Newborn with a very small jaw

3D CT of Pierre Robin syndrome — 3D CT without contrast of the face shows micrognathia.

The diagnosis was Pierre Robin syndrome.

Preschooler with wheezing

Upper GI of double aortic arch — CXR (left) shows a right paratracheal mass. AP image from an UGI exam (middle) shows kinking of the upper esophagus while lateral (right) image shows a posterior indentation on the esophagus.

The diagnosis was double aortic arch.

School ager with abdominal distension and generalized abdominal pain

AXR of constipation — AXR shows a marked amount of stool from the cecum to the rectum.

The diagnosis was constipation.

Infant who cannot have a nasogastric tube passed through either nare

CT of choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.

The diagnosis was bilateral choanal atresia.

Newborn with breech presentation

US of development dysplasia of the hip — Coronal US of the bilateral hips shows lateral subluxation of the left femoral head out of the left acetabulum with less than 50% coverage of the left femoral head and a decreased alpha angle of the left hip of 45 degrees. There is a normal alpha angle of the right hip of 69 degrees and the right femoral head is > 50% covered.

The diagnosis was left-sided developmental dysplasia of the hip.

School ager with left testicular pain and swelling

US of epididimo-orchitis — Sagittal (above left) and transverse (below left) color doppler US of the left testicle shows hypervascularity of the left epididymis and testicle when compared to the right testicle (above right).

The diagnosis was left epididimo-orchitis.

Newborn with choking while feeding

UGI of esophageal atresia with H-type tracheo-esophageal fistula — CXR (left) shows dextrocardia and diffuse lung infiltrates bilaterally. Oblique image from a pull-back esophagram performed with a nasogastric tube while injecting low-osmolar water soluble contrast in the distal esophagus (right) shows opacification of the trachea and bronchial tree via a fistula.

The diagnosis was aspiration pneumonia due to esophageal atresia with H-type tracheo-esophageal fistula.

Teenager with a chest wall deformity

CT of pectus excavatum — Axial CT without contrast of the chest shows a marked depression of the sternum towards the spine. The Haller index was 4.

The diagnosis was pectus excavatum.

Infant with dysphagia

Upper GI of right aortic arch with aberrant left subclavian artery — AP image (left) from an UGI exam shows a right sided aortic arch and an indentation running across the upper esophagus which on the lateral image (right) shows the indentation to be posterior to the esophagus.

The diagnosis was right aortic arch with an aberrant left subclavian artery.

School ager with recurrent abdominal pain

AXR of constipation — AXR shows a massive amount of stool from the cecum to the rectum.

The diagnosis was constipation.

Newborn who cannot have a nasogastric tube passed through the left nares

CT of left choanal atresia — Axial CT without contrast of the maxillofacial bones shows thickening and bowing of the vomer to the left resulting in a narrow left choana.

The diagnosis was left choanal atresia.

Infant with a positive Barlow and Ortolani maneuver in the left hip at birth

US of developmental dysplasia of the hip — Coronal ultrasound images of the left hip (left) and right hip (right) were obtained after 5 weeks of therapy in a Pavlik harness with the patient located in the Pavlik harness during the exam. The coronal view is meant to simulate an anterior-posterior radiograph of the hip. The left hip is still dysplastic with there still being a shallow acetabulum and decreased alpha angle even though the left hip appears fairly well located in the left acetabulum. The left hip alpha angle measured 45 degrees (normal is usually greater than 60 degrees) but had increased since the last exam. The right hip was normal in appearance.

The diagnosis was resolving developmental dysplasia of the left hip.

Newborn with oligohydramnios and hydroureteronephrosis on prenatal US

US of cystic renal dysplasia — Sagittal US of the kidneys (above) show small echogenic kidneys bilaterally with some cysts but no hydronephrosis. AP image from a VCUG (below left) shows bilateral grade 4 vesicoureteral reflux with intrarenal reflux and the bladder is trabeculated. Lateral image from the VCUG (below right) shows a urachal diverticulum arising from the dome of the bladder anteriorly. The urethra was normal.

The diagnosis was vesicoureteral reflux causing cystic renal dysplasia and an incidental urachal remnant.

Toddler with a lower abdominal midline mass

CT of colonic duplication — Axial CT with IV and oral contrast of the abdomen show a large midline mass which appears to contain air and stool (and no oral contrast) that extends from the lower abdomen (top) all the way to the rectum which it displaces posteriorly and to the right (bottom).

The diagnosis was colonic duplication.

Infant with stridor and a barky cough

Radiograph of croup — AP radiograph of the airway (left) shows loss of the normal shoulders of the subglottic trachea (steeple sign). Lateral radiograph of the airway (right) shows distension of the hypopharynx, a normal epiglottis and some narrowing of the subglottic trachea.

