Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-002

Left ventricular diverticulum is an uncommon congenital malformation defined as a localized, contractile outpouching of the ventricular wall. It must be carefully distinguished from acquired ventricular aneurysm or pseudoaneurysm, as the diagnostic implications, management strategies, and long-term prognosis differ substantially.

A 2-month-old infant was referred for advanced imaging after transthoracic echocardiography raised concern for an abnormal left ventricular contour. Cardiac CT and MRI confirmed a discrete outpouching along the basal to mid anterolateral wall, measuring approximately 2.1 cm in maximal diameter, with a neck dimension of 13–14 mm. Myocardium was clearly present overlying the outpouching, and the structure demonstrated preserved systolic contractility synchronous with the adjacent ventricular wall. No evidence of wall thinning, akinesia, dyskinesia, or delayed gadolinium enhancement was identified. Global biventricular function was preserved, and coronary anatomy was normal.
The initial impression suggested a basal anterolateral LV aneurysm; however, the morphological and functional features, including intact myocardial layers and preserved contraction, were more consistent with a congenital LV diverticulum. Importantly, the absence of clinical history of ischemic, inflammatory, or traumatic insult supported this conclusion.
The key differential diagnoses include congenital LV diverticulum, true aneurysm, and pseudoaneurysm. Congenital diverticula are contractile and narrow-necked, maintaining myocardial continuity. True aneurysms typically follow myocardial infarction or myocarditis and demonstrate dyskinesia and wall thinning. Pseudoaneurysms result from contained rupture, are characterized by absent myocardial continuity, and frequently have a wide neck. Careful assessment of wall, contractility, and enhancement characteristics are essential for accurate classification.
On follow-up echocardiogram imaging, the diverticulum remained stable in morphology and size, without evidence of thrombus formation or functional deterioration. Conservative management with periodic surveillance was advised.
This case underscores the importance of multimodality imaging in ventricular outpouchings, demonstrating how contractile morphology and myocardial integrity support the diagnosis of congenital LV diverticulum. Precise differentiation from acquired lesions prevents misclassification, informs prognosis, and guides appropriate long-term management. Read More

Authors:  Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Keywords:  Cardiac CTA ,  Cardiovascular ,  Congenital

Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Final Pr. ID: Poster #: CR-004

Transposition of the great arteries (TGA) is typically described using the prefixes “D” and “L,” based on the position of the aortic root relative to the pulmonary trunk. In current practice, these prefixes are often applied as shorthand to define specific segmental combinations, such as “D-TGA” for concordant atrioventricular and discordant ventriculo-arterial connections, or “L-TGA” for congenitally corrected variants. However, atypical and mirror-image cases challenge the accuracy of this prefix-based terminology and highlight the need for full segmental description.

A 4-year-old boy with a background of complex congenital heart disease presented for follow-up evaluation prior to surgical intervention. He had a known history of mirror-imaged visceral arrangement and had previously undergone a bidirectional Glenn shunt for palliation of pulmonary atresia, ventricular septal defect, and atrial septal defect. Cardiac computed tomography revealed mirror-imaged atrial arrangement, with the morphologic right atrium located on the left and the morphologic left atrium on the right. The thoraco-abdominal organs were similarly reversed, including a left-sided liver and right-sided stomach and spleen. The ventricles showed D-looping with right-handed topology, with the morphologic right ventricle on the right and morphologic left ventricle on the left. The aorta arose discordantly in a rightward and anterior position relative to the pulmonary trunk, consistent with transposition physiology in this mirror-image setting.
This case demonstrates the limitations of relying solely on “D” and “L” prefixes. In this patient, the aortic root position was consistent with “D-TGA” in its original spatial sense, yet the overall physiology was that of congenitally corrected transposition due to the underlying atrioventricular and ventriculo-arterial connections. Describing the case simply as “D-TGA” would be misleading and risk miscommunication in clinical and surgical planning.
This report emphasizes that accurate diagnosis and classification of TGA require comprehensive segmental analysis, including atrial arrangement, ventricular topology, and the nature of atrioventricular and ventriculo-arterial connections. The position of the aorta should be reported separately rather than equated with transposition type. Recognition of these principles is essential to avoid confusion and ensure clarity in the management of complex and mirror-image variants of congenital heart disease. Read More

Authors:  Priya Sarv,  Narayanasamy Sabarish,  Nagpal Prashant

Keywords:  Cardiac CTA ,  Complex Congenital Heart Disease ,  Cardiovascular

Castro Coria Maria,  Castrillon Macarena,  Kaplan Julio,  Dardanelli Esteban,  Prati Yanet,  Mackintosh Cecilia,  Orozco Maria,  Dujovne Noelia,  Santa Cruz Carina

Final Pr. ID: Poster #: CR-007

The incidence of thyroid nodules in the pediatric population is low, ranging from approximately 0.5% to 5%. The risk of malignancy is higher than in adults.
ultrasound is considered the “gold standard” for an accurate and reliable evaluation of thyroid nodules, identifying predictors of malignancy.
Epidermoid cysts (EC) can be distinguished from dermoid cysts, and EC are extremely rare with fewer than 20 cases reported, only two of them involved pediatric patients.
Due to the content of keratin and squamous cells, the epidermoid cyst may present a solid ultrasound appearance with echogenic punctiform images that could simulate calcifications, even in the color Doppler examination it could present scintillation artifact. Therefore, cytologic evaluation is essential in the diagnosis, and shows sheets of anucleated squamous cells mixed with few nucleated ones with absence of cellular atypia, granuloma or thyroid epithelial cells Read More

Authors:  Castro Coria Maria,  Castrillon Macarena,  Kaplan Julio,  Dardanelli Esteban,  Prati Yanet,  Mackintosh Cecilia,  Orozco Maria,  Dujovne Noelia,  Santa Cruz Carina

Keywords:  Thyroid

Robles Morales Carlos,  Carmant Laurence,  Amirabadi Afsaneh,  Shinar Shiri,  Miller Elka

Final Pr. ID: Poster #: CR-010

Fetal anemia is a severe condition with diverse etiologies that can lead to complications, including fetal hypoxia, heart failure, hydrops fetalis and intrauterine fetal death if left untreated. In severe cases, intrauterine transfusion (IUT) is a life-saving intervention. The impact of fetal anemia on brain development remains unclear. This study aimed to evaluate neuroimaging findings in fetuses diagnosed with anemia using magnetic resonance imaging (MRI). Read More

Authors:  Robles Morales Carlos,  Carmant Laurence,  Amirabadi Afsaneh,  Shinar Shiri,  Miller Elka

Keywords:  Anemia ,  Fetal Imaging ,  MRI Brain

Buras Megan,  Mulliken Dolores,  Pennino Adriana,  Rooks Veronica,  Marcelo Karina,  Fong Brandon,  Carlson Terri,  Wilson Tina,  Stewart J Alex,  Husson Christopher

Final Pr. ID: Poster #: CR-011

Illustrate radiological manifestations and clinical course from benign to severe subgaleal processes, highlighting the crucial role of advanced imaging in diagnosis, management, and outcome prediction. Read More

Authors:  Buras Megan,  Mulliken Dolores,  Pennino Adriana,  Rooks Veronica,  Marcelo Karina,  Fong Brandon,  Carlson Terri,  Wilson Tina,  Stewart J Alex,  Husson Christopher

Keywords:  Head And Neck ,  Scalp ,  Child

Mousa Abeer,  Perez Rachel,  Goncalves Luis

Final Pr. ID: Poster #: CR-012

Congenital high airway obstruction syndrome (CHAOS) is a rare but life-threatening fetal condition resulting from obstruction of the fetal upper airway, most commonly due to laryngeal or tracheal atresia. Accurate prenatal diagnosis is critical for perinatal management and potential surgical planning, including consideration of an ex utero intrapartum treatment (EXIT) procedure. While ultrasound is typically the initial modality for detection, fetal MRI provides superior anatomic detail and plays an increasingly important role in confirming the diagnosis, assessing the level and extent of obstruction, and evaluating associated anomalies.

