Hisham Dahmoush

All Publications

• Prenatal Imaging of Supratentorial Fetal Brain Malformation. Magnetic resonance imaging clinics of North America Hung, S., Dahmoush, H., Lee, H., Chen, H., Guimaraes, C. V. 2024; 32 (3): 395-412

  Abstract

  This review article provides a comprehensive overview of fetal MR imaging in supratentorial cerebral malformations. It emphasizes the importance of fetal MR imaging as an adjunct diagnostic tool used alongside ultrasound, improving the detection and characterization of prenatal brain abnormalities. This article reviews a spectrum of cerebral malformations, their MR imaging features, and the clinical implications of these findings. Additionally, it outlines the growing importance of fetal MR imaging in the context of perinatal care.

  View details for DOI 10.1016/j.mric.2024.03.002

  View details for PubMedID 38944430

• Incomplete partition type II in its various manifestations: isolated, in association with EVA, syndromic, and beyond; a multicentre international study. Neuroradiology D'Arco, F., Kandemirli, S. G., Dahmoush, H. M., Alves, C. A., Severino, M., Dellepiane, F., Robson, C. D., Lequin, M. H., Rossi-Espagnet, C., O'Brien, W. T., Nash, R., Clement, E., Juliano, A. F. 2024

  Abstract

  Incomplete partition type II (IP-II) is characterized by specific histological features and radiological appearance. It may occur in isolation or in association with an enlarged vestibular aqueduct (EVA). Among those with IP-II and EVA, a subset has a diagnosis of Pendred syndrome. This study aimed to explore the prevalence of isolated IP-II, IP-II with EVA, and cases with a genetic or syndromic basis in our cohort.From a large, multicentre database of dysplastic cochleae (446 patients, 892 temporal bones), those with imaging features of IP-II were examined in detail, including whether there was a genetic or syndromic association.A total of 78 patients with IP-II were identified. Among these, 55 patients had bilateral IP-II and EVA (only 12 with typical Mondini triad), 8 with bilateral IP-II and normal VA, 2 with bilateral IP-II and unilateral EVA, and 13 with unilateral IP-II (9 with unilateral EVA). Among the group with bilateral IP-II and bilateral EVA in whom genetic analysis was available, 14 out of 29 (48%) had SLC26A4 mutations and a diagnosis of Pendred syndrome, 1 had a FOXI1 mutation, and a few other genetic abnormalities; none had KCNJ10 pathogenic variants.Bilateral IP-II-bilateral EVA may be seen in the context of Pendred syndrome (SLC26A4 or FOXI1 mutations) but, in the majority of our cohort, no genetic abnormalities were found, suggesting the possibility of unknown genetic associations. IP-II in isolation (without EVA) is favored to be genetic when bilateral, although the cause is often unknown.

  View details for DOI 10.1007/s00234-024-03386-z

  View details for PubMedID 38833161

  View details for PubMedCentralID 7963624

• ACR Appropriateness Criteria Orbital Imaging and Vision Loss-Child. Journal of the American College of Radiology : JACR Expert Panel on Pediatric Imaging, Maheshwari, M., Ho, M., Bosemani, T., Dahmoush, H., Fredrick, D., Guimaraes, C. V., Gulko, E., Jaimes, C., Joseph, M. M., Kaplan, S. L., Miyamoto, R. C., Nadel, H. R., Partap, S., Pfeifer, C. M., Pruthi, S. 2024; 21 (6S): S219-S236

  Abstract

  Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

  View details for DOI 10.1016/j.jacr.2024.02.023

  View details for PubMedID 38823946

• Isolated Sixth Nerve Palsies in a Child With Familial Hemophagocytic Lymphohistiocytosis Type 2. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Chiang, H. H., Fernandez-Pol, S., Bae, G. H., Rieger, K. E., Dahmoush, H. M., Beres, S. J. 2023; 43 (1): 137-140

