To review the anatomy of the Space of Retzius and to highlight the array of disorders that can occur in this space in the pediatric population. These disorders present as abdominal pain and might be missed or misdiagnosed without paying attention to this space and knowing the differential and differentiating factors of pathology that are found there. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Dickson Paula, Braithwaite Kiery, Richer Edward

Keywords: Retzius

A 16 year old previously healthymale patient who initially presented with daily recurrent fevers and chills lasting 5-10 minutes. His parents brought him to a tertiary care hospital after developing vomiting and weight loss in the setting of progressively worsening fevers. Initial work up was remarkable for elevated CRP and a negative infectious workup. An MR enterography ordered to evaluate for a cause of weight loss demonstrated incidental lung base lesions. Follow up CTA revealed a lesion within the right ventricle and multiple lung nodules, concerning for endocarditis and septic emboli. He underwent two surgical resections over two months for the ventricular mass. Pathology revealed findings consistent with necrotizing endocarditis. During his hospital course, he was found to have a left cephalic venous thrombosis and was placed on Xarelto, later developing a right subclavian vein thrombus while on anticoagulation. He was readmitted 1 month later after presenting for right chest and right upper quadrant pain. Initial chest X-ray revealed right lower lobe mass and follow up CTA revealed two large right pulmonary artery pseudo-aneurysms. He underwent cardiac catheterization for pre-operative coiling of the pseudo-aneurysms and subsequent right lower lobectomy. Pathology revealed necrotizing arteritis and pulmonary artery pseudo-aneurysms. Based on clinical presentation and further work up, he was diagnosed with Hughes Stovin Syndrome and started on Cytoxan and Apixaban. While not yet considered in remission, his symptoms have improved since initiating treatment. Hughes Stovin Syndrome (HSS) is a rare disorder characterized by thrombophlebitis as well as multiple pulmonary and/or bronchial aneurysms. There is a male predilection, usually presenting between 12-48 years. There have been less than 40 cases published in the English literature. HSS is thought to be a variant of Bechet’s but does not present with oral or genital ulcers. The lack oral and genital ulcers in this patient excluded a diagnosis of Bechet’s. The underlying cause of HSS is unclear but is believed to be due to angiodysplasia or infection. Since there is no formally described diagnostic criteria, the clinical presentation of thrombophlebitis with pulmonary artery aneurysms characterize the disease. We present this case to illustrate the clinical presentation of a rare and possibly under recognized syndrome. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Gagnon Marie-helene, Richer Edward, Alazraki Adina

Keywords: Vasculitis, Aneurysm, Thrombophlebitis

Ileocolic intussusception is a common cause of intestinal obstruction in young children. Most patients undergo image-guided enema reduction followed by a surgical reduction in enema fails. Many factors associated with decreased enema success have been described in the literature, although a concise scoring system to identify patients who are at risk for surgical intervention and complications does not exist. The goal of this project was to develop a scoring system to identify patients who are at increased risk for enema failure and surgical complications. Read More

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

Authors: Patel Dhruv, Loewen Jonathan, Richer Edward

Keywords: Ileocolic Intussusception, Image guided therapeutic enema

Foreign body ingestion is common in children. Timely diagnosis of the nature and location of the foreign body is important. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. Machine learning that can detect anatomical regions of interest is an important step in computerized foreign body localization and may result in prioritization of radiographs with mediastinal foreign bodies. The purpose of this study is to develop a machine learning model to identify anatomical regions of interest on pediatric foreign body series radiographs. Read More

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

Authors: Rostad Bradley, Richer Edward, Riedesel Erica, Alazraki Adina

Keywords: Machine learning, Artificial intelligence, Foreign body

Timely diagnosis of foreign body ingestion in children is important, particularly in the case of an ingested button battery. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. It is also important to distinguish an ingested button battery from a coin; a button battery may be misdiagnosed a coin because of its similar radiographic appearance. The purpose of this study is to develop a machine learning model to identify button batteries and coins on pediatric foreign body series radiographs. Read More

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

Authors: Rostad Bradley, Richer Edward, Riedesel Erica, Alazraki Adina

Keywords: Machine learning, Artificial intelligence, Button battery

Idiopathic thickening of the pyloric muscle can occur in young infants, causing projectile vomiting, electrolyte abnormalities, and necessity for surgical intervention to relieve the gastric outlet obstruction. Case reports have been published describing infants with HPS who also have portal venous gas (PVG) visualized within the liver. The presence of PVG in other clinical scenarios often indicates a severe and potentially life threatening bowel condition. The purpose of this study was to determine the incidence of infants with hypertrophic pyloric stenosis (HPS) and concurrent portal venous gas (PVG), as well as whether there are unique clinical features or different outcomes in the HPS patients with PVG versus without PVG. Read More

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

Authors: Milla Sarah, Cantu Cera, Richer Edward, Braithwaite Kiery, Linam Leann, Riedesel Erica, Loewen Jonathan, Simoneaux Stephen

Keywords: pyloric stenosis, portal venous gas, pneumatosis