Society for Pediatric Radiology – Poster Archive
Technologist Posters - Case Report
Technologist Posters - Case Reports
Stanley Parker, Stanley Charles
Final Pr. ID: Poster #: CR-001 (T)
Superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is an obscure condition in which an acute angulation between the aorta and SMA leads to compression of the third part of the duodenum. Subsequently, patients typically present with a constellation of gastrointestinal findings that closely resemble small bowel obstruction, early satiety, and anorexia. SMA syndrome is most often observed in the setting of rapid weight loss, wasting conditions, and corrective spinal surgeries, where a decrease in retroperitoneal fat diminishes the cushion between the aorta and SMA, causing vascular compression of the duodenum. Diagnosis of SMA syndrome is one of exclusion and is based on the combination of highly suspicious clinical findings and confirmatory diagnostic imaging evidence of obstruction. Upper GI Fluoroscopy can demonstrate a dilated first and second portion of the duodenum, with compression of the third portion, and delayed passage of contrast past midline. Ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) enable measurement of the aortomesenteric angle and distance, with normal values ranging from 25-60° and 10-28mm, respectively, and values indicative of SMA syndrome ranging from 6-15° and 2-8mm, respectively.
We present a classic case of SMA syndrome in a 15-year-old patient. The patient presented with clinical symptoms consisting of scoliosis, chronic nausea and vomiting, weight loss, and anorexia. The patient then underwent Upper GI Fluoroscopy which demonstrated duodenal dilatation and delayed contrast transit past midline, achieved only after prolonged decubitus and prone positioning. Subsequently, abdominal ultrasound demonstrated an aortomesenteric angle of 10-18° and an aortomesenteric distance of 5 mm. Lastly, abdominal MRI demonstrated an aortomesenteric angle of 15° and an aortomesenteric distance of 3 mm, corroborating the ultrasound findings and confirming the diagnosis of SMA syndrome. The patient was initiated on nutritional support and at most recent follow-up was responding well to conservative treatments.
Read More
Authors: Stanley Parker, Stanley Charles
Keywords: SMA Syndrome , Ultrasound , MRI
Final Pr. ID: Poster #: CR-002 (T)
Gadolinium, a type of MRI contrast is typically used when imaging pediatric cardiac patients. Gadolinium enhances the images to give more clarity to the radiologists when distinguishing normal tissue from abnormal tissue. Further, contrast also allows for better visualization of the great vessels.
Gadolinium alters the magnetic properties of nearby water molecules in the tissue. While contrast itself does not alter the tissue composition, it does affect how the scanner takes the picture. Accordingly, images can differ between pre- and post-contrast administration. While IV contrast can be administered safely, it is not without logistic implications and/or risks.
MRI contrast can be given to pediatric cardiac patients intravenously, but IV access is oftentimes challenging in pediatric cardiac patients. In an effort to reduce the number of unsuccessful IV attempts and quantity of contrast administered, a novel non-contrast MR sequences is being utilized to better depict the great vessels in these children. If IV access is unsucessful or the patient cannot complete the MRI, this modality is employed to obtain more information on the patient's cardiact vasculature.
This purpose of this case report paper is to show the MR imaging when using a non-contrast sequence to identify cardiac vessels in pediatric patients who cannot recieve IV contrast.
Read More
Authors: Bryant Audrey, Kandil Ali
Keywords: Pediatric , Contrast , Vasculature
Final Pr. ID: Poster #: CR-003 (T)
Pediatric scrotal ultrasound pathology can be difficult because of the similar presentation of different pathology such as scrotal torsion, epididymitis, inguinal hernia, epididymal appendix torsion, and trauma. Identifying key factors of each condition is paramount to providing a clear diagnostic picture in the setting of an atypical presentation of any pathology.
Epididymitis is an inflammatory process precipitated by bacterial or viral infections. Symptoms typically present as increasing scrotal pain with swelling of the epididymis. Depending on degree of severity imaging presentation can mimic other pathology.
A 5 year old male transferred to a pediatric facility from an area hospital to assess suspected incarcerated hernia with outside CT and ultrasound images.
