Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema causing tension pneumothorax — CXR AP (left) shows bilaterally hyperexpanded lungs with multiple circular bubbly and branching interstitial lucencies bilaterally which appear to radiate from the hila. CXR AP obtained 1 day later (right) shows a large amount of air in the left pleural space causing mediastinal shift to the right and depression of the left hemidiaphragm resulting in a left-sided deep-sulcus sign.

The diagnosis was bilateral pulmonary interstitial emphysema causing a left tension pneumothorax.

Premature newborn after umbilical venous catheter placement

CXR of umbilical venous catheter perforation causing TPNoma in liver and TPN ascites — AXR AP (above left) after line placement shows the tip of the umbilical venous catheter to be inferior to the cavo-atrial junction. The bowel gas pattern is normal. There is a moderate right pleural effusion. AXR AP obtained 1 day later (above right) shows developing mild centralization of the bowel loops and increase in the size of the right pleural effusion. The tip of the umbilical venous catheter now projects over the umbilical vein. AXR AP obtained 1 day later (below left) shows marked centralization of bowel loops. Sagittal US of the right side of the abdomen (below right) shows a large right pleural effusion (left side of image), a large amount of ascites (right side of image anteriorly) and a cystic lesion within the liver (right side of image posteriorly).

The diagnosis was umbilical venous catheter malfunction due to perforation of the umbilical venous catheter out of the umbilical vein resulting in a TPNoma in the liver and TPN ascites.

School ager who sat on a rebar construction rod

CT of pediatric vaginal trauma and extraperitoneal bladder rupture — Immediate contiguous (above) sagittal CT with contrast of the pelvis shows on the immediate image fluid and air anterior to the bladder (above left) and air anteriorly in the fluid-filled vagina and active bleeding in the rectum posteriorly (above right). The delayed image (below) shows extravasated intravenous contrast anterior to the contrast filled bladder.

The diagnosis was vaginal trauma in the form of laceration of the rectum and vagina and extraperitoneal bladder rupture.

Teenager with gradual onset of gait disturbance

MRI of pediatric cervical spine disc herniation causing cord compression — Sequential sagittal T2 MRI of the spine shows at the level of C5-C6 low signal intensity material herniating posteriorly causing severe stenosis of the spinal canal along with bright signal in the spinal cord at that level.

The diagnosis was disc herniation of the C5-C6 intervertebral disc causing severe spinal canal stenosis and edema of the spinal cord.

School ager with headaches

CT of thrombosed pediatric basilar artery aneurysm — Axial (above left), sagittal (above right) and coronal (below) CT without contrast of the brain show a circular high density lesion posterior to the clivus that is in the course of the basilar artery.

The diagnosis was a thrombosed intracranial aneurysm of the basilar artery.

Premature newborn with bloody stools

AXR of pneumatosis intestinalis of whole colon in necrotizing enterocolitis — AXR AP shows bubbly appearing air in the wall of the entire colon from the cecum to the sigmoid colon.

The diagnosis was pneumatosis intestinalis of the whole colon in a patient with necrotizing enterocolitis.

Teenager post trauma

Radiograph of pediatric posterior dislocation of the elbow — AP (left) and lateral (right) radiographs of the elbow show posterior dislocation of the radius and ulna. There was a very small bone fragment superior to the coronoid process of the ulna on the lateral view which is seen between the radius and ulna on the AP view.

The diagnosis was posterior dislocation of the elbow with an associated fracture of the coronoid process of the ulna.

Premature newborn with respiratory distress

CXR of pediatric pulmonary interstitial emphysema — CXR AP shows hazy ground glass opacity throughout the right lung. The left lung is hyperexpanded and has multiple circular bubbly and branching interstitial lucencies that radiate from the left hilum.

The diagnosis was pulmonary interstitial emphysema in the left lung.

Premature newborn after peripherally inserted central catheter placement

CXR of pediatric PICC line tip in a left-sided superior vena cava — CXR AP shows the tip of the left upper extremity PICC line projecting over the heart and to the left of the spine.

The diagnosis was peripherally inserted central catheter malfunction with the tip of the PICC line in a persistent left superior vena cava which was confirmed on an ultrasound exam.

Teenager with a decreased urinary stream

Retrograde urethrogram of pediatric urethral stricture — Lateral image of the urethra from a retrograde urethrogram shows a persistent narrowing at the junction of the posterior urethra and bulbar urethra with the bulbar urethra being dilated.

The diagnosis was urethral stricture.

School ager who is having their bone age checked

Radiograph of pediatric lunotriquetral coalition — AP radiograph of the hand shows fusion of the lunate and triquetrum carpal bones.

The diagnosis was lunotriquetral carpal coalition.

Teenager with sore throat for 1 week who is now having difficulty breathing

CT of pediatric peritonsillar abscess — Axial (left) and coronal (right) CT with contrast of the head and neck show a round mass with a low density center and a thick enhancing rim that is lateral to the left palatine tonsil and which is causing mass effect on the airway.

