School ager whose gastrostomy tube fell out and has just been replaced

Upper GI of gastrostomy tube tip in the stomach — AP (above) and lateral (below) radiographs obtained after the injection of water soluble contrast through the gastrostomy tube show normal appearing gastric rugae. There is no leakage of contrast out of the stomach.

The diagnosis was correct position of the gastrostomy tube tip within the stomach.

Newborn who experienced oligohydramnios in utero

CXR and US of autosomal recessive polycystic kidney disease causing oligohydramnios and pulmonary hypoplasia — CXR AP (above) shows a small bell-shaped thorax with poorly expanded lungs despite being on a ventilator. Transverse US of the left kidney (below left) and right kidney (below right) shows the kidneys bilaterally to be enlarged and to be composed of innumerable microcysts giving the kidneys overall an echogenic appearance.

The diagnosis was autosomal recessive polycystic kidney disease resulting in oligohydramnios resulting in pulmonary hypoplasia.

School ager with arm pain after fall on outstretched hand

Radiograph of polyostotic fibrous dysplasia — AP radiograph of the humerus (left) shows a lengthy ground glass lesion with a sclerotic rim centered in the metaphysis of the humerus. AP radiograph of the hand (right) shows multiple lucent lesions with sclerotic rims in the capitate and hamate and in the proximal fourth and fifth metacarpal bones.

The diagnosis was polyostotic fibrous dysplasia.

Preschooler with developmental delay

MRI of arachnoid cyst of the posterior fossa — Axial (above left), coronal (above right) and sagittal (below) T2 MRI of the brain show a midline to right of midline high signal intensity lesion in the posterior fossa which is inferior to an intact cerebellar vermis and the right cerebellar hemisphere and which is having mass effect on the cerebellum.

The diagnosis was arachnoid cyst of the posterior fossa.

Premature newborn now 9 months old with abdominal distension

AXR of pneumatosis intestinalis of the colon — AXR AP (above) shows curvilinear air throughout the wall of the colon from the cecum to the rectosigmoid colon which is also appreciated on the AXR left lateral decubitus (below). There was no free air or portal venous gas.

The diagnosis was pneumatosis intestinalis of the colon of unknown etiology.

School ager with elbow pain after falling on outstretched hand

Radiology of elbow fracture of the medial epicondyle — AP radiograph of the elbow shows displacement, rotation, and fragmentation of the medial epicondyle.

The diagnosis was elbow fracture of the medial epicondyle of the elbow.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome with symmetrical distribution of artificial surfactant — Initial CXR AP (left) shows low lung volumes and symmetrical ground glass opacity in both lungs. CXR AP obtained 4 hours after the administration of artificial surfactant (right) shows increased lung expansion and clearing of the previously seen ground glass opacity in both lungs.

The diagnosis was respiratory distress syndrome showing the appearance of the chest before and after the symmetrical administration of artificial surfactant.

School ager who recently had their gastrostomy tube replaced and now have abdominal pain with tube feeds

AXR of the tip of the gastrostomy tube in the peritoneal space rather than in the stomach. — AXR AP obtained after the injection of water soluble contrast through the gastrostomy tube shows contrast throughout the peritoneum which is outlining the liver and spleen and pooling in the pelvis. The contrast in the bladder is from a CT exam performed earlier in the day.

The diagnosis was gastrostomy tube malfunction with the tip of the gastrostomy tube in the peritoneal space rather than in the stomach.

Teenager with tuberous sclerosis

MRI of renal angiomyolipomas in a patient with tuberous sclerosis. — Axial T1 MRI without contrast of the abdomen shows two oval hyperintense lesions in the right kidney that have similar signal intensity to the subcutaneous fat. No renal cysts were seen.

The diagnosis was renal angiomyolipomas in a patient with tuberous sclerosis.

School ager with an abdominal mass

MRI of fibrosarcoma of the abdomen — Coronal (above left) T2 MRI of the abdomen shows a right-sided heterogenous and hyperintense oval shaped suprarenal retroperitoneal mass that on sagittal T2 MRI (above right) is anterior to the spine (which has an incidental segmentation anomaly at T10-T12) and which on axial T2 MRI (below left) is seen to cross the midline in close proximity to the inferior vena cava and aorta. On axial T1 MRI with contrast (below right) the mass shows some enhancement. Other imaging (not provided) revealed invasion of the inferior vena cava by the mass and lung metastases.

