Toddler with intermittent abdominal distension

Small bowel follow through of protein losing enteropathy — AP image from a small bowel follow through exam shows diffuse fold thickening throughout the small bowel which is more prominent in the jejunum than in the ileum.

The diagnosis was protein losing enteropathy.

Teenager with back pain after motor vehicle accident

CT of multiple compression fractures in the lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior compression fractures of the T12 thru L3 vertebral bodies with corresponding loss of height in each which is more subtly appreciated on the 3D CT (right).

The diagnosis was multiple anterior compression fractures of the lumbar spine.

School ager with fever and left chest pain

CXR of bacterial pneumonia in left lower lobe — CXR PA (left) shows a dense opacity over the heart obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the CXR lateral (right) shows the opacity is located posteriorly over the lower thoracic spine (spine sign).

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

Preschooler with cough and fever

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a retrocardiac opacity which on the CXR lateral (right) is seen to be located over the lower spine resulting in a spine sign.

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

Infant with prenatal hydronephrosis

US and MAG3 scan of horseshoe kidney — Transverse midline US of the lower abdomen (above) shows renal parenchymal tissue in the midline just anterior to the spine representing the fused lower poles of both kidneys. MAG3 scan (below) shows radiotracer uptake in the bilateral kidneys as well as in their fused lower poles.

The diagnosis was horseshoe kidney.

Preschooler with right knee swelling after a tick bite

Radiograph of lyme arthritis of the knee — Lateral radiograph of the knee shows a large suprapatellar joint effusion.

The diagnosis was lyme arthritis.

Teenager with a left neck mass

CT of second branchial cleft cyst — Axial (above), coronal (below left), and sagittal (below right) CT with contrast of the neck show a thin walled low density mass anterior to the left sternocleidomastoid muscle and posterior to the left submandibular gland. Superiorly the mass goes to the angle of the mandible and inferiorly the mass goes to the hyoid bone.

The diagnosis was second branchial cleft cyst.

Newborn with respiratory distress

Upper GI and small bowel follow through of ileal stenosis — AXR AP (above) shows a distended abdomen with multiple dilated loops of bowel including an asymmetrically dilated loop of bowel in the right upper quadrant. Delayed images from an UGI small bowel follow through exam (below left) shows contrast entering this dilated loop which is in the distal ileum and eventually passing through this dilated loop and filling the appendix (below right).

The diagnosis was ileal stenosis.

Preschooler with forearm pain after a fall

Radiograph of greenstick fracture of the radius and bowing fracture of the ulna — AP (left) and lateral (right) radiographs of the forearm show an incomplete non-displaced fracture through one cortical surface with angulation in the mid-diaphysis of the radius. The AP radiograph also shows the ulna to be bowed in appearance.

The diagnosis was greenstick fracture of the radius and a bowing fracture of the ulna.

School ager with cough and fever

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the left mid lung that is obscuring the left heart border while on the CXR lateral (right) the opacity is seen to overlie the heart.

The diagnosis was bacterial pneumonia in the lingula.

Toddler with sickle cell disease and fever

CXR of bacterial pneumonia in right upper lobe — CXR PA (left) shows an opacity in the right upper lobe which on the CXR lateral (right) is seen to be located posteriorly causing a spine sign.

The diagnosis was bacterial pneumonia in the posterior segment of the right upper lobe in a patient with sickle cell disease. The organism was bacillus non-anthrax.

Teenager with pelvic pain

CT of hematometrocolpos due to vaginal atresia — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the pelvis show a distended fluid-filled bladder anterior to an extremely distended fluid-filled uterus and vagina. The fluid in the uterus and vagina was of higher density than the fluid in the bladder.

The diagnosis was hematometrocolpos due to vaginal atresia.

Preschooler with a right chest wall mass

US of lipoma of chest wall — Transverse (above) and sagittal (below) US of the chest wall show a solid well circumscribed mass in the subcutaneous tissue with heterogenous echogenicity that overall is isoechoic to adjacent fat and which did not have increased vascularity.

The diagnosis was lipoma.

Infant with multiple congenital anomalies

MRI of Blake pouch cyst — Sagittal (left) and axial (right) T1 MRI without contrast of the brain shows cystic dilation of the fourth ventricle.