The diagnosis was croup.

School ager with chest wall ecchymosis post motor vehicle accident

CT of false positive thoracic aortic injury / aortic dissection — Non-gated axial (above left) and coronal (above right) CT with contrast of the chest show a line in the lumen of the aorta from the sinotubular junction to the origin of the brachiocephalic artery. Repeat gated axial (below left) and coronal (below right) CT with contrast of the chest show absence of the previously seen line in the lumen of the aorta from the sinotubular junction to the origin of the brachiocephalic artery.

The diagnosis was false positive thoracic aortic injury due to the non-gated nature of the original CT scan.

Newborn with failure to pass meconium

Enema of colonic atresia — AXR (left) shows multiple dilated loops of bowel with an extremely dilated loop of bowel in the lower abdomen. AP (above right) and lateral (below right) images from an enema show a microcolon with contrast reaching the level of the cecum but not refluxing the terminal ileum, despite multiple attempts.

The diagnosis was colonic atresia.

Infant who is status post cardiac arrest

CT of hypoxic ischemic encephalopathy and interhemispheric subdural hematoma in child abuse — Axial CT without contrast of the brain shows decreased density of the cerebrum when compared to the density of the cerebellum. There is also loss of gray matter-white matter differentiation and effacement of the cerebral sulci and the basal cisterns. There is linear increased density present along the entire falx.

The diagnosis was hypoxic ischemic encephalopathy and interhemispheric subdural hematoma in a child abuse patient.

School ager with a heliotrope rash, pain and proximal weakness

MRI of dermatomyositis — Axial T2 MRI through the hips (above) shows small patchy areas of increased T2 signal bilaterally and symmetrically in the gluteus muscles and in the subcutaneous tissues of the lateral and posterior thighs which show mild enhancement on axial T1 MRI with contrast (below).

The diagnosis was mild dermatomyositis.

Newborn with anterior abdominal wall defect

AXR of cloacal exstrophy — AXR shows diastasis of the symphysis pubis, multiple loops of bowel outside the contour of the abdomen inferiorly, and multiple segmentation anomalies in the lower lumbar spine and sacrum.

The diagnosis was cloacal exstrophy in a patient with Omphalocele-Exstrophy of cloaca-Imperforate anus–Spinal defects (OEIS) syndrome.

Unjaundiced preschooler with vomiting and abdominal pain

CT and cholangiogram of choledochal cyst Type I — Axial (above left) and coronal (above right) CT without contrast of the abdomen show a large cystic lesion between the right kidney and pancreas with extensive surrounding inflammation. The gall bladder was normal. AP image from intraoperative cholangiogram (below) shows the lesion represents diffuse dilation of the common bile duct with free passage of contrast into the small bowel.

The diagnosis was choledochal cyst Type I.

Infant with an echogenic right lung mass on prenatal US

CT of congenital pulmonary airway malformation — Axial (above) and coronal (below) CT with contrast of the chest show a round mass in the right superior hilum that consists primarily of fluid density with a small air bubble in it superiorly.

The diagnosis was congenital pulmonary airway malformation.

Infant with choking with feedings

CT angiogram of right aortic arch with aberrant left subclavian artery — Lateral image from an esophagram (above left) shows a posterior indentation on the esophagus which was persistent. Coronal CT with contrast of the chest (above right) with 3D reconstructions (below) show a right-sided aortic arch with an aberrant left subclavian artery that originated from a Kommerell diverticulum and that courses behind the esophagus. The ductus arteriosus was noted to extend from the Kommerell diverticulum and completed the vascular ring.

The diagnosis was right aortic arch with aberrant left subclavian artery.

Teenager with right lower quadrant pain and WBC=30,000

US of acute appendicitis with appendicolith — Sagittal US of the right lower quadrant (above) shows a dilated, non-compressible, blind ending tubular structure measuring 10 mm in diameter with an echogenic focus at its tip causing posterior shadowing. Transverse US of the cecum (below) shows it to be thickened in appearance.

The diagnosis was acute appendicitis with an appendicolith at the tip of the appendix. In the operating room, the inflammed appendix was adherent to an inflamed cecum.

Toddler with left hearing loss

CT of acoustic neuroma — Axial CT without contrast of the temporal bones shows the left internal auditory canal (right) is smoothly expanded and much larger than the right internal auditory canal (left). This enlargement of the left internal auditory canal corresponded to the location of an enhancing mass within it on an MRI of the brain performed with contrast from an outside institution.

The diagnosis was left acoustic neuroma.