Bone dysplasias comprise a group of congenital disorders characterized by anomalies in the development or texture of bone and cartilage, which can cause significant morbidity and mortality. Achondroplasia is the commonest bone dysplasia associated with rhizomelic dwarfism and is non-lethal. Other commonly encountered bone dysplasias include pseudoachondroplasia, hypochondroplasia, the mucopolysaccharidoses as well as disorders of disorganized bone development (i.e. diaphyseal aclasia, Trevor disease, enchondromatosis) and of abnormal bone density (i.e osteogenesis imperfecta, osteopetrosis, osteopoikilosis, osteopathia striata and melorheostosis). The radiological diagnosis of bone dysplasias relies heavily on pattern recognition of established skeletal changes, which is often made on plain radiographs or skeletal survey. Whilst the radiographic features of bone dysplasias are generally well described in the axial and appendicular skeleton, its appearances in the lower limb, particularly of the foot and ankle, are usually less conspicuous compared to the rest of the skeleton. Moreover, the radiographic features may also overlap between dysplasia subtypes or mimic metabolic conditions. As such, accurate detection of these features can be challenging. Hence, knowledge and recognition of the radiographic features of bone dysplasias and its mimics presenting in the foot and ankle is crucial in aiding timely diagnosis, especially when interpreted together with other skeletal changes occurring elsewhere. Moreover, as bone dysplasias may be associated with other congenital disorders, radiologists play an essential role in directing further investigations for definitive diagnosis. Thus, the purpose of this educational exhibit is to review and familiarize radiologists with the radiographic features and pattern recognition of commonly encountered bone dysplasias occurring in the paediatric foot and ankle, so as to guide appropriate management, aimed at preventing disabling deformities.The radiographic features of the above conditions presenting in the paediatric foot and ankle will be discussed and illustrated. Read More

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

Authors: Tan Timothy Shao Ern, Teo Eu Leong Harvey James

Keywords: Bone Dysplasia, Foot, Ankle

Hemophilia is an inherited bleeding disorder occurring mainly in males. Bleeding in these patients may occur acutely in different and unusual locations throughout the body, sometimes with life-threatening consequences. Repeated bleeding episodes may cause chronic manifestations, frequently resulting in severe morbidity to the patient. The most common manifestation of the disease is acute hemorrhage into joints causing hemarthrosis. This usually affects large joints such as the knee, elbow, ankle, hip and shoulder. Repeated episodes can lead to pannus formation with destruction of the synovium, cartilage and subchondral bone resulting in a condition known as hemophilic arthropathy. In the long term, this may result in debilitating chronic pain and contractures. Soft tissue hematomas are another frequent manifestation of the disease. Chronic, organized hematomas are also known as hemophilic pseudotumours. These lesions may become calcified or infected and may result in bone erosion with pathological fractures. Bleeding may occur in other parts of the body such as the brain and spine causing acute stroke with subsequent seizures and neurological deficits. Intra-abdominal bleeding into the abdominal cavities and intramural bleeding into the genitourinary or gastrointestinal walls may rarely occur. It is hence important for radiologists and clinicians to recognize these complications in order to detect and treat these conditions in a timely manner. The aim of this exhibit is to familiarize readers with the imaging features of acute and chronic bleeding complications in hemophilia patients, highlighting unusual locations in the body where these can occur, using multimodality imaging i.e. Plain radiographs, ultrasound, CT and MRI. Read More

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

Authors: Tan Timothy Shao Ern, Teo Eu Leong Harvey James

Keywords: Hemophilia, Bleeding, Hemarthrosis

Vascular anomalies are commonly encountered in paediatrics, often presenting as clinically palpable superficial lesions, and may be associated with an underlying syndrome or congenital disease. According to the ISSVA classification, vascular anomalies are broadly categorized into proliferating vascular tumours and vascular malformations. Vascular tumours may be benign (infantile and congenital haemangiomas), locally aggressive (kaposiform hemangioendothelioma) and malignant (angiosarcoma). Vascular malformations are further subdivided into high-flow (e.g. arterio-venous malformations or fistulas), low-flow (capillary, venous and lymphatic malformations) and complex combined malformations. Ultrasound is usually the first-line imaging modality of choice to evaluate these lesions, particularly in children, due to its advantages such as excellent superficial spatial resolution, lack of ionizing radiation, negating any need for sedation, wide availability, low-cost and ability to assess vascularity and flow dynamics. Moreover, ultrasound is also useful in detecting complications, guiding further work-up and can be used for routine follow-up after treatment. Transducer selection is typically determined by lesion size and depth. However, mixed complex vascular malformations and deep extensive lesions, particularly those located in poorly accessible regions (e.g. near bony or air-filled structures) may not be well delineated on ultrasound and further evaluation with cross-sectional imaging, usually magnetic resonance imaging/angiography, would be warranted. The goals of this educational exhibit are to review and familiarize radiologists with the ISSVA classification as well as clinical and imaging features of commonly encountered soft tissue vascular anomalies occurring in children, with emphasis on the utility of ultrasound as a useful diagnostic tool. Sonographic and clinical features of the above mentioned conditions will be illustrated and reviewed. Read More

