Teenager after motor vehicle accident

CT of mastoid fracture — Axial CT without contrast of the maxillofacial bones shows a linear lucent line extending throughout the left mastoid bone with resultant opacification of the left mastoid air cells.

The diagnosis was left mastoid fracture.

Infant with cough who is hypoxemic

CXR of respiratory syncytial virus pneumonia — CXR AP shows central airway thickening and bilateral lung hyperinflation causing flattening of the diaphragm. There is also a small right apical pneumonthorax.

The diagnosis was respiratory syncytial virus pneumonia.

Toddler with hypoxia

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows a faint opacity in the lingula lateral to the heart while CXR lateral (right) shows the opacity to be located over the heart.

The diagnosis was bacterial pneumonia in the lingula.

Teenager with microscopic hematuria

US of nutcracker syndrome — Transverse US of the abdomen (above) shows focal compression of left renal vein between the superior mesenteric artery anteriorly and the aorta posteriorly resulting in stenosis of the proximal left renal vein (markers #2) with associated dilation of the distal left renal vein (markers #1). Sagittal US of the abdomen (below) shows a reduced aortic-superior mesenteric artery angle of less than 45 degrees.

The diagnosis was nutcracker syndrome.

Teenager with knee pain

Radiograph of Osgood-Schlatter disease — AP radiograph of the knee (left) is unremarkable while lateral radiograph (right) shows infiltration and obscuration of the infrapatellar fat pad and fragmentation of the anterior tibial tubercle.

The diagnosis was Osgood-Schlatter disease.

Newborn with a bump on the back of the head

MRI of occipital cephalocele — Sagittal T2 MRI (above) shows a high signal intensity structure projecting inferiorly off the occiput of the skull. Axial T1 MRI without contrast (below left) clearly shows the interruption of the occipital subcutaneous tissues and the saccular structure posterior to it. Axial T2 MRI (below right) shows the saccular structure to be primarily cystic and to contain a small amount of neural tissue.

The diagnosis was occipital cephalocele.

Teenager with abdominal pain

CT and US of acute cholecystitis — Axial CT with contrast of the abdomen (above) shows a distended gall bladder with gallbladder wall thickening with rim enhancement. Sagittal US of the gallbladder shows diffuse wall thickening of the gallbladder (below left) along with a stone in the neck of the gallbladder causing posterior acoustic shadowing (below right).

The diagnosis was acute cholecystitis.

Teenager with jaw pain after trauma

CT of mandibular fracture — AP 3D CT without contrast of the face (left) shows a fracture line through the mandibular symphysis while lateral 3D CT (right) shows a fracture line through the left mandibular ramus causing a dislocated left condyle.

The diagnosis was mandibular fracture.

Toddler with respiratory distress

CXR of respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia — CXR PA (left) shows central airway thickening and mild lung hyperinflation with a dense opacity in the right upper lobe and a dense opacity in the left lower lobe which is obscuring the left hemidiaphragm (silhouette sign). The lateral radiograph (right) shows dense opacities over the upper spine and over the lower spine (spine sign).

The diagnosis was respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia.

School ager with fever and vomiting

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a dense opacity overlying the heart and obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the lateral radiograph (right) shows dense opacity over the lower aspect of the spine (spine sign).

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

Teenager with flank pain

US of nephrocalcinosis — Sagittal US of the left kidney (above) and right kidney (below) show dense calcification in the medullary pyramids of both kidneys.

The diagnosis was bilateral nephrocalcinosis.

School ager with left hip pain for 2 weeks

MRI of myositis of the hip — Axial (above left and below left) and coronal (above right) T2 with fat saturation MRI of the pelvis shows bright signal in the expanded and edematous left obturator internis and left gluteus medius muscles, which on coronal T1 MRI with contrast (below right) are shown to faintly enhance.

The diagnosis was myositis of the left hip.

Newborn with a brain cyst on prenatal ultrasound

MRI of cavum velum interpositum — Axial (left), coronal (above right) and sagittal (below left) T2 MRI of the brain shows a cerebrospinal fluid space between the atria and trigones of the lateral ventricles, behind the foramen of Monro, beneath the columns of the fornices and above the tela choroidea of the third ventricle.

