Vaping is a recreational activity of inhaling heated liquid vapor from electronic cigarettes which has been increasingly used as an alternative to cigarettes. Common substances that may be used in the liquids include nicotine, tetrahydrocannabinol, cannabinoid oils and other additives. There is increasing concern about lung injury associated with vaping, especially in children. While a nascent body of literature is beginning to develop regarding this entity, further investigation from different geographic regions (with access to varying chemical profiles of vaping material) and in differing age populations is necessary to ascertain the imaging patterns of vaping associated lung injury. In this poster, we describe the imaging patterns of pediatric vaping associated lung injury we encountered in our institution. Although this is inherently a diagnosis of exclusion, we consider these imaging patterns strongly suggestive if there is a history of vaping and absence of other risk factors or preexisting disease. We observed the following imaging patterns of lung injury associated with vaping: <b>Chest radiograph findings:</b> 1) Normal. 2) Coarse bilateral interstitial opacities. 3) Pseudo pulmonary edema pattern: bilateral central predominant air space opacities with peripheral sparing. 4) Mixed pattern: combination of air space opacities and reticular opacities. <b>Various patterns of computed tomography findings: </b> 1) Bilateral central ground glass opacities (GGO). 2) Sub pleural sparing , in most of the cases. 3) Interlobular septal thickening in association with GGO - crazy paving pattern. 4) Lower lobe predominant thick subpleural parenchymal bands. 5) Scattered GGO without any lobar predominance - an atypical finding seen in one patient. 6) Mild bronchial wall thickening <b>Take home message: </b> - Bilateral central predominant ground glass opacities with lower lobe predominance and sub pleural sparing are the most consistent findings seen in most of the cases. The GGO show an anteroposterior (dependent) gradient of increasing attenuation. - Posterior dependent parenchymal bands were observed subjacent to subpleural spared lung parenchyma in several cases, a finding which has not been described previously to our knowledge. These parenchymal bands, in association with above mentioned findings, are highly suggestive of vaping associated lung injury in the appropriate clinical setting. - We have observed complete resolution of findings in at least two of the cases on short term followup. Read More

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

Authors: Krishnan Vijay, Schenker Kathleen, Saul David

Keywords: vaping, electronic cigarette

Congenital hepatic vascular shunts occur secondary to abnormal formation and aberrant communication of blood vessels during fetal development. This spectrum of anomalies can be challenging to diagnose without a strong understanding of their embryology and clinical and imaging manifestations. Ultrasound is among the most widely used modalities in pediatric imaging, given its real-time nature, easy portability and lack of radiation exposure. This case-based exhibit reviews ultrasound and doppler imaging findings of congenital vascular shunts in the pediatric liver. The broad categories of congenital hepatic vascular shunts include: arteriovenous (hepatic artery to hepatic vein), arterioportal (hepatic artery to portal vein), and portovenous (portal vein to hepatic vein). This exhibit starts by demonstrating the formation of normal hepatic vasculature during fetal development. This is followed by a discussion of embryological aberrations which lead to vascular shunts, clinical context of each anomaly (when to wait, worry or intervene), and the role of imaging in detection, quantification, prognostication and treatment of these anomalies. There are case presentations and discussion of the following vascular anomalies: extrahepatic portosystemic shunt (also known as Abernethy Malformation), intrahepatic portosystemic shunt, arterioportal fistula, intrahepatic arteriovenous malformation, patent ductus venosus, infradiaphragmatic total anomalous pulmonary venous return, and hepatic hemangioma. Illustrations and ultrasound/Doppler images are included for most of these cases. Besides providing a clinical and imaging review of anomalous hepatic vascular communications, this exhibit will reinforce an understanding of physiologic hepatic vascular shunts in fetal life and describe the sequence of successful transition to neonatal circulation. This understanding can be applied to clinical decision making. Supplemental Files- legends: 1. File 1: Hepatic vascular shunts. 2. File 2: Portosystemic shunt. Turbulent flow within an aberrant vessel connecting left portal to left hepatic vein. Flow pulsatility/triphasicity within the portal vein. 3. File 3: Intrahepatic Arteriovenous Malformation. Tangle of enlarged vessels within left liver lobe. High velocity, low resistance arterial waveforms and pulsatile venous flow. Read More

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

Authors: Chughtai Komal, Saul David, Chaturvedi Apeksha

Keywords: Arteriovenous malformation, Patent ductus venosus, Arterioportal fistula

Background: Dual source dual-energy CT scanners (DECT) has allowed for the collection of two data sets with a single scan, opening the potential for functional data acquisition. The technique combines two energy beams at distinct voltages applied concurrently during a single scanning phase. The source data can be combined to generate a single mixed composite image, or iodine can be subtracted to create a contrast map or a virtual non-contrast image. The result is functional information in the setting of decreased radiation dose when replacing a biphasic scan, or dose neutral when compared to conventional single source CT. Post processing lung perfusion software allows for imaging display (qualification) and quantification of iodinated contrast volumes in the lungs, a surrogate for lung perfusion. Purpose: This educational exhibit will demonstrate: 1. How to perform DECT in children, 2. How to use postprocessing software, and 3. How to interpret lung perfusion results through clinical examples of current pediatric clinical indications including pulmonary embolism, lung hypoplasia, pulmonary AV malformation, and pulmonary hypertension. Conclusion: Through this exhibit, readers will gain familiarity with technical aspects of DECT of the lungs in children, understand the basics of post processing and recognize focal or regional perfusion defects, segmented perfusion analysis, and focal lesion perfusion characteristics as well as identify future applications. Read More

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

Authors: Rapp Jordan, Saul David, Kaplan Summer, Barrera Christian, Otero Hansel

Keywords: dual energy, thoracic, perfusion

It is essential that budding pediatric radiologists have well-honed ultrasound (US) skills in order to provide correct image interpretation and excellent patient care. The lack of hands-on US experience is a critical gap in current radiology training. We sought to create an interactive, portable tool to remedy this issue. Read More

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

Authors: Retrouvey Michele, Saul David, Back Susan, Bellah Richard, Reid Janet

Keywords: App, Ultrasound, Resident

With advances in intensive care, increasing numbers of premature neonates with severe respiratory distress have led to major challenges related to prolonged mechanical ventilation and chronic bronchopulmonary dysplasia. Acute lung injury and acute respiratory distress syndrome in children still confer significant morbidity and mortality despite advances in ventilation and resuscitative therapies. Much of the damage attributed to mechanical ventilation in critically ill infants and children is due to surface tension and ventilation of atelectatic lung. First reported clinically in neonates in 1989, partial liquid ventilation involves the endotracheal administration of an inert volatile perfluorochemical liquid. These perfluorocarbons aid in gas exchange due to their large oxygen and carbon dioxide carrying capacity. In addition, these chemicals possess low surface tension that allows for greater alveolar recruitment and improved lung compliance through clearance of debris and secretions. Early trials in preterm neonates and neonates with congenital diaphragmatic hernia suggested a role for liquid ventilation as salvage therapy for patients not responding to conventional mechanical ventilation and extracorporeal membrane oxygenation. Currently, efforts are underway to reassess its clinical utility in bronchopulmonary dysplasia. With this renewed clinical interest, it is important for pediatric radiologists at institutions utilizing these perfluorocarbons to be familiar with the clinical use and radiographic appearance of liquid ventilation. Read More

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

Authors: Degnan Andrew, Biko David, White Ammie, Servaes Sabah, Otero Hansel, Fox William, Shaffer Thomas, Zhang Huayan, Saul David

Keywords: liquid ventilation, chest radiographs