  Abstract

  A previously healthy 2-year-old boy presented with a left sixth cranial nerve palsy. There was a family history of multiple sclerosis and optic neuritis. Neuroimaging showed multiple foci of T2/FLAIR hyperintense signal abnormality in both cerebral hemispheres and in the brainstem. The initial diagnosis was suspicious for demyelinating disease. However, there was no clinical improvement after a course of corticosteroids, and there was no change in his follow-up MRI. He later developed bilateral sixth nerve palsies, with esotropia addressed with bilateral medial rectus botulinum toxin injections. A brain biopsy was planned. However, his 3-month-old sister was separately admitted for fever and pancytopenia. She had markedly elevated ferritin, D-dimer, triglycerides, sIL-2R, CXCL9, and IL-18 and low fibrinogen. Her bone marrow biopsy showed hemophagocytosis. Genetic testing of both siblings revealed biallelic mutations in the PRF1 locus. The final diagnosis of familial hemophagocytic lymphohistiocytosis Type 2 was made. Both siblings underwent chemotherapy. The boy's sixth nerve palsies and MRI abnormalities resolved. Both siblings then went on to undergo bone marrow transplant.

  View details for DOI 10.1097/WNO.0000000000001807

  View details for PubMedID 36790062

• Classification and neuroimaging of ependymal tumors. Frontiers in pediatrics Mu, W., Dahmoush, H. 2023; 11: 1181211

  Abstract

  Ependymal tumors arise from the ependymal cell remnants of the cerebral ventricles, the central canal of the spinal cord, or the filum terminale or conus medullaris, although most pediatric supratentorial ependymomas do not exhibit clear communication or abutment of the ventricles. In this article, we discuss the classification, imaging characteristics, and clinical settings of these tumors. The WHO 2021 classification system has categorized ependymal tumors based on histopathologic and molecular features and location, in which they are grouped as supratentorial, posterior fossa (PF), and spinal. The supratentorial tumors are defined by either the ZFTA (formerly RELA) fusion or the YAP1 fusion. Posterior fossa tumors are divided into group A and group B based on methylation. On imaging, supratentorial and infratentorial ependymomas may arise from the ventricles and commonly contain calcifications and cystic components, with variable hemorrhage and heterogeneous enhancement. Spinal ependymomas are defined by MYCN amplification. These tumors are less commonly calcified and may present with the "cap sign," with T2 hypointensity due to hemosiderin deposition. Myxopapillary ependymoma and subependymoma remain tumor subtypes, with no change related to molecular classification as this does not provide additional clinical utility. Myxopapillary ependymomas are intradural and extramedullary tumors at the filum terminale and/or conus medullaris and may also present the cap sign. Subependymomas are homogeneous when small and may be heterogeneous and contain calcifications when larger. These tumors typically do not demonstrate enhancement. Clinical presentation and prognosis vary depending on tumor location and type. Knowledge of the updated WHO classification of the central nervous system in conjunction with imaging features is critical for accurate diagnosis and treatment.

  View details for DOI 10.3389/fped.2023.1181211

  View details for PubMedID 37287627

• Imaging of pediatric brain tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatric blood & cancer Jaju, A., Li, Y., Dahmoush, H., Gottardo, N. G., Laughlin, S., Mirsky, D., Panigrahy, A., Sabin, N. D., Shaw, D., Storm, P. B., Poussaint, T. Y., Patay, Z., Bhatia, A. 2022: e30147

  Abstract

  Tumors of the central nervous system are the most common solid malignancies in children and the most common cause of pediatric cancer-related mortality. Imaging plays a central role in diagnosis, staging, treatment planning, and response assessment of pediatric brain tumors. However, the substantial variability in brain tumor imaging protocols across institutions leads to variability in patient risk stratification and treatment decisions, and complicates comparisons of clinical trial results. This White Paper provides consensus-based imaging recommendations for evaluating pediatric patients with primary brain tumors. The proposed brain magnetic resonance imaging protocol recommendations balance advancements in imaging techniques with the practicality of deployment across most imaging centers.