In this case series, we present fetal MRI findings from four cases of CHAOS, each diagnosed in the second trimester. MRI demonstrated hallmark features including bilaterally enlarged, hyperintense lungs on T2-weighted images, flattened or inverted diaphragms, central compression of the heart, and dilated airways distal to the point of obstruction. Associated anomalies, including ascites and hydrops fetalis, were variably present. In all cases, MRI provided critical information for determining the severity and level of obstruction, distinguishing CHAOS from other causes of airway obstruction or other thoracic masses such as congenital pulmonary airway malformation (CPAM), and aiding multidisciplinary decision-making regarding delivery planning and neonatal resuscitation.

This case series underscores the diagnostic value of fetal MRI in the evaluation of CHAOS and highlights key imaging features that can facilitate accurate prenatal diagnosis. Early and precise recognition of this rare condition allows for appropriate counseling of expectant parents and coordination of specialized perinatal interventions that may improve neonatal outcomes. Read More

Authors:  Mousa Abeer,  Perez Rachel,  Goncalves Luis

Keywords:  Fetal ,  Airway ,  Atresia

Elhefnawi Yara,  Atasoy Duygu,  Herliczek Thaddeus,  Lee Edward,  Larosa Michelle,  Tivnan Patrick

Final Pr. ID: Poster #: CR-014

Malignant atrophic papulosis (MAP), also known as Degos disease, is an exceedingly rare chronic and progressive thrombo-obliterative vasculopathy with only about 200 reported cases worldwide. MAP can present in two forms: (1) a benign skin limited form characterized by pathognomonic skin lesions, or (2) more malignant systemic form that involves thrombo-obliterative vasculopathy of visceral organs; most commonly the gastrointestinal tract, specifically the small bowel. It can also involve the brain, heart, kidneys, or lungs. Visceral MAP is potentially life-threatening and warrants prompt identification and management. Our case is a 17-year-old female presenting to the emergency department with several days of fever, abdominal pain, and vomiting. Additionally, she reported unintentional weight loss and 1 year of generalized rash unresponsive to treatment for presumed Impetigo. Ultrasound revealed moderate ascites. A dermatology consultation including a punch skin biopsy diagnosed MAP for which she was admitted. CT of the abdomen and pelvis revealed diffuse small bowel inflammation, moderate volume complex ascites and small pleural effusion. Brain MRI showed findings concerning for small vessel vasculopathy. Medical treatment for MAP was initiated. Despite initial improvement on medical management and peritoneal drainage, her condition worsened with fever, pain and bilious emesis. Other infectious etiology were investigated and excluded. Surveillance CT persistent small bowel inflammation and dilation in keeping with ileus, pneumatosis intestinalis, and worsening signs of peritonitis without bowel obstruction. Pneumoperitoneum foci were present, at least partially attributable to paracentesis versus perforation. Subsequent bilious drainage from an indwelling peritoneal catheter warranted diagnostic laparoscopy. Small bowel inflammation and yellow serosal lesions characteristic of the MAP ulcers were identified in the operative suite. Additionally, focal ileal perforation was identified and repaired. Her MAP was managed via immunomodulation and she gradually recovered during her lengthy hospital stay. Her brain MRI findings resolved. However, she developed cardiac symptoms, and a cardiac MRI demonstrated reduced LV systolic function without late gadolinium enhancement. She remains hospitalized for management of her cardiac condition. Our case illustrates findings of this rare entity over serial abdominal CT and brain MRI. Read More

Authors:  Elhefnawi Yara,  Atasoy Duygu,  Herliczek Thaddeus,  Lee Edward,  Larosa Michelle,  Tivnan Patrick

Keywords:  Vasculopathy ,  Gastrointestinal ,  Perforated

Buyukkaya Ayla,  Zawin Joan

Final Pr. ID: Poster #: CR-015

Menetrier’s Disease is a rare form of hypertrophic gastropathy characterized by excessive mucous secretion, protein loss, and enlarged gastric folds. It poses a diagnostic challenge due to its nonspecific clinical presentation and is often misdiagnosed as more common gastric disorders. Although more prevalent in adults, pediatric cases—frequently associated with cytomegalovirus (CMV) infection—can present acutely and typically resolve spontaneously. We present a case that underscores the importance of recognizing this rare condition in children to ensure timely diagnosis and appropriate management.
A previously healthy 3-year-old boy presented with vomiting, anorexia, wet cough, and prominent periorbital and peripheral edema. Laboratory tests revealed hypoproteinemia, hypoalbuminemia, and elevated stool α1-antitrypsin levels, suggestive of protein-losing enteropathy. CMV viremia was detected, with no leukocytosis or peripheral eosinophilia.
Imaging studies, including abdominal ultrasound and computed tomography, revealed thickened and hyperemic gastric walls, moderate abdominopelvic ascites, and pleural effusion. CT demonstrated markedly enlarged and tortuous gastric folds in the fundus and body, particularly along the greater curvature, with sparing of the antrum and preserved gastric wall thickness between folds. The presence of tiny cystic structures within the thickened folds, likely representing hypertrophied glands, helped differentiate the condition from solid gastric tumors.
The differential diagnosis included eosinophilic gastritis, infectious gastritis (e.g., Helicobacter pylori), Crohn’s disease, Zollinger-Ellison syndrome, gastric lymphoma, gastrointestinal stromal tumors (GISTs), and familial protein-losing enteropathy. Upper gastrointestinal endoscopy confirmed the presence of enlarged polypoid folds in the fundus and body with mucosal hyperemia—findings consistent with Menetrier’s Disease.
This case highlights a classic presentation of pediatric Menetrier’s Disease associated with CMV infection. Recognition of its characteristic features and self-limiting nature in children is crucial to avoid unnecessary diagnostic procedures and interventions. Supportive care remains the cornerstone of treatment. Read More

