Newborn with respiratory distress

CXR of asphyxiating thoracic dystrophy (Jeune syndrome) — CXR AP shows shortened ribs resulting in a small thorax and a normal spine.

The diagnosis was asphyxiating thoracic dystrophy.

Premature newborn (35 weeks) with respiratory distress

CXR of hydrops fetalis — CXR AP shows low lung volumes, large bilateral pleural effusions, and extensive body wall edema.

The diagnosis was hydrops fetalis (non-immune). The patient had a thoraco-amniotic shunt placed at 24 weeks gestational age.

Newborn with meconium aspiration syndrome who is paralyzed while undergoing extracorporeal membrane oxygentation (ECMO)

CXR of neuromuscular paralysis — CXR AP shows extensive body wall edema and poorly expanded lungs with the tip of the ECMO venous canula in the right atrium (ra) and the tip of the ECMO arterial canula in the aortic arch (aa).

The diagnosis was neuromuscular paralysis leading to hypotonia.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome — CXR AP shows bilaterally poorly expanded lungs with diffuse ground-glass opacities throughout the lungs.

The diagnosis was respiratory distress syndrome.

Newborn with an amniotic fluid leak in-utero

CXR of pulmonary hypoplasia due to oligohydramnios — CXR AP shows bilateral poorly developed and poorly expanded lungs.

The diagnosis was oligohydramnios causing pulmonary hypoplasia.

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Pediatric Imaging Pearl of the Week

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School ager in a motor vehicle accident

CT of cerebral edema and subarachnoid hemorrhage — Axial CT without contrast of the brain shows diffuse low density through the bilateral cerebral hemispheres (anteriorly) with a normal density cerebellum (posteriorly) that appears relatively hyperdense when compared to the cerebral density. Subarachnoid hemorrhage was also seen bilaterally in the basal cisterns.

The diagnosis was diffuse cerebral edema.

Toddler with hemophillia who fell and hit their head

CT of epidural hematoma — Axial CT without contrast of the brain shows a mixed density biconvex intracranial extra-axial fluid collection posterior to the left cerebellum.

The diagnosis was a posterior fossa epidural hematoma.

School ager in a motor vehicle accident

CT of diffuse axonal injury — Axial CT without contrast of the brain shows multiple high density punctate intraparenchymal lesions at the gray matter-white matter junction in the bilateral cerebral hemispheres.

The diagnosis was diffuse axonal injury.

Teenager who was car surfing and fell off the car

CT of cerebral contusion — Axial CT without contrast of the brain shows multiple high density punctate intraparenchymal lesions in the bilateral frontal lobes.

The diagnosis was cerebral contusion.

Teenager ejected from the back of a pickup truck in a motor vehicle accident

CT of epidural hematoma — Axial CT without contrast of the brain shows a right frontal high density biconvex intracranial extra-axial fluid collection.

The diagnosis was epidural hematoma.

Teenager playing football who had a severe helmet to helmet collision with another player

CT of subdural hematoma — Axial CT without contrast of the brain with normal (left) and sharpened (right) windows shows a left hemispheric high density cresenteric intracranial extra-axial fluid collection that extends anteriorly along the falx.

The diagnosis was subdural hematoma.

School ager hit in head by a golf ball

CT of subgaleal hematoma — Axial CT without contrast of the brain shows a high density fluid collection in the left frontal subcutaneous tissue. There is also an underlying lentiform mixed density intracranial fluid collection.

The diagnosis was a left frontal subgaleal hematoma with an underlying epidural hematoma.

Our DDX For This Week Is

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

School ager with recent recurrent pneumonias who underwent esophageal atresia repair 5 years ago

Upper GI of esophageal atresia with recurrent fistula — Lateral image from an upper GI exam shows a contrast filled esophagus (posteriorly) connecting to the trachea (anteriorly) through a superiorly oriented fistula (in the middle).

The diagnosis was recurrent fistula after repair of esophageal atresia.

School ager who choked while eating tacos who is status post esophageal atresia repair 12 years ago

Upper GI of esophageal atresia — AP image from an upper GI shows marked luminal narrowing at the esophageal anastomosis between the dilated proximal esophageal pouch and the distal esophagus with a large filling defect in the proximal pouch. At endoscopy a large piece of meat was removed from above the anastomosis and the anastomosis was successfully dilated.

The diagnosis was a stricture at the esophageal anastomosis after repair of esophageal atresia.

Toddler who cannot swallow solid foods who is status post esophageal atresia repair a year ago

AP image from an upper GI shows ~ 75% luminal narrowing at the esophageal anastomosis between the dilated proximal esophageal pouch and the distal esophagus. This narrowing was subsequently successfully treated with dilation.

The diagnosis was a stricture at the esophageal anastomosis after repair of esophageal atresia.

Newborn with difficulty handling secretions who subsequently developed tracheomalacia

CXR AP (left) shows a nasogastric tube that cannot be advanced further in the esophagus. Vintage upper GI lateral image (right) shows a dilated proximal esophageal pouch compressing the airway. In current practice, there is no indication for doing an upper GI with positive contrast material.

The diagnosis was esophageal atresia with distal tracheo-esophageal fistula.

Infant with esophageal atresia without tracheo-esophageal fistula undergoing pre-operative imaging

AP image from an upper GI performed with a bougie dilator placed into the proximal esophageal pouch through the oropharynx and a bougie dilator placed through a gastrostomy tube site into the distal esophagus with both dilators held under tension shows a 2 cm gap between the proximal and distal esophageal segments.

The diagnosis was esophageal atresia with a long gap between the proximal and distal segments.

Infant with several episodes of aspiration pneumonia in the last year

CXR shows diffuse infiltrates in the right upper and lower lobes and hyperexpansion. An upper GI showed a fistula between the esophagus and trachea.

The diagnosis was esophageal atresia with H-type tracheo-esophageal fistula.

Our DDX For This Week Is

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Infant with recurrent pneumonias

2 lateral images from an upper GI shows contrast in the esophagus as expected (posteriorly) and in the airway unexpectedly (anteriorly). An H-type fistula is clearly seen connecting the airway and the esophagus.

The diagnosis was esophageal atresia with H-type tracheo-esophageal fistula.