  View details for DOI 10.1002/pbc.30147

  View details for PubMedID 36519599

• Fetal Brain Anatomy. Neuroimaging clinics of North America Guimaraes, C. V., Dahmoush, H. M. 2022; 32 (3): 663-681

  Abstract

  "Fetal brain development has been well studied, allowing for an ample knowledge of the normal changes that occur during gestation. Imaging modalities used to evaluate the fetal central nervous system (CNS) include ultrasound and MRI. MRI is the most accurate imaging modality for parenchymal evaluation and depiction of developmental CNS anomalies. The depiction of CNS abnormalities in a fetus can only be accurately made when there is an understanding of its normal development. This article reviews the expected normal fetal brain anatomy and development during gestation. Additional anatomic structures seen on brain imaging sequences are also reviewed."

  View details for DOI 10.1016/j.nic.2022.04.009

  View details for PubMedID 35843668

• NEUROIMAGING FINDINGS IN INBORN ERRORS OF METABOLISM: ATYPICAL FINDINGS FROM FIVE CASES AFFECTED BY SMALL MOLECULE DISORDERS Morales, J., Dahmoush, H., Enns, G. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2022: 251-252

  View details for Web of Science ID 000772339900017

• Attention-guided deep learning for gestational age prediction using fetal brain MRI. Scientific reports Shen, L., Zheng, J., Lee, E. H., Shpanskaya, K., McKenna, E. S., Atluri, M. G., Plasto, D., Mitchell, C., Lai, L. M., Guimaraes, C. V., Dahmoush, H., Chueh, J., Halabi, S. S., Pauly, J. M., Xing, L., Lu, Q., Oztekin, O., Kline-Fath, B. M., Yeom, K. W. 1800; 12 (1): 1408

  Abstract

  Magnetic resonance imaging offers unrivaled visualization of the fetal brain, forming the basis for establishing age-specific morphologic milestones. However, gauging age-appropriate neural development remains a difficult task due to the constantly changing appearance of the fetal brain, variable image quality, and frequent motion artifacts. Here we present an end-to-end, attention-guided deep learning model that predicts gestational age with R2 score of 0.945, mean absolute error of 6.7days, and concordance correlation coefficient of 0.970. The convolutional neural network was trained on a heterogeneous dataset of 741 developmentally normal fetal brain images ranging from 19 to 39weeks in gestational age. We also demonstrate model performance and generalizability using independent datasets from four academic institutions across the U.S. and Turkey with R2 scores of 0.81-0.90 after minimal fine-tuning. The proposed regression algorithm provides an automated machine-enabled tool with the potential to better characterize in utero neurodevelopment and guide real-time gestational age estimation after the first trimester.

  View details for DOI 10.1038/s41598-022-05468-5

  View details for PubMedID 35082346

• Neuroradiological Mimics of Periventricular Leukomalacia. Journal of child neurology Reddy, N., Doyle, M., Hanagandi, P., Taranath, A., Dahmoush, H., Krishnan, P., Oztekin, O., Boltshauser, E., Shroff, M., Mankad, K. 1800: 8830738211026052

  Abstract

  AIM: Periventricular leukomalacia (PVL) is a term reserved to describe white matter injury in the premature brain. In this review article, the authors highlight the common and rare pathologies mimicking the chronic stage of PVL and propose practical clinico-radiological criteria that would aid in diagnosis and management.METHODS AND RESULTS: The authors first describe the typical brain MRI (magnetic resonance imaging) features of PVL. Based on their clinical presentation, pathologic entities and their neuroimaging findings were clustered into distinct categories. Three clinical subgroups were identified: healthy children, children with stable/nonprogressive neurological disorder, and those with progressive neurological disorder. The neuroradiological discriminators are described in each subgroup with relevant differential diagnoses. The mimics were broadly classified into normal variants, acquired, and inherited disorders.CONCLUSIONS: The term "PVL" should be used appropriately as it reflects its pathomechanism. The phrase "white matter injury of prematurity" or "brain injury of prematurity" is more specific. Discrepancies in imaging and clinical presentation must be tread with caution and warrant further investigations to exclude other possibilities.

  View details for DOI 10.1177/08830738211026052

  View details for PubMedID 34937403

• Neuroimaging manifestations of epidermal nevus syndrome. Quantitative imaging in medicine and surgery De Vito, A., Taranath, A., Dahmoush, H., Ganapathy, S. S., Sudhakar, S., Mankad, K. 2021; 11 (1): 415–22

  Abstract

  Epidermal nevus syndrome (ENS) represents a diverse group of rare neurocutaneous diseases associated with the presence of characteristic epidermal nevi (EN) in the skin and extracutaneous manifestations in the eyes, skeletal, urogenital and central nervous systems. We present a case series of 7 children with ENS, with specific attention to the neuroradiological characteristics of this entity.