Authors:  Buyukkaya Ayla,  Zawin Joan

Keywords:  Stomach ,  Abdomen CT ,  Ultrasound

Zawin Joan,  Buyukkaya Ayla

Final Pr. ID: Poster #: CR-016

Case Report
Duodenum inversum is an uncommon congenital anomaly, in which the duodenum ascends to the level of the duodenal bulb, then passes posteriorly before crossing the midline above the pancreas.
This condition is thought to result from the persistence of the dorsal mesentery, leading to increased mobility of the duodenum. It is frequently associated with fixation or positional anomalies of the right kidney, pancreas, and transverse mesocolon.
Diagnosis is typically made via upper gastrointestinal (GI) series or laparoscopy, but may be delayed or overlooked if the configuration of the proximal duodenum is not carefully evaluated.
Although often asymptomatic, when symptoms such as vomiting, abdominal pain, or signs of obstruction are present, accurate diagnosis through imaging is essential for appropriate management. Awareness of this condition can help differentiate it from disorders such as malrotation, duodenal obstruction, or superior mesenteric artery (SMA) syndrome, and prevent potential complications associated with misinterpretation of imaging findings.
Associated conditions can include pancreatitis, gallbladder disease, duodenal ulcer, and, more rarely, gastric ulcer. Many of these symptoms are believed to result from stasis within the duodenal loop.
We present the case of a 1-year-old child with a history of hypoxic ischemic encephalopathy, who underwent upper GI imaging for evaluation of vomiting that had worsened over the past two weeks. On imaging, the first and second portions of the duodenum appeared normal. However, the third portion of the duodenum did not cross the midline, as would be expected. Instead, it ascended on the right side of the spine, posterior and parallel to the descending duodenum, reaching the level of the duodenal bulb. It then completed a transverse course to the left upper abdomen, where the duodenojejunal junction was appropriately located on the left side of the spine, at the level of the duodenal bulb findings consistent with duodenum inversum.
Treatment is primarily medical in the absence of obstruction. In cases where obstruction is attributed to SMA syndrome, transpyloric feeding is considered. Surgical intervention is reserved for cases of obstruction caused by fibrotic bands, in which a partial Ladd’s procedure may be performed. Read More

Authors:  Zawin Joan,  Buyukkaya Ayla

Keywords:  Abdominal Imaging ,  Duodenum ,  Upper GI Study

Osinska Aleksandra,  Wozniak Magdalena,  Materniak Andrzej,  Wyzkiewicz Karolina,  Bialek Wiktoria,  Sochocki Radoslaw

Final Pr. ID: Poster #: CR-020

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder of the central nervous system characterized by antibodies targeting NMDA receptors. It primarily affects adolescent and young adult females and frequently coexists with ovarian teratoma. The disease often begins with psychiatric symptoms such as agitation, hallucinations, or affective instability, which may delay proper diagnosis and treatment.
A 16-year-old girl was admitted to a psychiatric ward due to acute behavioral disturbances and depressive symptoms. Four days after admission, she developed impaired consciousness (GCS 9) and focal neurological signs, including right eye divergent strabismus and bilateral Babinski reflex. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and elevated protein concentration. Anti-NMDAR antibodies were detected in cerebrospinal fluid. MRI showed hyperintense lesions in the occipital lobes. Abdominal ultrasound identified a right ovarian mass; urgent surgical resection confirmed an immature teratoma. The patient received combined immunotherapy including corticosteroids, intravenous immunoglobulins, plasma exchange, and rituximab. Gradual clinical improvement was observed over subsequent weeks.

This case illustrates the complex neuroimmunological interaction between ovarian teratoma and the central nervous system. Psychiatric symptoms were the initial manifestation, delaying recognition of the underlying encephalitis. The presence of anti-NMDAR antibodies in cerebrospinal fluid and identification of ovarian teratoma confirmed the diagnosis. Early tumor resection combined with immunotherapy significantly improves outcomes and reduces neurological sequelae.

Acute-onset psychiatric symptoms in adolescent females should prompt consideration of autoimmune encephalitis, especially in the presence of an ovarian mass. Early detection and multidisciplinary management are crucial for full recovery and prevention of long-term complications. Read More

Authors:  Osinska Aleksandra,  Wozniak Magdalena,  Materniak Andrzej,  Wyzkiewicz Karolina,  Bialek Wiktoria,  Sochocki Radoslaw

Keywords:  Testicular Tumor

Durnford Luke,  Kolanjian Harout,  Jenkins Richard

Final Pr. ID: Poster #: CR-021

Mullerian duct anomalies are a spectrum of malformations resulting from complications of mullerian duct development in utero. They are common, seen in up to 5% of the female population, and whilst many are mild and asymptomatic, more severe deformities can result in miscarriage or infertility. They have a common association with mesonephric duct abnormalities, often resulting in concomitant renal agenesis. Some of these complete constellations have been grouped into defined syndromes such as OHVIRA (Herlyn-Werner-Wunderlich), and Meyer-Rockitansky-Kunster-Hauser. This means upon discovery of mullerian abnormalities, further investigations are often required to exclude these associations.
We present a case of a child who presented at birth with a unilateral cystic right flank mass identified antenatally. Post-natal US visualised a cystic mass with no viable renal tissue seen, and MCKD was suspected. This was seemingly confirmed when a DMSA scan demonstrated no functional renal tissue on the side of the mass. Follow up US imaging showed apparent involution of the mass, again consistent with MCKD, and the patient was then asymptomatic until the age of 15. The patient then represented with abdominal pain and was referred for an US. This discovered a large multiloculated cystic mass in the right flank, the same side as the one seen at birth. MRI imaging was then performed which confirmed a large multiloculated cystic mass, but with a rim of enhancing tissue suggestive of ovarian stroma. Incidentally, no renal tissue was seen on the right, and a contralateral unicornuate uterus with a single normal ovary on the left was seen. The lesion was surgically excised, and histology confirmed an ovarian cystadenoma. Previous imaging was retrospectively reviewed, and the initial cystic mass surmised to have represented an ectopic ovary with multiple follicles rather than an MCDK. The DSMA findings were explained by an ipsilateral renal agenesis in the context of mullerian duct abnormalities.
Unicornate uterus with contralateral ectopic ovary and renal agenesis has been reported in the literature but not formally categorised. This case demonstrates the pitfalls of multiple abnormalities in the context of mullerian duct pathology, and how renal agenesis with ipsilateral ectopic ovary can demonstrate near identical appearances to MCDK and poses a significant diagnostic challenge. Read More

Authors:  Durnford Luke,  Kolanjian Harout,  Jenkins Richard

Keywords:  Mullerian Duct Anomalies ,  MCDK ,  Renal Agenesis

Harris Debra,  Maniyar Jenny,  Dixon Rachel,  Kapadia Tejas

Final Pr. ID: Poster #: CR-022

1. The overall incidence of Mullerian Duct anomalies (MDAs) has been estimated as approximately 5 percent in the general population and higher in those with pregnancy loss. The categories of MDAs are seven-fold.
2. OHVIRA – obstructed hemivagina and ipsilateral renal agenesis is a class 3 MDA. We will describe imaging appearance of OHVIRA. This rare condition includes uterine didelphys, haematocolpos and ipsilateral renal agenesis.
3. This poster will explain the embryogenesis and interdependence of the urinary and reproductive systems.
4. We will highlight that early detection and diagnosis is key to prevent worsening of symptoms by the time of puberty.
5. We will demonstrate the importance of scan technique which, at our institution, includes a 3D turbo spin echo (SPACE™) acquired in the coronal plane with the ability to reformat in all three planes to produce a superior high-resolution sequence to analyse small structures.
6. We provide high quality imaging from several cases of this particular MDA at our institution for this poster. Read More

Authors:  Harris Debra,  Maniyar Jenny,  Dixon Rachel,  Kapadia Tejas

Keywords:  Mullerian Duct Anomalies ,  Improvement

Sensbach Jessica,  Ghias Adeeba,  Anderson Kelly,  Rooks Veronica

Final Pr. ID: Poster #: CR-025

The thyroglossal duct cyst (TGDC) is the most common congenital malformation in the neck. The Sistrunk procedure is the standard surgical treatment and includes resection of the central hyoid and a cuff tongue base musculature toward the foramen cecum.

