Hepatic sinusoidal obstruction syndrome (SOS) - previously termed hepatic veno-occlusive disease (VOD) - is a serious cause of acute liver failure in patients undergoing hematopoietic cell transplantation (HCT). Hepatic SOS results from injury to the hepatic venous endothelium during intensive myelopablative chemotherapy or radiation therapy prior to HCT. Endothelial injury eventually leads to fibrous obliteration of the terminal hepatic venules with sinusoidal obstruction, hepatocyte necrosis, and hemorrhage, typically seen in the first 3-6 weeks post-transplant. Early identification of this disease process is critical given high incidence of multi-organ failure and significant morbidity and mortality. Ultrasound is extremely valuable in accurate early diagnosis as imaging findings often precede clinical signs of disease. Spectrum of findings on gray-scale ultrasound includes hepatomegaly, heterogeneous hepatic parenchymal echotexture, ascites, and gallbladder wall thickening. Findings on Doppler ultrasound - increased mean hepatic artery resistive index (RI) and decreased or reversed portal venous flow - are highly sensitivie for hepatic SOS. In this education exhibit we will review the epidemiology and pathophysiology of hepatic sinusoidal obstruction syndreom (SOS) and discuss imaging findings that aid in accurate diagnosis. Special attention will be given to Doppler ultrasound findings and additional diagnostic information provided by B-flow Doppler ultrasound. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Shore Matthew, Riedesel Erica

Keywords: Hepatic Sinusoidal Obstruction Syndrome, Doppler Ultrasound, B-flow Ultrasound, Educational Exhibit

Currarino’s Syndrome (CS) is a unique form of caudal regression syndrome characterized by triad of sacral dysplasia, anorectal malformation, and presacral mass. Additional congenital malformations of the genitourinary tract and spine may be present. Currarino's Syndrome has a variety of clinical presentations - from asymptomatic to severe chronic constipation - depending on associated malformations. Early identification and adequate treatment prevents eventual serious complications. Plain radiograph of the sacrum is the first diagnostic step. Ultrasound or pelvic/spinal MRI is used to better evaluate for presacral mass. Fluoroscopic enema studies may be used for further evaluation of anorectal malformation. Additional imaging of the GU tract with US and VCUG is suggested due to risk for associated GU anomaly or vesicoureteral reflux. We present two cases of Currarino’s Syndrome which demonstrate classic imaging findings on plain film radiograph, ultrasound, and MRI. Case 1 presented in infancy with severe chronic constipation. Abdominal radiograph demonstrated classic "scimitar" sacrum. Fluoroscopic enema demonstrated high grade anal stenosis. US and MRI of the spine and sacrum revealed large anterior sacral meningocele. Case 2 presented at birth with imperforate anus. Abdominal radiograph demonstrated classic "scimitar" sacrum. MRI of the spine and sacrum revealed small anterior sacral meningocele. Additional GU anomalies were discovered including vesicoureteral reflux and uterine didelphis. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Wepking Kelly, Gill Kara, Riedesel Erica

Keywords: Currarino's Triad, Sacral dysplasia, Presacral mass, Anorectal malformation, Case Report

1. Cervical lymphadenopathy is common in the pediatric population and is associated with a wide range of pathologies. 2. Ultrasound evaluation plays a critical role in distinguishing benign versus malignant etiologies. 3. Ultrasound characteristics can guide further management and potential interventions. Case Discussion: 1. Normal cervical lymph nodes 2. Primary lymphoproliferative disorders 3. Metastatic disease 4. Granulomatous lymphadenitis 5. Reactive lymphadenopathy Read More

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

Authors: Mrak Lara, Riedesel Erica, Maxfield Bradley, Gill Kara

Keywords: Lymph Nodes