Posts

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.

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.

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.

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.

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 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.