We present a 24yr old F with a TGDC complicated by fistulous drainage and multiple surgeries. Imaging was critical for definitive identification of a sinus tract and treatment. She presented initially with a cystic neck lesion treated as a ranula with sublingual then submandibular gland excision. She subsequently presented with spontaneous drainage of saliva from the neck 2 yrs later and underwent Sistrunk procedure. When she presented with persistent salivary draining within 1 week of Sistrunk, there was concern for a persistent thyroglossal duct tract or alternate connection to the oropharynx not visualized despite direct laryngoscopy.

Obturation of the wound was attempted, without success. This novel concept of balloon occlusion pullback fistulogram in the open surgical wound led to discovering a tract extending superiorly toward the tongue base. A 14 Fr Foley catheter was inserted into the draining neck wound, balloon expansion in the cavity. Gentle traction was used to occlude the wound and fill the cavity. Ten mL of Omnipaque 180 contrast was infused through the catheter, outlining the balloon in the subcutaneous cavity and an opacified fistulous tract extending midline toward the tongue base posteriorly.

The otolaryngologist, present during flouroscopic exam, employed a similar technique in the OR with methylene blue diluted with saline. This created a roadmap resulting in a revised Sistrunk procedure, excising all abnormal appearing tissue and tongue base. The procedure was completed under direct laryngoscopy identifying the tongue base tissue that needed to be cored out. Only a few reported cases in the literature used fistulograms to identify TGDCs and determine the extent including associated sinus tracts, none of which described the same novel technique of balloon occlusion pullback within the open wound.

Radiographic demonstration of the thyroglossal tract is useful to indicate the extent and location. We present this novel balloon occlusion pullback fistulogram to provide crucial information about the fistulous tract regarding extent, direction, and relationship with adjoining structures for complicated or recurrent TGDCs. This information is crucial in definitive surgical planning. Read More

Authors:  Sensbach Jessica,  Ghias Adeeba,  Anderson Kelly,  Rooks Veronica

Keywords:  Fluoroscopy ,  Thyroid ,  Neck

Joya Sosa Yocelin,  Madden Joseph,  Fadell Michael,  Carrico Caroline,  Maxfield Charles,  Cao Joseph

Final Pr. ID: Poster #: CR-026

Background:
Conventional medullary osteosarcoma is a malignant bone-forming tumor characterized by the production of osteoid matrix by malignant mesenchymal cells. Although it is the most common primary malignant bone tumor in children, primary osteosarcoma of the spine is exceptionally rare, accounting for less than 5% of pediatric osteosarcomas. Symptoms are frequently nonspecific, and early radiographic clues may be subtle. Due to its rarity and nonspecific presentation, spinal osteosarcomas are often diagnosed late, typically after structural destruction or neurologic compromise has occurred.

Case Report:
A 12-year-old female presented with two months of progressive low back pain and an unintentional 15-pound weight loss. She denied weakness, sensory loss, or bowel/bladder dysfunction. Lumbar spine radiographs revealed a lucency of the left L2 pedicle, producing a “winking owl sign.” Follow-up CT demonstrated a lytic, destructive lesion with asymmetric enlargement of the left psoas and paraspinal musculature. Additionally, CT was useful in demonstrating the presence of osseous matrix within the primary tumor. MRI revealed an expansile, enhancing lesion centered in the left posterior elements of L2, with paraspinal soft-tissue extension and circumferential epidural involvement causing moderate to severe canal stenosis. Biopsy confirmed the diagnosis of conventional medullary osteosarcoma. The patient remained neurologically intact and was referred for multidisciplinary oncologic management. Read More

Authors:  Joya Sosa Yocelin,  Madden Joseph,  Fadell Michael,  Carrico Caroline,  Maxfield Charles,  Cao Joseph

Keywords:  Oncology ,  Osteosarcomas ,  Radiographic Findings

Oliva Vanesa,  Daneman Alan,  Bedoya M. Alejandra

Final Pr. ID: Poster #: CR-027

Epiphyseal separation of the distal femur is a rare entity. It usually occurs as a complication of a traumatic vaginal or cesarean delivery, particularly in breech position. It is considered a Salter-Harris type 1 fracture, where the epiphysis separates from the metaphysis resulting in physeal widening and frequently displacement of the epiphysis in relationship to the metaphysis. Only a few cases are reported in the literature.

We report a case of distal epiphyseal separation of the distal femur in a 5-day-old patient who presented to the emergency department with swollen right foot. He was born at term in breech presentation via C-section delivery. At the presentation the physical examination revealed edema from the thigh to foot, decreased range of movement of the right hip, and he cried with palpation of the right tight.

Lateral radiographs of the right lower limb showed metaphyseal irregularity involving the distal femur simulating a corner fracture, and posterior displacement of the distal femoral epiphysis relative to the metaphysis. Subsequent ultrasound of the right knee demonstrated posterior displacement of the distal femoral epiphysis with a 5 mm gap and significant soft tissue swelling, confirming epiphyseal separation of the distal femoral epiphysis.

As the distal femoral epiphyseal secondary ossification center appears at approximately 38th week of gestational age, the radiograph is commonly the first imaging method to depict distal femoral epiphyseal separation. However, the radiographic diagnosis is challenging, and it can mimic a corner fracture leading to the suspicion of non-accidental injury. Therefore, ultrasound is an excellent complementary tool given its lack of radiation, no need for sedation, short examination time and high ability to assess the musculoskeletal structures with direct evaluation of the surface of osseous elements, cartilage and soft-tissue structures.