The diagnosis was left peritonsillar abscess.

Premature newborn with increasing residuals

Radiograph of pneumatosis intestinalis in necrotizing enterocolitis — The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.

The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.

School ager who fell on an outstretched hand and has elbow pain

Radiograph of pediatric elbow fracture of coronoid process of ulna — Lateral radiograph of the elbow shows elevation of the anterior and posterior fat pads of the elbow. There is a very small bone fragment just superior to the coronoid process of the ulna.

The diagnosis was elbow fracture of the coronoid process.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR AP shows hazy ground glass opacity throughout the left lung. The right lung is hyperexpanded and has multiple circular bubbly and branching interstitial lucencies that radiate from the right hilum.

The diagnosis was pulmonary interstitial emphysema in the right lung.

Newborn with respiratory distress

CXR of normal position of arterial venous ECMO catheters — CXR AP shows multiple loops of small bowel that are minimally filled with air in the lower left hemithorax. There is mediastinal shift to the right. The tip of the arterial canula placed from the right carotid artery projects over the aortic arch while the tip of the venous canula placed from the right internal jugular vein projects over the right atrium. There are two chest tubes in the right hemithorax.

The diagnosis was normal position of the arterial canula and venous canula in a patient on extracorporeal membrane oxygenation due to left congenital diaphragmatic hernia.

School ager with nausea and vomiting

US and MAG3 nuclear medicine scan of orthotopic ureterocele — Transverse US of the bladder (above left) shows a round cystic lesion in the base of the bladder. Sagittal US of the bladder (above right) shows to the left of the image an extremely dilated left ureter and to the right of the image again the round cystic lesion in the base of the bladder. Sagittal image of the left renal fossa (below left) shows non-visualization of the left kidney. Nuclear medicine MAG3 scan (below right) shows a normal right kidney, non-visualization of the left kidney, and a round photopenic defect in the bladder.

The diagnosis was left non-functioning kidney with left hydroureter and a left orthotopic ureterocele.

Teenager with right lower extremity swelling

MRI of pediatric cellulitis of the lower extremity — Two non-contiguous axial T2 MRI images of the right lower extremity show diffuse circumferential high T2 signal in the subcutaneous tissues and along the deep fascial plane. There were no abscesses seen.

The diagnosis was cellulitis of the lower extremity.

Teenager with fever and odynophagia

CT of intratonsillar abscess of right palatine tonsil — Axial (left), coronal (above right) and sagittal (below right) CT with contrast of the head and neck show a low density fluid collection in the right palatine tonsil that is surrounded by a thin enhancing rim of tissue. The airway is widely patent.

The diagnosis was intratonsillar abscess of the right palatine tonsil.

Newborn with bloody stools

AXR of pneumatosis intestinalis in necrotizing enterocolitis — AXR AP shows curvilinear appearing air in the wall of the descending colon.

The diagnosis was pneumatosis intestinalis of the descending colon in a patient with necrotizing enterocolitis.

School ager who fell on an outstretched hand and now has elbow pain

Radiograph of pediatric capitellum fracture of the elbow — AP (left), oblique (middle) and lateral (right) radiographs of the elbow show a fracture line through the capitellum which is displaced anteriorly and superiorly along the humerus which is best shown on the lateral radiograph, which also shows elevation of the anterior and posterior fat pads of the elbow.

The diagnosis was elbow fracture of the capitellum.

Newborn with respiratory distress

CXR of pediatric Group B streptococcus pneumonia — CXR AP shows normal lung expansion with fine interstitial infiltrates bilaterally.

The diagnosis was Group B streptococcus pneumonia.

School ager with a ventriculoperitoneal shunt and a new headache

Radiograph of broken ventriculoperitoneal shunt tubing — AP radiograph of the skull (left) shows a break in the VP shunt tubing just above the right orbit. AXR (right) shows the remaining VP shunt tubing coiled in the pelvis.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing.

Teenager after motor vehicle accident

CT of renal laceration and suspected ureter transection — Axial CT with contrast of the abdomen (above left) shows an extensive laceration of the left kidney with an associated low density retroperitoneal hematoma surrounding the left kidney. Delayed lower axial image from the same CT exam (below left) shows extravasation of high density IV contrast around the left psoas muscle. 3D CT urogram performed the next day (right) again shows massive extravasation of IV contrast medial to the left kidney with non-visualization of the left ureter suggesting ureteral transection. The right kidney and ureter are normal. However, a retrograde urogram performed the next day showed the left ureter was not transected which allowed placement of a left ureteral stent.

The diagnosis was left kidney laceration and suspected left ureteral transection which was not confirmed on a retrograde pyelogram exam.

Teenager with a soft tissue mass between the first and second digits of the hand

Radiograph and US of venous malformation of the hand — AP radiograph of the hand (above) shows a large round laminated appearing calcified phlebolith between the first and second digits of the hand. Transverse US of the area of calcification (below) shows two laminated appearing clots of varying age.

The diagnosis was vascular malformation of the hand in the form of a venous malformation.