Newborn term infant with respiratory distress

CXR of congenital pulmonary airway malformation — CXR shows the left hemithorax filled with multiple cysts of various sizes causing mediastinal shift to the right. There is herniation of some normal appearing left apical lung across the midline. The stomach is in the abdomen.

The diagnosis was left congenital pulmonary airway malformation.

Newborn term infant with respiratory distress

CXR of tension pneumothorax — AP CXR (above) shows increased lucency in the left hemithorax when compared to the right and a deep sulcus sign is seen. There is mediastinal shift to the right implying underlying tension. Right lateral decubitus CXR (below) shows a clear pleural edge.

The diagnosis was a left tension pneumothorax.

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View the illustrated DDX of surgical causes of respiratory distress in the neonate (pre-term or term)

Newborn term infant with respiratory distress

CXR of chylothorax — CXR shows a large right pleural effusion.

The diagnosis was chylothorax.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of medical causes of respiratory distress in the neonate (pre-term or term)

Term newborn with respiratory distress

CXR of meconium aspiration syndrome — Initial CXR shows increased lung volumes and coarse interstitial infiltrates.

The diagnosis was meconium aspiration syndrome.

Term newborn with respiratory distress

CXR of Group B streptococcus pneumonia — Initial CXR shows normal lung volumes and fine interstitial infiltrates.

The diagnosis was Group B streptococcus pneumonia.

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Term newborn with respiratory distress

CXR of transient tachypnea of the newborn — CXR on day 1 (above) shows normal lung volumes and fine interstitial infiltrates which have resolved on the CXR from day 2 (below).

The diagnosis was transient tachypnea of the newborn.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome — Initial CXR shows low lung volumes and symmetrical (apex to base as well as left to right) ground glass opacity in both lungs.

The diagnosis was respiratory distress syndrome (also known as hyaline membrane disease and surfactant deficiency disorder).

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View the illustrated DDX of high bowel obstruction in the newborn

Newborn with vomiting

UGI of annular pancreas — Lateral image from an upper GI exam shows complete obstruction at the second part of the duodenum.

The diagnosis was annular pancreas.

Newborn with vomiting

UGI of jejunal atresia — AP image from an upper GI exam shows dilation of the duodenum and extreme dilation of the proximal jejunum. There was no distal passage of contrast on delayed images.

The diagnosis was jejunal atresia.

Toddler with vomiting with feeding

UGI of jejunal stenosis — Delayed image from an upper GI with small bowel follow through exam shows the jejunum to be extremely dilated (left side of image) while the ileum is decompressed (right side of image).

The diagnosis was jejunal stenosis.

Newborn with bilious vomiting

UGI of malrotation with midgut volvulus — Two AP images from an upper GI exam show the duodenal-jejunal junction to be to the left of the spine but to be low lying. The proximal jejunum has a spiral appearance.

The diagnosis was malrotation with midgut volvulus.

Infant with difficulty feeding

UGI of duodenal web — Image from an upper GI exam shows a wind-sock deformity at the junction of the second and third portions of the duodenum.

The diagnosis was duodenal web.

School ager with Trisomy 21 and vomiting with feeding

AXR and UGI of duodenal stenosis — AXR (above) shows the tip of the nasogastric tube within a very dilated duodenal bulb. There is extensive distal bowel gas. Spot image from an upper GI exam (below) shows a fixed area of narrowing between the first and second portions of the duodenum through which contrast passed slowly.

The diagnosis was duodenal stenosis.

Newborn with a distended abdomen

AXR of duodenal atresia — Supine (left) and upright (right) AXR shows large air fluid levels in the duodenal bulb (to the right of the spine) and in the stomach (to the left of the spine). There is no distal bowel gas.

The diagnosis was duodenal atresia.

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View the illustrated DDX of high bowel obstruction in the newborn

Newborn who can’t handle their secretions

CXR of esophageal atresia with distal fistula — CXR shows a nasogastric tube coiled within a dilated proximal esophagus. There is gas in the stomach.

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

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View the illustrated DDX of liver masses

Preschooler with hepatosplenomegaly

AXR of acute lymphocytic leukemia — AXR shows diffuse enlargement of the liver and spleen.

The diagnosis was acute lymphocytic leukemia.

Toddler with hepatomegaly

MRI of mesenchymal hamartoma — Axial T1 weighted without contrast (above) and T2 weighted (below) MRI of the abdomen shows a mass in the right lobe as well as in the medial segment of the left lobe of the liver, measuring 13 x 13 x 7 cm in size and having a cystic and solid appearance.

The diagnosis was mesenchymal hamartoma.

Infant with hepatomegaly

CT and US and angiogram of hepatoblastoma — Axial CT without (above left) and with (above right) contrast of the abdomen shows a large, coarsely calcified, heterogenously enhancing liver mass. US image (below left) shows its multinodular nature and an angiogram (below right) shows its neovascularity.

The diagnosis was hepatoblastoma.

Teenager with hepatomegaly

US of hepatocellular carcinoma — Sagittal US of the liver shows it to be enlarged and multinodular in appearance.

The diagnosis was hepatocellular carcinoma.