The diagnosis was fibrosarcoma of the abdomen.

Newborn with a skin defect and a bump on the skull

MRI of aplasia cutis — Axial T1 MRI without contrast (above left) and axial T2 (above right) of the brain show an oval lesion in the subcutaneous tissue which is isointense on T1WI and hyperintense on T2WI. Coronal T1 MRI without contrast (below) show a bone defect in the skull beneath the cystic lesion.

The diagnosis was aplasia cutis.

Premature newborn with a rising lactate level

AXR and US of spontaneous intestinal perforation with dirty ascites — AXR AP (above left) shows a nasogastric tube projecting over the left upper quadrant of the abdomen. There is a collection of air in the mid-abdomen that does not appear to conform to being within bowel. There is no portal venous gas or pneumatosis intestinalis. Transverse US of the abdomen (above right) shows echogenic ascites in the abdomen surrounding the loops of bowel. AXR left lateral decubitus (below) shows a large amount of air between the abdominal wall and the liver. Subsequent placement of a surgical drain returned stool.

The diagnosis was spontaneous intestinal perforation resulting in pneumoperitoneum and complicated ascites.

Preschooler with elbow pain who fell on their outstretched hand

Radiograph of elbow fracture of lateral epicondyle — AP radiograph of the elbow (left) shows a fracture line through the lateral epicondyle. Lateral radiograph (right) shows elevation of the anterior and posterior fat pads due to a large elbow joint effusion.

The diagnosis was elbow fracture of the lateral epicondyle.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome with symmetrical distribution of artificial surfactant in the lungs — Initial CXR AP (left) shows low lung volumes and symmetrical ground glass opacity in both lungs. CXR AP obtained 1 hour after the administration of artificial surfactant (right) shows increased lung expansion and clearing of the previously seen ground glass opacity in both lungs.

The diagnosis was respiratory distress syndrome showing the appearance of the chest before and after the symmetrical administration of artificial surfactant.

Premature newborn after placement of an umbilical venous catheter

AXR of umbilical venous catheter tip in the right portal vein — AXR AP shows the course of the umbilical venous catheter taking a 90 degree turn within the liver with its tip projecting over the right lobe of the liver.

The diagnosis was umbilical venous catheter malfunction with the catheter tip projecting over the right portal vein.

Teenager with scrotal pain

US of varicocele — Transverse US of the left scrotum (above) shows a collection of enlarged serpiginous appearing veins superior to the testicle which are greater than 3 millimeters in diameter and which on transverse US of the left scrotum during a Valsalva maneuver (below) increase in diameter.

The diagnosis was varicocele.

School ager with beta thalassemia

MRI of extramedullary hematopoesis of the spleen — Coronal T2 MRI of the abdomen (above) shows multiple round high signal intensity lesions in the spleen. Axial T1 MRI with contrast (below) shows the splenic lesions to enhance avidly and homogenously

The diagnosis was extramedullary hematopoesis in the spleen.

Teenager with nasal stuffiness

CT of antochoanal polyp — Axial CT with contrast of the face (left) shows a low-density left-sided polyp originating in and filling the left maxillary sinus which extends medially to the nasal cavity and which on the sagittal CT (right) is then seen to continue to extend inferiorly into the posterior nasopharynx and oropharynx.

The diagnosis was antrochoanal polyp.

Premature newborn now 1 month old with blood in their stools

AXR of necrotizing entercolitis — AXR AP (above) shows an extremely dilated bowel gas pattern with cuvilinear air in the wall of the entire colon. There is increased lucency in the center of the image just beneath the diaphragm. AXR left lateral decubitus (below) shows a small amount of air between the abdominal wall and the liver. There is also an extensive amount of branching air seen within the liver.

The diagnosis was necrotizing enterocolitis resulting in pneumatosis intestinalis, portal venous gas, and pneumoperitoneum.

Toddler with elbow pain after a fall

Radiograph of lateral epicondyle elbow fracture — AP radiograph of the elbow (left) shows a fracture line through the lateral epicondyle. Lateral radiograph (right) shows elevation of the anterior and posterior fat pads due to a large elbow joint effusion.

The diagnosis was elbow fracture of the lateral epicondyle of the elbow.

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.