  View details for DOI 10.21037/qims-20-634

  View details for PubMedID 33392041

• Magnetic resonance imaging of the fetal musculoskeletal system. Pediatric radiology Chauvin, N. A., Victoria, T., Khwaja, A., Dahmoush, H., Jaramillo, D. 2020; 50 (13): 2009–27

  Abstract

  Diagnosing musculoskeletal pathology requires understanding of the normal embryological development. Intrinsic errors of skeletal development are individually rare but are of paramount clinical importance because anomalies can greatly impact patients' lives. An accurate assessment of the fetal musculoskeletal system must be performed to provide optimal genetic counseling as well as to drive therapeutic management. This manuscript reviews the embryology of skeletal development and the appearance of the maturing musculoskeletal system on fetal MRI. In addition, it presents a comprehensive review of musculoskeletal fetal pathology along with postnatal imaging.

  View details for DOI 10.1007/s00247-020-04769-z

  View details for PubMedID 33252766

• Imaging phenotype correlation with molecular and molecular pathway defects in malformations of cortical development. Pediatric radiology Guimaraes, C. V., Dahmoush, H. M. 2020; 50 (13): 1974–87

  Abstract

  The increase in understanding of molecular biology and recent advances in genetic testing have caused rapid growth in knowledge of genetic causes of malformations of cortical development. Imaging diagnosis of malformations of cortical development can be made prenatally in a large subset of fetuses based on the presence of specific deviations from the normal pattern of development, characteristic imaging features, and associated non-central-nervous-system (CNS) abnormalities. In this review the authors discuss the role of four key cell molecules/molecular pathways in corticogenesis that are frequently implicated in complex prenatally diagnosed malformations of cortical development. The authors also list the currently described genes causing defects in these molecules/molecular pathways when mutated, and the constellation of imaging findings resultant of such defects.

  View details for DOI 10.1007/s00247-020-04674-5

  View details for PubMedID 33252763

• Binasal Visual Field Defects in a Child with Acute Necrotizing Encephalopathy Liu, Y., Dahmoush, H., Beres, S. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965900397

• Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology Campion, T. n., Taranath, A. n., Pinelli, L. n., Ugga, L. n., Nash, R. n., Talenti, G. n., Dahmoush, H. n., D'Arco, F. n. 2019

  Abstract

  Understanding the underlying pathophysiology and the patterns of disease spread is crucial in accurate image interpretation. In this pictorial review, the common and important inflammatory processes of the temporal bone in children will be discussed, and key computed tomography (CT) and magnetic resonance imaging (MRI) features described.Inflammatory processes are categorized by anatomical location: the petrous apex and the inner, middle and outer ear. A complete review of the literature is provided.Cholesteatoma, cholesterol granuloma and mucoceles are inflammatory processes that occur across the anatomical subsites of the temporal bone, whilst site-specific inflammatory processes include labyrinthitis ossificans in the inner ear and keratosis obturans in the external ear. Infection is a key cause of inflammation in the temporal bone, and specific infections include petrous apicitis, otitis media and necrotizing otitis externa. Finally, important mimics and do-not-touch lesions are considered. CT and MRI are complementary in assessing these disorders, as two of the most important diagnostic clues are the presence of bone erosion, best appreciated on CT, and true diffusion restriction as seen on MRI. Flow charts to assist in the diagnosis of paediatric temporal bone inflammatory disease are also provided.Paediatric temporal bone inflammatory processes are common and can have severe clinical sequelae. Timely intervention, facilitated by correct radiological diagnosis, can often prevent progression of disease, loss of hearing and systemic illness.