Although this condition is uncommon, awareness of its imaging features among pediatric radiologists is crucial to avoid misdiagnosis and unnecessary additional imaging. Read More

Authors:  Oliva Vanesa,  Daneman Alan,  Bedoya M. Alejandra

Keywords:  Trauma ,  Neonate ,  Femur

Zawin Joan,  Buyukkaya Ayla

Final Pr. ID: Poster #: CR-031

Subcutaneous fat necrosis of the newborn (SCFN) is an infrequent, self-limiting panniculitis observed in neonates. We report an unusual presentation of SCFN in a premature infant who developed a progressively enlarging mass in the supraclavicular region. Lesions commonly develop on the shoulders, back, buttocks, thighs, and cheeks.
The patient was a male infant born via emergency cesarean delivery at 30 weeks and 6 days gestation due to fetal distress. Maternal history was significant for diabetes. His postnatal course was complicated by hypoglycemia, episodes of apnea associated with hypoxia, and hypotension.
Physical examination revealed a firm, non-tender, subcutaneous mass without overlying skin changes in the left supraclavicular area. Ultrasonography demonstrated ill-defined thickening of the subcutaneous fat with heterogeneous echogenicity and internal blood flow. MRI showed reduced T1 signal intensity lower than that of normal fat and increased signal on T2 and fat-suppressed T2 sequences, indicating abnormal subcutaneous fat.
The differential diagnosis included SCFN, infantile myofibromatosis, embryonal rhabdomyosarcoma, hemangioma, and neurofibroma. Embryonal rhabdomyosarcoma is the most prevalent tumor affecting young children. Unlike subcutaneous fat necrosis, however, rhabdomyosarcoma typically arises after the first few months of life. It usually presents as a solitary, rapidly growing, firm mass involving striated muscle. Infantile myofibromatosis commonly involves multiple sites, including the bone, lungs, heart, and gastrointestinal tract. Given the infant’s prematurity and clinical history of perinatal hypoxia, metabolic derangements, and maternal diabetes, SCFN was considered the most likely diagnosis.
While SCFN resolves spontaneously, the most significant potential complication is hypercalcemia, which occurs in approximately 28% of cases. Additionally, renal ultrasound should be performed to assess nephrocalcinosis and nephrolithiasis.
In summary, subcutaneous fat necrosis may be present in premature infants with relevant perinatal risk factors. Its clinical and radiologic features can mimic neoplastic or infectious conditions. It is essential for radiologists to recognize the clinical and imaging characteristics of this rare condition to enable timely diagnosis and avoid unwarranted surgical intervention. Read More

Authors:  Zawin Joan,  Buyukkaya Ayla

Keywords:  Soft Tissue Mass ,  MR ,  Ultrasound

Osinska Aleksandra,  Materniak Andrzej,  Wozniak Magdalena

Final Pr. ID: Poster #: CR-032

Malignant ectomesenchymoma (MEM) is a rare, rapidly growing soft tissue tumor composed of mesenchymal and neuroectodermal elements. It usually develops in the pelvis, retroperitoneum, or genitourinary tract of children. According to WHO, MEM is classified among skeletal muscle tumors containing embryonal rhabdomyosarcoma mixed with neuroblastic components, typically positive for desmin, myogenin, and synaptophysin. The tumor most often occurs during the first years of life and is characterized by aggressive behavior. Fewer than one hundred cases have been described worldwide. Read More

Authors:  Osinska Aleksandra,  Materniak Andrzej,  Wozniak Magdalena

Keywords:  Musculoskeletal

Prasher Sparsh,  Wigmore Edward,  Surana Snehal,  Vraka Katerina,  Bonney Denise

Final Pr. ID: Poster #: CR-036

Encephalopathy is a well-recognised complication of intrathecal methotrexate in paediatric acute lymphoblastic leukaemia (ALL), often presenting with seizures, altered consciousness, and motor deficits that typically resolve spontaneously within 24–48 hours. In contrast, methotrexate-induced myelopathy is a far rarer and under-recognised entity, with the potential for lasting neurological sequelae if not diagnosed and treated promptly.
We present an unusual case of methotrexate-induced myelopathy in a child with ALL, featuring an atypical clinical presentation and novel MRI findings that expand the recognised radiological phenotype.

A 4-year-old boy in remission from low-risk B-cell ALL (without CNS involvement) received intrathecal and intravenous methotrexate via an atraumatic lumbar puncture. Within hours, he developed left-sided hemiparesis, progressing to quadriparesis, with predominant weakness on the left and brief truncal involvement. He remained afebrile and haemodynamically stable, and laboratory tests, CSF analysis, and methotrexate clearance were all unremarkable. Brain imaging (CT, MRI, MRA) was normal. However, spinal MRI revealed extensive T2 hyperintensity throughout the cervical, thoracic, and lumbar spinal cord, involving both grey and white matter — a pattern more reminiscent of transverse myelitis than classic methotrexate myelopathy. CSF cytology was negative for malignant cells, and autoimmune and infectious screens, including MOG and AQP4 antibodies, were negative. Treatment with high-dose corticosteroids, folinic acid rescue, and IVIG was initiated within 12 hours of symptom onset. The patient showed marked improvement and was discharged ambulant after six weeks, with only mild residual left-sided weakness.

Classic methotrexate myelopathy typically affects the dorsal columns in a caudal-to-rostral progression. In contrast, this case demonstrated diffuse longitudinal cord involvement with mixed grey and white matter changes. Such imaging findings are not widely reported. Histopathological studies in similar cases support a mechanism of superficial demyelination from CSF-contact toxicity, aligning with this radiological presentation.

This case expands the radiological spectrum of methotrexate-induced myelopathy. Recognition of atypical spinal imaging findings is critical for timely diagnosis and early immunomodulatory treatment, which can significantly improve neurological outcomes. Read More

Authors:  Prasher Sparsh,  Wigmore Edward,  Surana Snehal,  Vraka Katerina,  Bonney Denise

Keywords:  ALL ,  Spinal Cord ,  Pediatric Neuroradiology

Walters Courtney,  Pfeifer Cory,  Long Clayton,  Retson Laura,  Vaughn Jennifer

Final Pr. ID: Poster #: CR-037

Neurotoxicity is a potential adverse effect from chemotherapeutic agents such as cytarabine (Ara-C) when treating children with acute myeloid leukemia (AML). Ara-C is an antineoplastic antimetabolite that, once activated by deoxycytidine kinase, mimics and competes with natural nucleosides to disrupt DNA synthesis. If present in the nervous system, Ara-C can lead to central nervous system (CNS) (e.g., cerebellar syndrome, encephalopathy, necrotizing leukoencephalopathy, and seizures), spinal cord (e.g., myelopathy), and peripheral nerve (e.g., sensory polyneuropathy) symptoms. Although neuroradiologic literature is sparse and variable, unique cases of neurotoxicity continue to occur.
We present a 2-year-old male with a history of recurrent infections, leg pain at night, weight loss, and night sweats, who was diagnosed with AML and started on an intrathecal (IT) and intravenous chemotherapy regimen (i.e., Ara-C, daunorubicin, etoposide, and methotrexate). During Intensification II, several days after receiving their fourth dose of IT Ara-C and two weeks after IT methotrexate, the patient developed acute altered mental status, ataxia, and right-sided weakness. MRI brain with and without intravenous contrast showed an atypical expansile region of abnormal signal in the left thalamus, brainstem, temporal lobe, and cerebellum with asymmetric increased perfusion, patchy enhancement, and patchy faint restricted diffusion. There were also patchy non-enhancing areas of white matter signal abnormality and tiny microhemorrhage. MRI of the spine, MR angiography and venography of the brain were normal. The patient’s symptoms gradually improved without intervention with mild residual right-sided weakness and ataxia. Infectious workup was negative. A follow-up brain MRI showed a reduction in the size of lesions. Ara-C was held from the subsequent chemotherapy regimen and symptoms did not recur. This case highlights a unique thalamic and brainstem finding not previously reported in the literature for Ara-C neurotoxicity in pediatric AML. Of the other chemotherapeutic agents, methotrexate (MTX)-induced neurotoxicity remains on the differential, however, such radiographic features are typically characterized by MTX-related leukoencephalopathy of the central white matter, which we do not see in this case. Altogether, Ara-C neurotoxicity should remain on the differential for children with neurological symptoms after receiving this agent. Read More

