Infant with respiratory distress

CXR of prominent thymus in inspiration and expiration — Inspiratory CXR AP (left) shows an enlarged mediastinal silhouette with a normal heart size while the pulmonary vascularity is normal and the lungs are clear. Expiratory CXR AP (right) shows an even more enlarged mediastinal silhouette with a now enlarged appearing heart.

The diagnosis was prominent thymus which appears even more prominent on expiration.

Infant with urinary tract infection

US and VCUG of pediatric everting orthotopic ureterocele — Transverse ultrasound of the bladder (above left) shows an oval lesion in the center of the bladder that has a thick wall and a hypoechoic center. AP image early in the filling phase of a voiding cystourethrogram exam (above right) shows an oval lucent filling defect representing a lesion in the center of the bladder. AP image from later in the filling phase (below left) shows the filling defect / lesion is within the bladder. Lateral image from the voiding phase (below right) shows the lesion has everted out of the bladder. Left sided vesicoureteral reflux was also present.

The diagnosis was everting orthotopic ureterocele.

Newborn with lower extremities that are asymmetric in length

Radiograph of proximal focal femoral deficiency — AP radiograph of the right femur (left) shows the right femoral head and right femoral shaft are hypoplastic in appearance. AP radiograph of the pelvis (right) shows the difference in length between the femurs.

The diagnosis was right proximal focal femoral deficiency.

School ager with left jaw pain

CT of pediatric dentigerous cyst — Coronal (left) and axial (right) CT without contrast of the face show the sixth right tooth to be uninterrupted with an expansile cyst surrounding its crown and extending to the maxilla.

The diagnosis was dentigerous cyst.

Infant with abdominal pain and a palpable lump just superior to the umbilicus

US of pediatric abdominal wall hernia — Transverse US of the abdominal wall (above) shows superior to the umbilicus a heterogenous isoechoic mass in the midline between the rectus muscles which are just lateral to it. Sagittal US (below) shows the mass passing through a defect in the anterior abdominal wall just superior to the umbilicus. In the operating room the mass was seen to be omental fat.

The diagnosis was abdominal wall hernia.

School ager who fell off an all terrain vehicle

Radiograph of Salter Harris Type II fracture of the ankle — AP radiograph of the ankle shows a fracture line through the distal physis of the tibia that extends superiorly into the tibial metaphysis and the tibial fracture fragments are not in anatomic alignment and apposition. There is also a comminuted fracture of the distal fibular metaphysis and the fibular fracture fragments are not in anatomic alignment and apposition.

The diagnosis was Salter Harris fracture Type II of the tibia and a complete fracture of the fibula.

Preschooler with Trisomy 21 and respiratory distress

CXR of pediatric AV canal — CXR AP shows enlargement of the heart and markedly increased pulmonary vascularity. The lungs are clear.

The diagnosis was atrioventricular canal.

Infant with respiratory distress

CXR of a prominent thymus — CXR AP (left) shows a mass projecting over the right superior mediastinum and right superior heart. CXR lateral (right) shows the mass to be in the anterior mediastinum.

The diagnosis was prominent thymus.

School ager with right scrotal pain for 1 day

US of torsion of the appendix epididymis — Sagittal US of the scrotum on the day of presentation (above) shows a hypoechoic oval lesion in the epididymis just above the testicle. Sagittal US of the scrotum 2 weeks later (below) shows the previously seen hypoechoic lesion in the epididymis to have evolved into an anechoic cyst.

The diagnosis was torsion of the appendix epididymis.

School ager with a palpable mass behind the knee

US of pediatric popliteal cyst — Transverse grayscale (above) and sagittal color doppler (below) US of the popliteal fossa show a large anechoic lesion in the popliteal fossa which is avascular and whose neck at its deepest extent was seen to extend into the joint space between the semimembranosus tendon and medial head of gastrocnemius tendon.

The diagnosis was popliteal cyst.

Newborn with a posterior fossa cyst on prenatal US

MRI of Dandy Walker variant — Sagittal T1 MRI without contrast of the brain (above left) shows a cystic lesion in the inferior posterior fossa which is not causing any mass effect in a normally sized posterior fossa. Coronal T2 MRI (above right) and axial T1 MRI without contrast (below) show a mildly enlarged fourth ventricle which is connecting to the cystic lesion due to mild agenesis of the cerebellar vermis.

The diagnosis was Dandy Walker variant.