The diagnosis was cavum velum interpositum.

Newborn with an abdominal mass

US and enema of colonic atresia due to in-utero cecal volvulus — Transverse US of the abdomen (left) shows a large round meconium filled lesion anterior to the right kidney which is at the bottom left of the image. AP image from an enema (right) shows a microcolon with the cecum in the midline of the abdomen. The terminal ileum could not be refluxed.

The diagnosis was a meconium-filled cecum causing in-utero cecal volvulus and subsequent colonic atresia.

School ager who has pain at the distal interphalangeal joint after jamming their finger

Radiograph of mallet finger fracture — Lateral radiograph of the finger shows a faint triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal aspect of the distal phalanx at the distal interphalangeal joint.

The diagnosis was mallet finger fracture.

Teenager with left scrotal pain

US of scrotolith — Transverse (above) and sagittal (below) US of the left scrotum show an oval hyperechoic lesion that is in the scrotum but that is extratesticular in location and which has posterior acoustical shadowing.

The diagnosis was scrotolith.

School ager who had a Nissen fundoplication 4 years ago who now has gagging while eating

UpperGI of para Nissen herniation — AP (left) and lateral (right) images from an UpperGI exam show the Nissen fundoplication wrap is intact. However, a small portion of the stomach has herniated superiorly and posteriorly through the wrap into the chest. This is best seen on the lateral view.

The diagnosis was Nissen fundoplication malfunction due to a para Nissen herniation.

Toddler whose parents both have chronic coughs

CXR of pulmonary tuberculosis — CXR AP shows bilateral hilar adenopathy, right greater than left, and a faint right lower lobe infiltrate.

The diagnosis was tuberculosis pneumonia.

Infant with fever

CT angiogram of polyarteritis nodosa — Axial (above) and coronal (below) CT with contrast of the chest show multiple aneurysms along the course of the bilateral subclavian arteries beginning near their origins.

The diagnosis was polyarteritis nodosa.

Toddler who was on extracorporeal membrane oxygenation as a newborn one year ago

MRI of diffuse cerebral atrophy due to extracorporeal membrane oxygenation — Axial (left) and coronal (right) T2 MRI without contrast of the brain shows diffuse thinning of the grey matter and white matter with subsequent prominence of the cerebral suci, subarachnoid space, and lateral and third ventricles.

The diagnosis was diffuse cerebral atrophy secondary to extracorporeal membrane oxygenation.

Teenager with a productive cough and fever

CXR of right upper lobe bacterial pneumonia — CXR PA (left) shows a dense opacity in the right upper lobe which is located superiorly on the CXR lateral (right).

The diagnosis was right upper lobe bacterial pneumonia.

School ager with cough and fever

CXR of left lower lobe bacterial pneumonia — CXR PA (left) shows a faint opacity in the left lower lung that is obscuring the left hemidiaphragm (silhouette sign) and this opacity is seen just anterior to the lower spine on the lateral radiograph (right).

The diagnosis was bacterial pneumonia in the left lower lobe.

School ager with cough and shortness of breath

CXR of right middle lobe bacterial pneumonia — CXR PA (left) shows dense opacity throughout the right middle lobe which is obscuring the right heart border (silhouette sign). CXR lateral (right) shows the opacity located over the heart.

The diagnosis was right middle lobe bacterial pneumonia.

Teenager with right lower quadrant pain

MRI of Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx — Contiguous axial (above) and coronal (below) T2 MRI of the pelvis show a bicornuate unicollis uterus with the left horn intact and with the right horn atretic and dilated and associated with a right hydrohematosalpinx.

The diagnosis was Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx.

School ager with a left mandibular mass

CT of myofibroma — Coronal CT without contrast of the face (above left) shows a soft tissue mass adjacent to or arising from the left mandible which on coronal CT with contrast (above right) is seen to be enhancing and well circumscribed. Coronal CT with bone windows (below) better shows the mandibular disruption and destruction caused by the mass.

The diagnosis was myofibroma.