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

Authors: Tan Timothy Shao Ern, Teo Eu Leong Harvey James

Keywords: Vascular Anomalies, Hemangioma, Ultrasound

Bowel obstruction in newborns are divided into high and low obstruction. High obstruction occurs before the proximal jejunum and comprise congenital causes including: atresia of the esophagus, stomach, duodenum or jejunum, duodenal stenosis from annular pancreas, duodenal web, malrotation without or without midgut volvulus and congenital abdominopelvic cysts or masses. Low obstruction occurs distal to the proximal jejunum and consist of congenital causes such as ileal and colonic atresia, anorectal malformation, Hirschsprung’s diseasem, congenital abdominopelvic cysts or masses. Other causes include meconium ileus or functional immaturity of the colon. Bowel obstruction in older neonates and children includes congenital causes such as Meckel’s diverticulum, malrotation, congenital hernia as well as inflammatory conditions such as appendicitis and Inflammatory bowel disease. Other causes include hypertrophic pyloric stenosis, intussusception, adhesions, sigmoid volvulus and ingested foreign bodies. Plain radiographs are often the first-line imaging modality for neonates and children presenting with suspected gastrointestinal pathology. A comprehensive radiographic approach along with sound knowledge of the common causes and imaging features of bowel obstruction in the various pediatric demographics will help facilitate timely and appropriate management and also prevent unnecessary further investigations. Additionally, differentiating between high and low bowel obstruction will help guide the next step in management. The purpose of this education exhibit are to: 1. Review normal and abnormal bowel gas pattern on plain radiographs and associated intepretation pitfalls in newborns, older neonates and children. 2. Familiarise radiologists with common causes and radiographic features of bowel obstruction in newborns, older neonates and children. Illustrative cases for the above conditions will be shown. Relevant further investigations are also discussed. Read More

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

Authors: Tan Timothy Shao Ern, Tan Eelin

Keywords: Obstruction, Neonate, Meconium

Congenital coronary artery (CA) anomalies can be classified into abnormalities pertaining to origin, course and termination, which can serve as important prognostic factors. Some of these anomalies are asymptomatic with a benign clinical course, while others can give rise to symptoms of chest pain and even sudden death (e.g. malignant interarterial CA course). Acquired CA abnormalities such as coronary arterial aneurysms associated with Kawasaki disease may result in thrombi development, necessitating a change in patient management. Early and accurate diagnosis of these abnormalities is therefore crucial but can be technically challenging owing to the small size of the coronary arteries, rapid heart rate, and limited cooperation of children. Whilst the proximal aspect of the coronary arteries can be visualized with echocardiography, computed tomography angiography (CTA) provides a more comprehensive assessment of the coronary arteries even without ECG-triggering. Moreover, CTA offers the flexibility of customizing acquisition parameters for the individual patient. As such, CTA is rapidly becoming the imaging modality of choice for evaluating complex congenital and acquired CA abnormalities in children. The aims of this educational exhibit are to review the embryology of coronary arteries, outline congenital and acquired CA abnormalities, and discuss the utility of optimizing low-dose CTA to evaluate these abnormalities in children. Determining the origin and course of CAs is key for pre-operative planning in some types of congenital heart disease, for example, the arterial switch procedure for transposition of great arteries and in Taussig Bing anomaly. Identifying the malignant interarterial intramural CA course can be lifesaving. Evaluating for co-existing abnormalities, such as CPAM, is also an integral part of these studies. Read More

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

Authors: Tan Timothy Shao Ern, Woon Tian Kai, Fortier Marielle

Keywords: Coronary artery, Computed tomography, Aneurysm