Toddler with a right-sided abdominal mass

Gross pathological image of neuroblastoma — Gross pathological image with the aorta in the midline cut open shows a large mass arising from the right adrenal gland, which displaces the right kidney inferiorly and which crosses the midline and encases the aorta.

The diagnosis was neuroblastoma of the right adrenal gland.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Teenager with lap belt eccymoses on the abdomen after a motor vehicle accident

Radiograph of Chance fracture — AP (left) and lateral (right) radiographs of the lumbar spine show a three column fracture of the L3 vertebral body.

Teenager who cannot move their left shoulder after being pushed into a metal beam

Radiograph of anterior shoulder dislocation with Hills-Sachs lesion — AP (upper left) and axillary (above right) radiographs of the left shoulder show the left humeral head to be displaced anteriorly and medially in relation to the glenoid fossa. Post-reduction AP radiograph of the left shoulder (below) shows a defect in the posterolateral aspect of the humeral head.

The diagnosis was an anterior shoulder dislocation with a Hills-Sachs lesion post reduction.

Teenager with shoulder pain after a football injury

Radiograph of anterior shoulder dislocation — AP (above) and axillary (below) radiographs of the right shoulder show the right humeral head to be displaced anteriorly and medially in relation to the glenoid fossa.

The diagnosis was an anterior shoulder dislocation.

Teenager hit in the right thigh 1 month ago with a shot put

Radiograph of myositis ossificans — AP (left) and lateral (right) radiographs of the femur show an amorphous area of calcification anterior and lateral to the femur.

The diagnosis was myositis ossificans.

School ager with ankle pain after a fall

Radiograph and CT of triplane fracture — AP (left upper) and lateral (right upper) radiographs of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis. This is better demonstrated on the coronal (lower left) and sagittal (lower right) CT 2D reconstructions without contrast of the ankle.

The diagnosis was a triplane fracture (Salter-Harris Type III fracture).

Preschooler who cannot bear weight after falling on a trampoline

Radiograph of trampoline fracture — AP (left) and lateral (right) radiographs of the knee show a cortical irregularly in the lateral and anterior contour of the tibial metaphysis.

The diagnosis was a trampoline fracture.

Toddler who will not bear weight after falling from a slide

Radiograph of toddler fracture — AP (left) and lateral (right) radiographs of the tibia and fibula show a thin spiral lucency in the diaphysis of the tibia.

The diagnosis was a toddler fracture.

Teenager with ankle pain after crashing his sled into a fence

Radiograph and CT of Tillaux fracture

The diagnosis was a Tillaux fracture (Salter-Harris Type III fracture) of the ankle.

Teenager with foot pain developing after beginning a vigorous program of running

Radiograph of stress fracture — AP radiograph of the foot obtained at presentation (left) shows a mild amount of perisoteal reaction around the diaphysis of the second metatarsal that is much better seen on the repeat radiograph from 1 month later (right).

The diagnosis was a stress fracture of the second metatarsal.

Teenager with wrist pain after a fall

Radiograph of scaphoid fracture — AP radiograph of the wrist shows a thin lucent line through the center of the scaphoid bone. On physical exam the patient had point tenderness over this area.

The diagnosis was a non-displaced scaphoid fracture.

Preschooler who tripped and fell and cannot stand up

Radiograph of a pathologic fracture through a fibrous cortical defect — AP and lateral radiographs of the distal femur show a thin linear lucency running obliquely through a large, lucent, well corticated lesion in the femoral metaphysis.

The diagnosis was a non-displaced pathologic fracture through a fibrous cortical defect.

Preschooler with forearm pain after a fall

Radiograph of Monteggia fracture dislocation — AP and lateral radiographs of the elbow show a fracture of the ulnar diaphysis and a dislocation of the radial head.

The diagnosis was a Monteggia fracture dislocation.

Preschooler with forearm pain after an all terrain vehicle accident

Radiograph of Galeazzi fracture dislocation — AP radiograph (left) of the forearm shows a fracture of the radial diaphysis and lateral radiograph (right) shows a dislocation of the distal radial ulnar joint.

The diagnosis was a Galeazzi fracture dislocation.

Teenager with wrist pain after falling on an outstretched hand

Radiograph of Colles fracture — AP and lateral radiographs of the wrist show a comminuted distal radius metaphyseal fracture with dorsal angulation of the distal fracture fragment.

The diagnosis was a Colles fracture.

Teenager with right hip pain

Radiograph of avulsion of the lessor trochanter — AP radiograph of the pelvis shows avulsion of the apophysis of the right lesser trochanter.

The diagnosis was a pelvis and hip apophyseal avulsion fracture of the lesser trochanter.

Our DDX For This Week Is

Newborn with an anterior abdominal wall defect and a skin covered spinal dysraphism

Clinical image of cloacal exstrophy — Clinical image (left) shows the umbilical stump superiorly and inferior to it is an anterior abdominal wall defect with bladder and cecum herniated through it. Clinical image (right) also shows the skin covered spinal dysraphic defect posteriorly.

The diagnosis was cloacal exstrophy.

Teenager with pelvic fracture from trauma who cannot void

VCUG and RUG of urethral transection — AP (upper left) and oblique (upper right) images from a voiding cystourethrogram with the bladder filled through a suprapubic catheter shows extravasation of contrast into the base of the penis when the patient attempts to void. Oblique image from a retrograde urethrogram (below) shows an inability to fill the urethra completely during retrograde injection.

The diagnosis was urethral transection confirmed at cystoscopy.

Teenager with chest pain and shortness of breath

CXR and CT of thymoma — CXR PA and lateral (above) shows a mass centered in the anterior mediastinum with a right pleural effusion. Axial images from a CT with contrast of the chest shows a large solid anterior mediastinal mass that has a few areas of calcification (lower left) and fat (lower right) within it.

The diagnosis was thymoma.

Preschooler with febrile seizure and abdominal pain

CT and US of renal abscess — Axial (left upper) and coronal (right upper) CT with contrast of the abdomen shows a round low density lesion in the lower pole of the left kidney. Transverse (lower left) and sagittal (lower right) color doppler US of the the left kidney shows the round lesion in the lower pole to be solid and avascular in nature.

The diagnosis was renal abscess.

Preschooler with colicky abdominal pain

US of pancreatitis caused by pancreatic duct stone — Transverse US of the pancreatic head (above) shows just to the right of midline a round echogenic lesion with posterior shadowing in the center of the pancreatic head while transverse US of the pancreatic body (below) shows a dilated pancreatic duct throughout the body of the pancreas.

The diagnosis was a large stone in the pancreatic head portion of the pancreatic duct causing pancreatic duct obstruction and pancreatitis.

Toddler with a left abdominal mass

US and MRI of nephroblastomatosis — The diagnosis was Wilms tumor of the left kidney and nephrogenic rests from nephroblastomatosis in the right kidney.

The diagnosis was Wilms tumor of the left kidney and nephrogenic rests from nephroblastomatosis in the right kidney.

Toddler with a connective tissue disease

CXR of Marfan syndrome — CXR AP shows a prominent aortic arch and left lateral border of the aorta due to aortic ectasia.

The diagnosis was Marfan Syndrome.