Authors:  Walters Courtney,  Pfeifer Cory,  Long Clayton,  Retson Laura,  Vaughn Jennifer

Keywords:  MRI Brain ,  Neuroradiology ,  Central Nervous System

Banaz Tuba,  Omaç Birinci Aysegül,  Ayaz Ercan,  Akyel Nazli Gülsüm

Final Pr. ID: Poster #: CR-038

Introduction: Hereditary spastic paraplegias (HSP) are heterogeneous neurodegenerative disorders causing progressive lower limb spasticity. MRI findings are variable but crucial for differential diagnosis. Classic radiological features include spinal cord atrophy (most common), corpus callosum thinning, and T2/FLAIR hyperintensities in the corticospinal tracts, such as the posterior limb of the internal capsule and the " ears of the lynx" sign (periventricular frontal signal). We present a case demonstrating both typical and significant atypical MRI findings.
Case Report: A 16-year-old male patient presented to our clinic with a three-year history of "finger-tip walking." Neurological examination revealed mild mental retardation, increased deep tendon reflexes (DTR) in the lower extremities, and mild spasticity in the feet. The patient's history indicated normal developmental milestones, and there was no known family history of neurological disease. Clinical findings were primarily consistent with HSP, and radiological evaluation was planned.
Radiological Findings: Cranial MRI showed findings typical for HSP: symmetric T2 hyperintensities in the posterior limbs of both internal capsules and in the frontal periventricular white matter (the " ears of the lynx" sign). The corpus callosum was markedly thin, especially the genu and body. Atypical findings were also present: diffuse symmetric T2 signal changes in the bilateral temporoparietal white matter and prominent cerebral sulcal spaces (cerebral atrophy) for his age.
Discussion and Conclusion: This case highlights the classic radiological triad of complicated HSP: corpus callosum thinning, posterior internal capsule signal changes, and the "ears of the lynx" sign, all reflecting corticospinal tract involvement. However, the presence of significant cerebral atrophy and widespread temporoparietal white matter abnormalities are atypical. These atypical features expand the differential diagnosis, necessitating clinical correlation to rule out overlapping conditions such as periventricular leukomalacia (PVL) sequelae or a hypomyelination disorder. This case underscores that while MRI can reveal characteristic signs of HSP, it may also present a mixed picture with unexpected findings, emphasizing its role in characterizing the full scope of white matter pathology.. Read More

Authors:  Banaz Tuba,  Omaç Birinci Aysegül,  Ayaz Ercan,  Akyel Nazli Gülsüm

Keywords:  Neuroradiology ,  MRI Brain ,  Paediatric Radiology

Muthee Bernadette,  Ombati Kevin,  Wanyonyi Benjamin

Final Pr. ID: Poster #: CR-040

Scedosporium apiospermum is a filamentous soil-dwelling fungus and an emerging opportunistic pathogen that typically affects immunocompromised individuals, causing pulmonary, sinus, or soft tissue infections. However, central nervous system (CNS) involvement is rare, particularly in children, and is associated with delayed diagnosis, limited treatment options, and a high mortality rate.
We report a challenging case of a previously healthy 5-year-old boy who presented with sudden-onset seizures and anisocoria. Initial contrast-enhanced CT of the brain revealed numerous ring-enhancing hypodense lesions diffusely infiltrating the right cerebral hemisphere, basal ganglia, thalamus, and brainstem, crossing the midline, and resulting in marked mass effect, leftward midline shift, right uncal and subfalcine herniation, with obstructive hydrocephalus.
Subsequent MRI of the brain demonstrated multiple infiltrative lesions of varying sizes with peripheral T2-weighted hypointensity, central restricted diffusion, irregular ring enhancement, and a distinct “target sign,” accompanied by extensive surrounding vasogenic edema. These findings mimicked diffuse high-grade glioma, tuberculous abscess, and pyogenic abscess.
Chest radiography revealed bilateral hilar soft-tissue fullness suggestive of lymphadenopathy.
Due to the atypical imaging features and rapid neurological decline, a stereotactic brain biopsy was performed, confirming invasive fungal infection caused by Scedosporium apiospermum. Despite supportive neurocritical care and initiation of antifungal therapy, the patient rapidly deteriorated and succumbed to severe neurological complications a few days later.
This case highlights the diagnostic complexity of intracranial Scedosporium apiospermum infection in pediatric patients, particularly due to its radiological similarity to neoplastic and other infective conditions. Key imaging indicators, including peripheral T2 hypointensity, central diffusion restriction, and the “target sign,” may suggest a fungal etiology and should prompt early biopsy. Timely recognition and initiation of targeted antifungal therapy are crucial but may not prevent fatal outcomes in extensive CNS involvement. Increased awareness of this rare but lethal infection is essential to avoid delays in diagnosis and improve clinical decision-making. Read More

Authors:  Muthee Bernadette,  Ombati Kevin,  Wanyonyi Benjamin

Keywords:  Magnetic Resonance Imaging ,  Brain ,  Infection

Yadav Ratan,  Subramanian Subramanian

Final Pr. ID: Poster #: CR-041

Leigh disease is a mitochondrial encephalopathy characterized by bilateral symmetric involvement of the brainstem and basal ganglia. SURF1 variants demonstrate restricted diffusion and symmetric T2/FLAIR hyperintensity of the substantia nigra, periaqueductal gray, and inferior olivary nuclei. MORC2 mutations, though primarily affecting the peripheral nervous system (causing Charcot–Marie–Tooth disease, spinal muscular atrophy–like features, and DIGFAN syndrome), can present with Leigh-like MRI patterns, leading to diagnostic uncertainty. Distinguishing these entities on MRI is essential for targeted genetic testing and counseling.
The purpose of this study is to compare MRI findings of a child with a confirmed MORC2 mutation to those of SURF1-variant Leigh disease, highlighting overlapping and distinguishing brainstem features that aid differential diagnosis. Read More