Read More
Authors: Durfee Teela, Cielma Tara
Keywords: epididymitis , pediatric scrotal Ultrasound , Acute scrotal pain
Final Pr. ID: Poster #: CR-002 (T)
Gadolinium, a type of MRI contrast is typically used when imaging pediatric cardiac patients. Gadolinium enhances the images to give more clarity to the radiologists when distinguishing normal tissue from abnormal tissue. Further, contrast also allows for better visualization of the great vessels.
Gadolinium alters the magnetic properties of nearby water molecules in the tissue. While contrast itself does not alter the tissue composition, it does affect how the scanner takes the picture. Accordingly, images can differ between pre- and post-contrast administration. While IV contrast can be administered safely, it is not without logistic implications and/or risks.
MRI contrast can be given to pediatric cardiac patients intravenously, but IV access is oftentimes challenging in pediatric cardiac patients. In an effort to reduce the number of unsuccessful IV attempts and quantity of contrast administered, a novel non-contrast MR sequences is being utilized to better depict the great vessels in these children. If IV access is unsucessful or the patient cannot complete the MRI, this modality is employed to obtain more information on the patient's cardiact vasculature.
This purpose of this case report paper is to show the MR imaging when using a non-contrast sequence to identify cardiac vessels in pediatric patients who cannot recieve IV contrast.
Read More
Authors: Bryant Audrey, Kandil Ali
Keywords: Pediatric , Contrast , Vasculature
Final Pr. ID: Poster #: CR-003 (T)
Pediatric scrotal ultrasound pathology can be difficult because of the similar presentation of different pathology such as scrotal torsion, epididymitis, inguinal hernia, epididymal appendix torsion, and trauma. Identifying key factors of each condition is paramount to providing a clear diagnostic picture in the setting of an atypical presentation of any pathology.
Epididymitis is an inflammatory process precipitated by bacterial or viral infections. Symptoms typically present as increasing scrotal pain with swelling of the epididymis. Depending on degree of severity imaging presentation can mimic other pathology.
A 5 year old male transferred to a pediatric facility from an area hospital to assess suspected incarcerated hernia with outside CT and ultrasound images.
Read More
Authors: Durfee Teela, Cielma Tara
Keywords: epididymitis , pediatric scrotal Ultrasound , Acute scrotal pain
Stanley Parker, Stanley Charles
Final Pr. ID: Poster #: CR-001 (T)
Superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is an obscure condition in which an acute angulation between the aorta and SMA leads to compression of the third part of the duodenum. Subsequently, patients typically present with a constellation of gastrointestinal findings that closely resemble small bowel obstruction, early satiety, and anorexia. SMA syndrome is most often observed in the setting of rapid weight loss, wasting conditions, and corrective spinal surgeries, where a decrease in retroperitoneal fat diminishes the cushion between the aorta and SMA, causing vascular compression of the duodenum. Diagnosis of SMA syndrome is one of exclusion and is based on the combination of highly suspicious clinical findings and confirmatory diagnostic imaging evidence of obstruction. Upper GI Fluoroscopy can demonstrate a dilated first and second portion of the duodenum, with compression of the third portion, and delayed passage of contrast past midline. Ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) enable measurement of the aortomesenteric angle and distance, with normal values ranging from 25-60° and 10-28mm, respectively, and values indicative of SMA syndrome ranging from 6-15° and 2-8mm, respectively.
We present a classic case of SMA syndrome in a 15-year-old patient. The patient presented with clinical symptoms consisting of scoliosis, chronic nausea and vomiting, weight loss, and anorexia. The patient then underwent Upper GI Fluoroscopy which demonstrated duodenal dilatation and delayed contrast transit past midline, achieved only after prolonged decubitus and prone positioning. Subsequently, abdominal ultrasound demonstrated an aortomesenteric angle of 10-18° and an aortomesenteric distance of 5 mm. Lastly, abdominal MRI demonstrated an aortomesenteric angle of 15° and an aortomesenteric distance of 3 mm, corroborating the ultrasound findings and confirming the diagnosis of SMA syndrome. The patient was initiated on nutritional support and at most recent follow-up was responding well to conservative treatments.
Read More
Authors: Stanley Parker, Stanley Charles
Keywords: SMA Syndrome , Ultrasound , MRI