5 yo male with PMHx significant only for autism presented to ED with acute abdominal pain, hematemesis, and melena. Patient was tachycardic but normotensive with Hgb 5.6 g/dL (normal 11.5 – 13.5 g/dL) requiring transfusion. Patient was also jaundiced with scleral icterus, markedly elevated liver enzymes, and direct hyperbilirubinemia. Abdominal X-ray and Abdominal US did not demonstrate significant bowel pathology. However, gallbladder was abnormal with thickened, hyperemic wall and abundant internal debris. Common bile duct was massively dilated to the level of ampulla and filled with heterogeneous, avascular debris. No cholelithiasis or mass was demonstrated. Based on US, a differential diagnosis of cholecystitis, cholangitis, or choledochal cyst complicated by hemobilia was offered. MRI demonstrated dilated central intrahepatic and extrahepatic bile ducts containing layering T1 bright, T2 dark material. On arterial post-contrast images, the right hepatic artery was immediately adjacent to dilated common hepatic duct and blush of enhancement was seen concerning for active hemorrhage into type 4b choledochal cyst. The patient proceeded to diagnostic angiography, which was unable to demonstrate a site of arterial bleeding. Biliary drain was placed across the choledochal cyst with initial drainage of bloody material followed by drainage of bile. Patient subsequently underwent open cholecystectomy. Pathology demonstrated "mucinous papillary proliferation with increased histiocytes in lamina propria, consistent with gallbladder changes in Metachromatic Leukodystrophy (MDL)." Subsequent brain MRI demonstrated classic findings of MDL. Read More

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

Authors: Richards Morgan, Riedesel Erica, Richer Edward

Keywords: Metachromatic Leukodystrophy, Gallbladder, Hemobilia

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

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

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

Authors: Arceo Salvador, Christopher Ross, Milla Sarah, Riedesel Erica

Keywords: Dual Energy, Trauma, Intracranial Hemorrhage

The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Ramirez Suarez Karen, Miranda Schaeubinger Monica, Barton Katherine, Riedesel Erica, Otero Hansel

Keywords: Pediatric, Imaging, Radiology

Over the last twenty years there has been a rapid expansion in the vast array of implantable cardiac devices utilized in pediatric patients. Imaging plays a key role in the management of patients with these devices. It is important for the pediatric radiologist to recognize the specific type of cardiac device visualized on radiographic images in order to make an accurate assessment of the appropriate position and any potential complications. With new cardiac devices entering the market it can be very perplexing and daunting for the radiologist to stay familiar with them all. We will seek to review old and new pediatric cardiac devices currently used at our institution and their radiographic appearance. These devices will be divided into categories of pacing devices, prosthetic heart valves, stents, closure devices, ventricular assist devices, extracorporeal membrane oxygenation systems (ECMO), and external monitoring devices. Pacing devices: a) Epicardial and transvenous pacing systems b) Leadless pacemakers Prosthetic heart valves: a) Surgically implanted valves b) Transcatheter valves Cardiac stents Closure devices: a) Patent ductus arteriosus closure device, b) Atrial septal defect closure device c) Vascular plugs and coils Ventricular assist devices: a) Left ventricular assist device, b) Right ventricular assist device, c) Bi-ventricular assist device Extracorporeal membrane oxygenation (ECMO) cannulas: a) Venous-arterial ECMO, b) Venous-venous ECMO External monitoring devices: a) Holter monitor, b) Loop recorder Read More

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

Authors: Dennison Chelsea, Taylor Susan, Wilson Hunter, Slesnick Timothy, Riedesel Erica

Keywords: Cardiac Devices, Radiograph

Demonstrate how a pediatric radiology division at a single institution structures short-interval feedback to residents. Describe how the division collects interval resident feedback. Demonstrate resident responses to this pilot program of instituting standardized weekly feedback. Read More

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

Authors: Gilyard Shenise, Dickson Paula, Loewen Jonathan, Richer Edward, Riedesel Erica, Tuburan Smyrna

Keywords: education, feedback, radiology resident

Demonstrate how the Pediatric Radiology Department at a single institution structures short-interval feedback to residents. Describe how the department collects short-interval feedback from residents regarding their experiences. Demonstrate resident responses to this pilot program of instituting standardized weekly feedback Read More

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

Authors: Gilyard Shenise, Dickson Paula, Loewen Jonathan, Richer Edward, Riedesel Erica, Tuburan Smyrna

Keywords: education, feedback, radiology resident

Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography. We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR. Read More

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

Authors: Bodner Jeffrey, Khanna Geetika, Riedesel Erica, Gill Anne, Hawkins Matt, Shah Jay, Variyam Darshan, Alazraki Adina

Keywords: Lymphatic, Lymphangiography, MR

Pediatric stomach tumors encompass a broad range of pathologies. These tumors are rare in the pediatric and adolescent population and can be easily misdiagnosed. In addition, approach to imaging diagnosis in this population may differ from adults. In this educational exhibit, we will focus on stomach tumors. This exhibit will provide viewers with: 1. A visual differential diagnosis of common and uncommon tumors in each section of the stomach with a focus on multi-modality imaging. 2. Review of common imaging findings for each tumor, highlighting high-yield characteristic findings of each. 3. Key findings and tips that can help the practicing radiologist differentiated between benign and malignant tumors. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Mulvey Tom, Gagnon Marie-helene, Richer Edward, Loewen Jonathan, Alazraki Adina, Khanna Geetika, Mitchell Sarah, Riedesel Erica

Keywords: Stomach, Tumor, Malignancy