Authors:  Yadav Ratan,  Subramanian Subramanian

Keywords:  Genetics ,  MRI Brain ,  Mitochondrial Disease

Derinkuyu Betul

Final Pr. ID: Poster #: CR-042

Embryonal tumor with multilayered rosettes (ETMR) is a rare and aggressive type of brain tumor that primarily affects infants and young children. ETMRs are highly malignant tumors with poor prognosis. The VP shunt is used to drain excess cerebrospinal fluid into the abdominal cavity, can inadvertently provide a pathway for tumor cells to travel from the central nervous system to the peritoneum, especially in high grade CNS tumors. Here, we present a young boy diagnosed with ETMR in the posterior fossa with peritoneal dissemination related to VP shunt.
19 month old boy was first noted to have a well defined 3 cm mass in the right pons. It demonstrates diffusion restriction and lack of contrast enhancement. Tissue biopsy was performed first, that came with the diagnosis of ETMR. Then, gross total resection of the mass was performed with VP shunt placement. During therapy, the follow up scans demonstrate residual/recurrent disease along the resection margins. Furthermore, the disease continued to progress and 10 months later from the first surgery, 2nd surgery was performed for tumor debulking from the brainstem. But the diseased continued to progress after the 2nd surgery under therapy with new development of intraspinal leptomeningeal tumor dissemination. 2 months later after the 2nd surgery, multiple peritoneal masses and excess ascitis were noted in the follow-up Spine MRI, in the presence of a VP shunt. Read More

Authors:  Derinkuyu Betul

Keywords:  Neuroradiology ,  Tumor ,  Metastasis

Tierradentro-garcia Luis,  Martinez-correa Santiago,  Forero-millan Julian,  Martinez Mesha

Final Pr. ID: Poster #: CR-043

Background:

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a rare neuroinflammatory entity that is often associated with infectious and non-infectious triggers. This condition was first associated with recent Streptococcal infections (PANDAS) in the late 1990s. PANS manifests with sudden obsessive-compulsive disorder and/or restricted food intake with additional neuropsychiatric abnormalities. Children with PANS demonstrate generalized increased median diffusivity in the brain, more prominently in the deep gray matter, including the thalami, basal ganglia, and amygdala. Although neuroimaging plays a supportive role in diagnosis, its use is limited by the lack of positive findings in cases with clinically diagnosed PANS.

Purpose:

We aim to showcase brain MRI findings in a child with a clinical diagnosis of PANS at different time points. Our goal is to build on the potential role of neuroimaging in this condition in the acute and subacute phases.

Case description:

We discuss the case of an 11-year-old boy who presented with fever and altered mental status two weeks after having an upper respiratory infection. The patient underwent a contrast-enhanced brain MRI, which showed increased T2W/FLAIR signal and swelling of the caudate nuclei and putamina bilaterally, with no abnormal enhancement or restricted diffusion; notably, there was mild increased diffusion in the basal ganglia, likely reflecting vasogenic edema. Five days later, a repeat brain MRI revealed mild, diffuse high T2W/FLAIR signal, which was overall decreased compared to the prior scan. Additionally, diffusion in the caudate relatively decreased compared to the putamina. Twelve days later, there was a continued decrease in the T2W/FLAIR signal in the putamina, caudate nuclei, and possibly the lateral portion of the globi pallidi.

Discussion points:

-To present common neuroimaging findings in patients with suspicion/diagnosis of PANS/PANDAS over time, including increased T2W/FLAIR signal and mild increased diffusion in the basal ganglia.
-To discuss the current roles/limitations of neuroimaging in the workup based on the existing literature.
-To illustrate the primary differential diagnoses that can mimic PANS/PANDAS neuroimaging findings in children, including autoimmune encephalitis, Sydenham chorea, mitochondrial disorders, and tic disorders.
-To hypothesize the role of glymphatic, CSF, and venous dynamics in neuroinflammation in PANS/PANDAS related to early vasogenic edema. Read More

Authors:  Tierradentro-garcia Luis,  Martinez-correa Santiago,  Forero-millan Julian,  Martinez Mesha

Keywords:  Pediatric Neuroradiology ,  Basal Ganglia ,  Diffusion Weighted Imaging

Hopkins Erin,  James Anna,  Hayward Mark

Final Pr. ID: Poster #: CR-045

A 14-year-old male from a rural community presented with a 4-week history of loose stools and recent lower respiratory tract infection. Initial investigations revealed elevated inflammatory and liver markers (CRP 100 mg/L, ALT 90 U/L, ALP 586 U/L), thrombocytosis (661 × 10^9/L), anemia (Hgb 74 g/L), and hypoalbuminemia (21 g/L). Ultrasound demonstrated a “starry sky” liver and gallbladder sludge. CT of the chest, abdomen, and pelvis showed multiple bilateral pulmonary nodules, small pleural effusions, mild colitis, and enlarged mesenteric and periportal lymph nodes, initially raising concern for metastatic disease. PET/CT revealed FDG-avid pulmonary nodules and lymph nodes near the pancreatic head and tail. MRI/MRCP confirmed nodal conglomerates in these regions without a discrete pancreatic lesion. Testicular ultrasound was normal. There were no superficial FDG-avid lymph nodes available for biopsy. Laparoscopic resection of the pancreatic tail lymph node conglomerate was considered but not pursued as the patient began to improve clinically and biochemically. Infectious and autoimmune workup was largely negative except for a low-titre positive ANA (polar/Golgi-like pattern, 1:80). IgG subclass testing showed isolated IgG1 elevation (IgG4 negative). No specific infectious or malignant etiology was identified. The patient’s condition improved spontaneously within three weeks, with normalization of inflammatory and liver parameters and interval reduction of lymphadenopathy on follow-up imaging. This case highlights a self-limiting multisystem inflammatory process that radiologically mimicked disseminated malignancy. Knowledge of transient self-limiting autoinflammatory syndromes should be considered to prevent unnecessary invasive investigations or treatments. Read More

Authors:  Hopkins Erin,  James Anna,  Hayward Mark

Keywords:  Autoinflammation ,  FDG PET ,  Lymphadenopathy

Gardner Kyle,  Gagnon Marie-helene

Final Pr. ID: Poster #: CR-048

A term 8-day-old male presented to an outside emergency department with acute respiratory distress. Prenatal history was unremarkable except for prenatal diagnosis of a right sided nonspecific congenital lung malformation (CLM), possibly a congenital pulmonary airway malformation (CPAM). Anatomy ultrasound reported a right mid-lung echogenic lesion measuring with two small internal cysts. Fetal MRI demonstrated a non-segmental T2-hyperintense lesion in the peripheral right lower lobe with two small peripheral cysts and no feeding vessel. The lung mass to volume ratio was 0.05 with favorable observed to expected total fetal lung volumes.
Initial examination revealed absent breath sounds on the right, and chest radiograph confirmed a large right tension pneumothorax. A chest tube was placed, and he was transferred to a higher level of care. CT angiography of the chest demonstrated a pleural-based multicystic lesion with internal air–fluid levels and focal solid nodular components, without a systemic feeding vessel. On day 12 of life, he underwent a right lower lobe wedge resection. Intraoperatively, surgeons noted an exophytic cystic lesion arising from the medial aspect of the right lower lobe on a narrow stalk. Pathology findings revealed a multicystic lesion consistent with Type 1r pleuropulmonary blastoma (PPB). Follow up genetic testing revealed a positive test for DICER-1 genetic mutation. 6 month follow up CT was negative and he continues to be followed at higher care institution. PPB is a rare, aggressive tumor originating from primitive mesenchymal cells of the lung or pleuraprimarily affecting infants and young children. PPB occurs in 1 in 250,000 live births and is associated with DICER1 gene mutations. Early detection is essential, offering a window for curative surgery before the disease progresses. PPB is difficult to distinguish from a benign CLM and is more commonly diagnosed in infancy. As of 2022, fewer than 6 confirmed cases of PPB were diagnosed prenatally. Despite the diagnostic overlap between PPB and CLM, pediatric radiologists play a key role in raising early suspicion, guiding surgical planning, and prompting genetic evaluation when imaging features deviate from typical benign patterns. This case highlights the diagnostic complexity and clinical features of the rare occurrence of prenatal diagnosis of pleuropulmonary blastoma, a malignancy that may be underrecognized due to its overlap with benign cystic lung lesions. Read More

