<u>History </u> 15 y/o female with congenital glaucoma presents to the emergency room with right eye pain, redness and swelling. She has baseline corneal opacifications and can see light and shadows but is otherwise visually impaired. The symptoms started 2 weeks prior foreign body sensation her right eye. Antibiotic drops were prescribed but symptoms continued to worsen. A week later another topical antibiotic was added but the eye began to swell, have increased pain, and developed discharge. Her opthomalogist referred her to the ER with concern of endophthalmitis (serious intraocular infection that affects the vitreous and/or aqueous humors of the eye). Read More

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

Authors: Riemann Monique, Bell Denise

Keywords: ultrasound, orbits, cellulitis

Retinoblastoma is an aggressive malignant tumor and the most common malignant intraocular tumor in children. The key to better treatment is early detection, before it metastasizes. We aim to provide better quantifiable measurements to assist the clinician in the evaluation of tumor response. Currently, 2D sonography is performed to confirm the diagnosis, and after each sequential treatment. Thus, a change in tumor size during treatment is made by 2D evaluation only. Three-dimensional (3D) ultrasonography is an enhancement of the ultrasonographic technique that allows an examiner to obtain, non-invasively, 3D volumetric images. 3D ultrasound imaging is primarily performed in the Ob/Gyn setting. However, more and more it is being used for other areas of the body. We think that 3D technology may be particularly useful since retinoblastomas can have very irregular shapes and, therefore, simpler techniques to estimate volumes such as the performance of three orthogonal two-dimensional measurements multiplied by 0.523 to estimate the volume of an oval structure using the ellipsoid formula may be unreliable. We present several case studies performed at our institution with a developed protocol for such imaging along with the results of the study. Read More

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

Authors: Riemann Monique, Goncalves Luis, Ramasubramanian Aparna, Abruzzo Todd

Keywords: orbital, 3D, retinoblastoma

PFV is a rare congenital orbital malformation in which there is failure of the hyaloid artery to regress causing a persistent vasculature within the vitreous portion of the eye. Patients present with leukocoria that can be unilateral or bilateral. The most concerning differential diagnosis is retinoblastoma. We present three case studies referred for evaluation to exclude retinoblastoma in which MFI assisted in making the diagnosis of PFV. Imaging was perfomed with a high frequency linear array transducer and established preset in accordance with FDA guidelines. When characterizing orbital masses, early and accurate diagnosis is crucial to the patient’s prognosis. Ultrasound can be a superior method due to its ability to visualize superficial structures and detect slow velocity blood flow. While CD and SD are able to determine direction and velocity of flow, MFI improves the sensitivity and ability to display microvascularities. Case 1 Three-month-old male with right eye leukocoria. Ultrasound demonstrated smaller right than left globe. A triangular retrolental amorphous and heterogeneous soft tissue mass was present. A mass with fibrovascular stalk containing a persistent hyaloid artery was observed with layering debris. Left orbit was normal. Findings consistent with right PFV. Case 2 Six-week-old female with left eye leukocoria. Ultrasound demonstrated a normal right globe. The left globe had a hyperechogenic triangular mass extending from the posterior margin of the lens to the optic nerve. A persistent hyaloid artery was noted. The posterior margin of the lens was irregular. A small amount of subretinal fluid over lied the optic nerve. Findings consistent with left PFV. Case 3 Newborn male with microphthalmia and possible cataractous lens. Ultrasound demonstrated right globe with lens intact, anechoic and normally located. A hyperechogenic mass with ill-defined borders extends from the posterior aspect of the lens to the retina along the central aspect of the globe. No calcifications were observed. Blood flow noted within a persistent hyaloid artery. The triangular portion of the mass attached to the lens also demonstrated increased microvascularity. Left globe with intact lens which was anechoic and normally located. Evaluation of the left posterior chamber demonstrates a similar-appearing mass with a persistent hyaloid artery. Findings consistent with bilateral PFV. Read More

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

Authors: Riemann Monique, Bisbing Brecken, Goncalves Luis, Ramasubramanian Aparna

Keywords: orbital, persistent fetal vasculature, micro flow imaging

Slipping Rib Syndrome (SRS) is a condition that affects adolescents and young adults. Dynamic Ultrasound imaging has a potential and likely significant role; however, limited data exists describing the protocol and techniques available for evaluating SRS. It is the intent of this study to describe the development of an effective and reproducible protocol for dynamic imaging in patients with SRS. Read More

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

Authors: Van Tassel Dane, Riemann Monique, Mcmahon Lisa, Barnes Craig, Wong Kevin

Keywords: Slipping Rib, Dynamic Ultrasound, Ultrasound

Approximately 800 children in the United States undergo renal transplant each year. Allograft failure is driven by interstitial fibrosis often due to chronic antibody mediated rejection. Renal biopsy is the gold standard to detect allograft dysfunction but limited by sampling error and inherent procedural and anesthesia risk. Ultrasound shearwave elastography (US-SWE) is a non-invasive imaging technique that assesses the mechanical stiffness of tissue. The primary aim of this study was to examine the relationship between US-SWE values, pathologic fibrosis/rejections scores and serology in pediatric recipients of renal transplant. Read More

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

Authors: Riemann Monique, Bailey Smita, Angadi Siddhartha, Biyyam Deepa, Turman Martin

Keywords: ultrasound, elastography, pediatric renal transplant