The diagnosis was Blake pouch cyst.

Teenager with an untreated lysosomal storage disease

MRI of Gaucher disease — Coronal T1 MRI without contrast (left) and T2 MRI (right) of the femurs shows a heterogeneous appearance to the bone marrow of the femurs due to diffuse marrow infiltration. The femurs have a mildly reduced constriction of diaphysis and flaring of metaphysis due to undertubulation, giving them the appearance of an Erhlemeyer flask.

The diagnosis was Gaucher disease.

School ager with pain at the base of the fifth metatarsal after injuring their foot

Radiograph of fracture of the apophysis of the fifth metatarsal — AP (left) and oblique (right) radiographs of the foot show fragmentation of the apophysis of the fifth metatarsal and displacement of it away from the fifth metatarsal.

The diagnosis was fracture of the apophysis of the fifth metatarsal.

Teenager with fever and hemoptysis

CXR and CT of bacterial pneumonia in the left lower lobe — CXR PA (above left) shows an opacity in the medial left lower lobe that obscures the medial left hemidiaphragm. CXR lateral (above right) shows a spine sign over the lower thoracic vertebral bodies. Axial CT without contrast of the chest (below left) shows a dense infiltrate in the posterior aspect of the left lower lobe while the sagittal CT (below right) again shows the infiltrate to be located inferiorly and posteriorly in the chest.

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

School ager with upper respiratory infection and decreased right breath sounds

CXR of bacterial pneumonia of right middle lobe — CXR PA (left) shows a dense opacity in the middle of the right lung that obscures the right heart border which on the CXR lateral (right) is located over the heart.

The diagnosis was bacterial pneumonia of the medial segment of the right middle lobe.

Infant with an enlarged left scrotum

US of encysted hydrocele of the spermatic cord — Sagittal US of the left scrotum shows a large anechoic mass in the left inguinal canal and upper scrotum that is superior to the left epididymis and testicle which are located on the right most aspect of the image. The mass did not communicate with the peritoneal cavity.

The diagnosis was an encysted hydrocele of the spermatic cord.

School ager with left hip pain for 5 weeks

Radiograph of Legg-Calve-Perthes disease — AP (left) and frog-leg (right) radiographs of the left hip show in the left femoral head a subarticular lucency and sclerosis and an irregular contour along with loss of height of the femoral head.

The diagnosis was Legg-Calve-Perthes disease.

Infant with left postauricular swelling

CT of Bezold abscess and coalescent mastoiditis — Axial CT with contrast of the brain (above left) shows two rim enhancing fluid collections in the subcutaneous tissues next to the left mastoid air cells. There is also extensive soft tissue inflammation tracking up the left side of the skull (above right). Axial CT bone windows (below) shows complete opacification of the left mastoid air cells and bone erosion and destruction along the lateral wall of the mastoid bone that is allowing communication between the mastoid air cells and the largest rim enhancing fluid collection.

The diagnosis was Bezold abscess in a patient with coalescent mastoiditis.

Teenager with dysphagia

Upper GI of esophageal web — Lateral images from an upper GI exam show a persistent anterior indendation and narrowing of the esophagus at the level of the C3 vertebral body which impedes the flow of contrast through it.

The diagnosis was esophageal web.

School ager with lateral foot pain after trauma

Radiograph of fifth metatarsal fracture — AP (left) and oblique (right) radiographs of the foot show a transverse lucent line through the base of the fifth metatarsal.

The diagnosis was fracture of the fifth metatarsal.

School ager with fever and cough

CXR of bacterial pneumonia in right middle lobe — CXR PA (left) shows dense opacity in the lateral aspect of the right mid-lung. CXR lateral (right) shows the opacity to be located in the right middle lobe.

The diagnosis was bacterial pneumonia in the lateral segment of the right middle lobe.

School ager with cough and fever

CXR of bacterial pneumonia in left upper lobe — CXR PA (above left) shows an opacity in the left lung that obscures the left mediastinum and left heart border which on the CXR lateral (above right) is seen to be located in the upper lung. Coronal (below left) and sagittal (below right) CT without contrast of the chest better localizes the opacities in the left upper lung.

The diagnosis was bacterial pneumonia of the left upper lobe.