Authors:  Gardner Kyle,  Gagnon Marie-helene

Keywords:  DICER1 ,  Congenital ,  Pleuropulmonary Blastoma

Tamer Nicole,  Dahl Amy

Final Pr. ID: Poster #: CR-049

Ultrasound is the most commonly used modality in evaluating the thyroid gland and in classifying thyroid nodules. We present a three-case series of intrathyroidal ectopic thymus. Two of these cases were initially classified as high grade (TI-RADS 4) thyroid nodules and subsequently underwent fine needle aspiration (FNA). The third was recognized initially as intrathyroidal ectopic thymus, avoiding the need for FNA and followed conservatively. Ectopic thymic tissue can occur anywhere along the embryologic path of descent from the 3rd branchial pouch to the anterior mediastinum. Embryology of the thymus and common locations of ectopic thymic tissue will be reviewed. We will also review and illustrate ultrasound imaging characteristics of normal thymic tissue in the mediastinum as well as in ectopic locations, focusing primarily on the thyroid gland. We hope that the radiologist will consider the diagnosis of intrathyroidal ectopic thymus when evaluating thyroid nodules by ultrasound, differentiating them from other thyroid lesions and avoiding the need for FNA. Read More

Authors:  Tamer Nicole,  Dahl Amy

Keywords:  Thymic Rest ,  Ultrasound ,  Thymus

Madden Joseph,  Joya Sosa Yocelin,  Carrico Caroline,  Cao Joseph

Final Pr. ID: Poster #: CR-050

Background: Bronchopulmonary foregut malformations are defined as aberrant communications between an isolated segment of respiratory tissue and the esophagus or stomach. Based on the anatomic relationship of the fistulous connection, these rare malformations are classified into four groups (I–IV). Diagnosis typically involves a combination of cross-sectional imaging (CT or MRI) and an upper gastrointestinal series (UGI). Case: A 1-month-old infant with a history of lipomyelomeningocele was transferred from an outside hospital for neurosurgical evaluation. An incidental right lower lobe (RLL) pulmonary mass was identified on spinal MRI. Further evaluation with contrast-enhanced CT revealed a RLL lesion with a systemic arterial supply from the celiac artery. Internal cystic and branching lucencies were also present, raising concern for a hybrid lesion. The patient was discharged, and readmitted four months later for neurosurgical intervention for spinal dysraphism. The admission was complicated by intermittent oxygen desaturations, suspected to be secondary to gastroesophageal reflux. UGI revealed a communication between the lower esophagus and the isolated pulmonary segment in the right medial lung base confirming a diagnosis of group III CBPFM. Conclusions: This case highlights a hybrid lesion (sequestration and CPAM) with rare communication with the gastrointestinal tract, consistent with a communicating bronchopulmonary foregut malformation (CBPFM). Vague symptoms including recurrent pneumonia and workup for feeding intolerance often lead to delayed diagnosis. Surgical excision of CBPFMs is definitive treatment; however, identification of the communicating esophageal component is necessary prior to resection. Read More

Authors:  Madden Joseph,  Joya Sosa Yocelin,  Carrico Caroline,  Cao Joseph

Keywords:  Bronchopulmonary Malformation ,  Bronchopulmonary Sequestration ,  CPAM

Sherwani Poonam,  Singh Man,  Rathaur Vyas

Final Pr. ID: Poster #: CR-051

A 3-year-old boy presented with fever, cough, and breathlessness for 7 days. He had a prior history of recurrent respiratory distress episodes requiring mechanical ventilation. On examination, he was tachypneic with left-sided decreased chest expansion, tracheal deviation to the right, and impaired percussion notes. Chest radiograph revealed a large left thoracic opacity with mediastinal shift. Contrast-enhanced CT showed a large, well-defined anterior mediastinal mass (approximately 12 × 8 × 5 cm) with predominantly soft-tissue attenuation and focal fat densities, suggesting thymolipoma or thymolymphoma.
USG-guided core biopsy initially revealed scant thymic tissue with Hassall corpuscles, favoring thymic origin but non-diagnostic. A repeat CT-guided biopsy showed a biphasic pattern of thymic epithelial cells admixed with lymphocytes. The child underwent complete surgical excision of the mass via an extrapleural approach. Grossly, two encapsulated masses (19 × 13 × 4.5 cm and 9 × 6.5 × 4 cm) were noted with smooth surfaces and lobulated gray-white cut surfaces. Histopathology confirmed WHO Type A thymoma, with intact capsule margins. Read More

Authors:  Sherwani Poonam,  Singh Man,  Rathaur Vyas

Keywords:  Chest Masses ,  Masses ,  Biopsy

Durnford Luke,  Kolanjian Harout,  Jenkins Richard

Final Pr. ID: Poster #: CR-052

This case series will present a pictorial review of common and rare differentials for cystic lung pathology in the paediatric population, with cases taken from our tertiary paediatric institution.
Cystic lung lesions in children can present a diagnostic challenge due to a wide variety of potential aetiologies. Our review includes rarer pathologies such as our highlighted case of kerosene ingestion, where clinical history was crucial in establishing a diagnosis, and an atypical bilateral pleuropulmonary blastoma giving the appearance of a more diffuse process. These are presented alongside more commonly seen pathologies such as congenital pulmonary airway malformations, Langerhans cell histiocytosis, ChILD, and post infective sequelae. We present the clinical and radiological findings of these pathologies, with some histopathological correlation, highlighting the typical radiographic features of both these key differentials for cystic lung lesions, as well as rare differentials to consider in difficult cases. Multiple imaging modalities, including computed tomography and plain radiography, as well as multi-disciplinary discussion played a crucial role in establishing accurate diagnoses.
Understanding the clinical presentation in children with cystic lung pathology is crucial in correct diagnosis, and rare differentials must be considered in correlation with clinical history when evaluating cystic lung lesions. In the paediatric population, accurate and timely diagnosis is essential for starting appropriate management, excluding potentially malignant pathologies, and improving outcomes. Read More

Authors:  Durnford Luke,  Kolanjian Harout,  Jenkins Richard

Keywords:  Cystic ,  Lung ,  Cystic Mass