variable clinical spectrum of disease with either unifocal or multifocal pain and acute (duration < 6months) or chronic (>6 months) symptoms. The disease course may be recurrent. In some cases, patients endure multiple lesions over a course of exacerbations and remissions. Bone lesions are often in symmetrical regions. Interestingly, clinically asymptomatic bone lesions are discovered during the imaging evaluation. Patient symptoms and clinical course may mimic other diseases, making CNO often difficult to diagnose with a consequent delay in diagnosis. Children with CNO may also develop arthritis and demonstrate similar cytokine profiles with children with juvenile idiopathic arthritis (JIA), suggesting at least a partial common disease pathway. Read More

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

Authors: Mowrer Gregory, Jaramillo Diego, Restrepo Ricardo, Imundo Lisa, Flemming Don, Chauvin Nancy

Keywords: chronic nonbacterial osteomyelitis, osteitis, CRMO