  View details for DOI 10.1007/s00234-019-02258-1

  View details for PubMedID 31321462

• Rare Saposin A deficiency: Novel variant and psychosine analysis. Molecular genetics and metabolism Calderwood, L. n., Wenger, D. A., Matern, D. n., Dahmoush, H. n., Watiker, V. n., Lee, C. n. 2019

  Abstract

  Saposin A is a post-translation product of the prosaposin (PSAP) gene that serves as an activator protein of the galactocerebrosidase (GALC) enzyme, and is necessary for the degradation of certain glycosphingolipids. Deficiency of saposin A leads to a clinical picture identical to that of early-infantile Krabbe disease caused by GALC enzyme deficiency. Galactosylsphingosine, also known as psychosine, is a substrate of the GALC enzyme that is known to be elevated in classic Krabbe disease. We present the case of an 18-month-old male with clinical and radiological findings concerning for Krabbe disease who had preserved GALC enzyme activity and negative GALC gene sequencing, but was found to have a homozygous variant, c.257 T > A (p.I86N), in the saposin A peptide of PSAP. Psychosine determination on dried blood spot at 18 months of age was elevated to 12 nmol/L (normal <3 nmol/L). We present this case to add to the literature on the rare diagnosis of atypical Krabbe disease due to saposin A deficiency, to report a novel presumed pathogenic variant within PSAP, and to suggest that individuals with saposin A deficiency may have elevated levels of psychosine, similar to children with classic Krabbe disease due to GALC deficiency.

  View details for DOI 10.1016/j.ymgme.2019.08.001

  View details for PubMedID 31439510

• Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas RADIOGRAPHICS Gunda, D., Cornwell, B. O., Dahmoush, H. M., Jazbeh, S., Alleman, A. M. 2019; 39 (1): 213–28

  View details for DOI 10.1148/rg.2019180084

  View details for Web of Science ID 000455091000015

• Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas. Radiographics : a review publication of the Radiological Society of North America, Inc Gunda, D., Cornwell, B. O., Dahmoush, H. M., Jazbeh, S., Alleman, A. M. 2018: 180084

  Abstract

  Infants and children under 2 years of age are at greatest risk for devastating neurologic complications following nonaccidental trauma. While a subdural hematoma (SDH) is the most common finding and is often enough to raise suspicion for abuse, no single injury is pathognomonic for abusive head trauma (AHT). Rather, the combination of imaging and physical findings and the clinical presentation help confirm the diagnosis of AHT. Familiarity with the spectrum of findings and proper identification of the imaging abnormalities is important for the radiologist to facilitate treatment and removal of the patient from the abusive environment. Injury is usually a result of shaking, which includes hyperflexion, hyperextension, and rotational forces, and less commonly impact trauma or a combination of both. Key anatomic features unique to the infant's head, neck, and spine and associated biomechanical forces are responsible for entities such as hypoxic ischemic injury, bridging vein thrombosis, SDH, parenchymal lacerations, and spinal and retinal injuries. Although the association of subpial hemorrhage with AHT has not been investigated, it warrants attention in very young infants who endure accidental or inflicted trauma. A combination of CT of the head and MRI of the brain and cervical spine aids in the accurate diagnosis, appropriate management, and subsequent protection of these patients. ©RSNA, 2018.

  View details for PubMedID 30468627

• Lobular capillary hemangioma of the mandible: A case report CLINICAL IMAGING Chan, C., Iv, M., Fischbein, N., Dahmoush, H. 2018; 50: 246–49

  View details for DOI 10.1016/j.clinimag.2018.04.012

  View details for Web of Science ID 000437818900040

• Lobular capillary hemangioma of the mandible: A case report. Clinical imaging Chan, C. n., Iv, M. n., Fischbein, N. n., Dahmoush, H. n. 2018; 50: 246–49

  Abstract

  Lobular capillary hemangiomas are acquired benign vascular neoplasms which typically affect the skin and mucous membranes. While these lesions commonly involve the head and neck, particularly the oral cavity, there are no reports in the literature of lobular capillary hemangioma arising from the mandible. The diagnosis of such a rare entity can therefore be challenging, especially as it may mimic more aggressive lesions, including malignancy. We present a rare case of an 8-year-old male with a lobular capillary hemangioma of the mandible, highlighting its imaging features and discussing the differential diagnosis of primary mandibular lesions in the pediatric population.