Preschooler with elevated liver function tests

US of pediatric acute hepatitis — Sagittal (above left) and transverse (above right) US of the liver show increased echogenicity around the portal veins – a starry sky appearance. Sagittal (below left) and transverse (below right) US of the gallbladder show diffuse gallbladder thickening.

The diagnosis was acute hepatitis.

Newborn who experienced shoulder dystocia during delivery

CXR of humerus fracture due to shoulder dystocia — CXR AP shows a complete fracture through the diaphysis of the left humerus. The fracture fragments are not in anatomic alignment and apposition.

The diagnosis was proximal humerus fracture.

Toddler with respiratory distress

CXR of pediatric atrial septal defect — CXR AP (left) and CXR lateral (right) show the heart to be enlarged and the pulmonary vascularity to be increased. The lungs are clear.

The diagnosis was atrial septal defect.

Newborn with respiratory distress

Pediatric lordotic CXR — CXR AP is angled superiorly at greater than 90 degrees to the patient and therefore shows the apices of the lungs very clearly. The ribs have a different contour than would be expected on a normal CXR AP angled at 90 degrees to the patient. The heart size is normal, the pulmonary vascularity is not congested, and the lungs are clear.

The diagnosis was normal lordotic view of the chest.

Newborn with bilateral unpalpable testicles

US of pediatric intraabdominal testicle — Transverse (above left) and sagittal (below left) US of the pelvis show the right testicle to lie lateral to the superior aspect of bladder. Transverse (above right) and sagittal (below right) US of the left inguinal canal shows the left testicle to lie within the left inguinal canal.

The diagnosis was bilateral undescended testicles with the left testicle in the inguinal canal and the right testicle in the abdomen.

School ager with left preauricular mass

CT of pediatric pilomatricoma — Axial (above) and coronal (below) CT with contrast of the face show a well-circumscribed oval lesion near the left ear that has calcifications within it. There are no inflammatory changes associated with it.

The diagnosis was pilomatricoma.

Newborn with a brain cyst on prenatal ultrasound

MRI of Dandy Walker malformation — Coronal (above right) and axial (below) T1 MRI without contrast of the brain show hypoplasia of the inferior cerebellar vermis. Sagittal T1 MRI (above left) shows dilation of the fourth ventricle, expansion of the posterior fossa and elevation of the tentorium and torcula.

The diagnosis was Dandy Walker malformation.

Toddler with abdominal pain

US of pediatric hepatic steatosis — Sagittal (above) and transverse (below) US of the liver show diffusely increased echogenicity of the liver parenchyma when compared to the right kidney parenchyma.

The diagnosis was hepatic steatosis.

Teenager who hurt his finger playing football

Radiograph of Salter Harris Type II fracture of phalanx — AP radiograph of the hand shows a fracture line through the physis at the base of the second proximal phalanx that extends up into the metaphysis of the phalanx.

The diagnosis was Salter Harris Type II fracture of the second proximal phalanx of the hand.

Toddler with congestive heart failure

CT of pediatric anomalous left coronary artery from the pulmonary artery — Two contiguous images from axial CT with contrast of the chest shows the left coronary artery arising from the left anterior pulmonary sinus in the main pulmonary artery.

The diagnosis was anomalous left coronary artery from the pulmonary artery.

Toddler with gastroesophageal reflux

Upper GI of normal pediatric esophagram — AP (left) and lateral (center and right) images from an upper GI exam show the esophagus to have a smooth contour without fixed narrowing or extrinsic compression.

The diagnosis was normal fluoroscopic appearance of the pediatric esophagus.

Newborn with complex congenital heart disease

US of Tamm Horsfall proteins — Sagittal US of the right kidney (above) and left kidney (below) show multiple round echogenic foci in the renal pyramids bilaterally.

The diagnosis was Tamm Horsfall proteins.

Infant being worked up for suspected child abuse

Radiograph of physiologic periosteal reaction — AP radiographs of the bilateral tibiae and fibulae show bilateral symmetrical periosteal reaction along the medial diaphyses of the tibiae.

The diagnosis was physiologic periosteal reaction.

School ager with excessive right-sided tearing after a right facial fracture

CT of dacrocystocele — Axial (above) and coronal (below) CT with contrast of the orbits show an oval low density lesion with a thin enhancing wall located along the course of the right nasolacrimal duct.

The diagnosis was right dacrocystocele.