  View details for PubMedID 29704808

• Pretransplant functional imaging and outcome in pediatric patients with relapsed/refractory Hodgkin lymphoma undergoing autologous transplantation. Pediatric blood & cancer Ozuah, N. W., Dahmoush, H. M., Grant, F. D., Lehmann, L. E., LaCasce, A. S., Billett, A. L., Margossian, S. P. 2018; 65 (1)

  Abstract

  Pretransplant functional imaging (FI), particularly a negative positron emission tomography (PET), is a strong predictor of outcome in adults with relapsed or refractory Hodgkin lymphoma (HL), but data in pediatrics are limited.The medical records of 49 consecutive pediatric patients, who received autologous transplant at a single institution, were retrospectively analyzed. All patients had either gallium or PET scan before transplant and were conditioned with carmustine, etoposide, cytarabine, and melphalan (BEAM). Deauville scores were retrospectively assigned for patients with PET (score ≥ 4 positive).Of the 49 patients (median age, 16.2 years), 41 (84%) were pretransplant FI negative and eight (16%) were pretransplant FI positive, after first- to fourth-line salvage therapy, and a median of two salvage cycles. Eighteen patients (37%) received posttransplant radiation. At a median follow up of 46 months, 45 patients (92%) were alive and disease free, and there were three nonrelapse deaths and only one relapse death (Deauville score of 5). The 4-year progression-free survival (PFS) for the entire cohort was 92% (95% confidence interval [CI]: 78-97), and PFS based on pretransplant disease status was 95% (95% CI: 82-99%) in the negative FI group versus 75% (95% CI: 31-93) if positive FI (P = 0.057).Our analysis revealed outstanding outcomes for children and adolescents with relapsed/refractory HL. There were too few relapses to identify the predictive value of pretransplant metabolic status, but pediatric patients with relapsed/refractory HL and a negative pretransplant FI had excellent survival.

  View details for DOI 10.1002/pbc.26707

  View details for PubMedID 28696028

• Pretransplant functional imaging and outcome in pediatric patients with relapsed/refractory Hodgkin lymphoma undergoing autologous transplantation PEDIATRIC BLOOD & CANCER Ozuah, N. W., Dahmoush, H. M., Grant, F. D., Lehmann, L. E., LaCasce, A. S., Billett, A. L., Margossian, S. P. 2018; 65 (1)

  View details for DOI 10.1002/pbc.26707

  View details for Web of Science ID 000416119400004

• Multimodality imaging findings of massive ovarian edema in children. Pediatric radiology Dahmoush, H., Anupindi, S. A., Pawel, B. R., Chauvin, N. A. 2017

  Abstract

  Massive ovarian edema is a rare benign condition that predominantly affects childbearing women as well as preadolescent girls. It is thought to result from intermittent or partial torsion of the ovary compromising the venous and lymphatic drainage but with preserved arterial supply. The clinical features of massive ovarian edema are nonspecific and can simulate tumors, leading to unnecessary oophorectomy.To demonstrate imaging features that should alert radiologists to consider the diagnosis of massive ovarian edema preoperatively so that fertility-sparing surgery may be considered.We identified five girls diagnosed with massive ovarian edema at pathology. Presenting symptoms, sidedness, imaging appearance, preoperative diagnosis, and operative and histopathological findings were reviewed.Age range was 9.6-14.3 years (mean age: 12.5 years). Common imaging findings included ovarian enlargement with edema of the stroma, peripherally placed follicles, isointense signal on T1-W MRI and markedly hyperintense signal on T2-W MRI, preservation of color Doppler flow by US, and CT Hounsfield units below 40. The uterus was deviated to the affected side in all patients. Two of the five patients had small to moderate amounts of free pelvic fluid. Mean ovarian volume on imaging was 560 mL (range: 108-1,361 mL).While the clinical presentation of massive ovarian edema is nonspecific, an enlarged ovary with stromal edema, peripherally placed follicles and preservation of blood flow may be suggestive and wedge biopsy should be considered intraoperatively to avoid unnecessary removal of the ovary.

  View details for DOI 10.1007/s00247-017-3782-4

  View details for PubMedID 28246900