Newborn with blueberry muffin skin lesions

Radiograph of cytomegalovirus encephalitis — AP (above) and lateral (below) radiographs of the skull show bilateral thick, chunky, periventricular calcifications outlining the lateral ventricles.

The diagnosis was cytomegalovirus encephalitis.

Teenager with wrist pain

Radiograph of hand in juvenile idiopathic arthritis — AP radiographs of the hands shows bilateral periarticular osteoporosis throughout the hands. There is bilateral loss of the joint spaces in the carpal bones due to cartilage destruction and erosions at the proximal interphalangeal joints.

The diagnosis was juvenile idiopathic arthritis.

Infant with non-palpable testicles bilaterally

US of intra-abdominal undescended testicles — Sagittal US of the left lower abdomen (above) shows the left testicle lying on the left psoas muscle just inferior to left kidney. Sagittal US of the right lower abdomen (below) shows the right testicle lying on the right psoas muscle just inferior to the right kidney.

The diagnosis was bilateral intra-abdominal undescended testicles.

School ager with nausea, vomiting, and jaundice who is Hepatitis A positive

US of acute hepatitis — Transverse (above) and sagittal (below) US of the liver show a starry sky appearance to the liver with hypoechoic liver parenchyma and echogenic portal tracts.

The diagnosis was acute hepatitis.

Teenager with shortness of breath for 1 month

CXR and CT of granulomatosis with polyangiitis — CXR (above left) shows bilateral peripheral airspace disease that is more prevalent in the lower lobes than the upper lobes. Coronal (above right) and axial (below) CT with contrast of the chest better demonstrates the disease distribution and the presence of a few small non-cavitary nodules bilaterally.

The diagnosis was granulomatosis with polyangiitis.

Newborn after chest tube placement for a right pneumothorax

CXR of chest tube tip in the subcutaneous tissues of the chest wall — CXR AP shows a right sided chest tube whose tip is in the right subcutaneous tissues and not in the right hemithorax. There is a small right pneumothorax. The remainder of the tubes and lines are in appropriate position.

The diagnosis was chest tube malfunction due to the chest tube tip being in the subcutaneous tissues.

Teenager with back pain and elevated WBC, ESR, and CRP

MRI of epidural abscess of thoracic spine — Sagittal T1 without contrast (above left), T2 (above middle) and T1 with contrast (above right) MRI of the thoracic spine shows a long extradural mass that is compressing the spinal cord and which enhances heterogeneously. Axial T2 (below left) shows bright signal intensity in the paraspinal tissues representing myositis which on T1 with contrast (below right) enhances heterogenously. The spinal cord compression from the extradural mass is also well seen on the axial images.

The diagnosis was spinal epidural abscess with a paraspinal abscess as well.

Preschooler with a nasal mass

MRI of frontonasal encephalocele — Sagittal (left) and axial (right) T2 MRI without contrast of the brain shows herniation of the frontal lobes of the brain through the nasofrontal suture.

The diagnosis was frontonasal cephalocele.

Infant with irritability

CXR of infantile cortical hyperostosis — CXR AP (above) shows marked cortical thickening of all of the left ribs and the lower right ribs and the left humerus. CXR AP taken one year later (below) shows complete resolution of the cortical thickening.

The diagnosis was infantile cortical hyperostosis.

Infant with a urinary tract infection

CT of horseshoe kidney — Axial (above) and coronal (below) CT with contrast of the abdomen shows the lower poles of the kidneys to be fused in the midline. There is mild hydronephrosis of both kidneys.

The diagnosis was horseshoe kidney.

Teenager with substernal dysphagia

Upper GI of achalasia — Three lateral images from an upper GI exam shows dilation of the proximal esophagus which narrows to a beak distally which never opens up. A barium pill would not pass through the distal esophagus into the stomach.

The diagnosis was achalasia.

School ager with fever, stridor and a sore throat

Airway radiograph of bacterial tracheitis — Lateral radiograph of the airway shows subglottic asymmetric narrowing of trachea with an irregular tracheal border and loss of the normal definition of the tracheal walls with membranes and plaques noted within the subglottic trachea.

The diagnosis was bacterial tracheitis.

School ager with meningitis with a ventriculoperitoneal shunt that was placed a week ago who has developed a new headache today

MRI of ventriculoperitoneal shunt malfunction due to migration of the tip of the shunt out of the ventricular system. — Axial T2 MRI without contrast of the brain immediately after ventriculoperitoneal shunt placement a week ago (left) shows the tip of the VP shunt placed from a left parietal approach to be in appropriate position in the the posterior horn of the left lateral ventricle. Axial T2 MRI of the brain from today (right) shows the tip of the ventriculoperitoneal shunt to no longer be within the left lateral ventricle but to be in the brain parenchyma.

The diagnosis was ventriculoperitoneal shunt malfunction due to migration of the tip of the ventriculoperitoneal shunt out of the left lateral ventricle.

Preschooler after acid ingestion

Upper GI of gastritis due to acid ingestion — AP image from an upper GI exam shows a very distended stomach with a large air fluid level within it. Gastric emptying was extremely slow due to marked narrowing of the gastric antrum caused by gastritis. The esophagus was normal in appearance

The diagnosis was corrosive gastritis due to acid ingestion causing gastric outlet obstruction.

Teenager with a sore throat for several days

CT of a palatine tonsil intrastonillar abscess — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the face shows a large low density fluid collection centered in the right palatine tonsil.

The diagnosis was an intratonsillar abscess in the right palatine tonsil.

Teenager with a headache

CT of fibrous dysplasia of the sphenoid bone — Axial (left) and coronal (right) CT without contrast of the face show a lesion involving the clivus, sphenoid, and greater wing of the left sphenoid and that is causing a narrowing of the left orbital apex which has osseous matrix and ground glass appearance with a narrow zone of transition and no periosteal new bone.

The diagnosis was fibrous dysplasia.

Female school ager with acute urinary retention

US of hematocolpos — Sagittal US of the pelvis (above) shows the uterus (upper left) to have a pubertal appearance and to have no fluid within it while the vagina (to the right) is massively distended with heterogeneous appearing fluid. Transverse US of the pelvis better shows the complex nature of the fluid in the vagina.

The diagnosis was hematocolpos.

Preschooler with nausea and vomiting who had a congenital diaphragmatic hernia repaired 4 years ago

AXR of small bowel obstruction due to abdominal adhesions — AXR supine (left) shows multiple dilated loops of small bowel that have a stacked appearance. AXR upright (right) shows multiple air fluid levels within those loops of small bowel.

The diagnosis was abdominal adhesions from the prior surgery causing a distal closed loop small bowel obstruction.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome — CXR AP shows symmetrical low lung volumes bilaterally with ground glass opacities that are symmetrical from apex to base as well as from medial to lateral in each hemithorax. The endotracheal tube tip is just beneath the thoracic inlet.

The diagnosis was respiratory distress syndrome.

Infant after chest tube removal

CXR of chest tube fracture during chest tube removal — CXR AP (left) shows a chest tube in the left hemithorax. CXR AP after chest tube removal (right) shows a long fragment of the chest tube remaining in the left hemithorax.

The diagnosis was chest tube malfunction due to fracture of the chest tube during chest tube removal.

School ager with sinusitis and left eye proptosis

CT and MR of clivus chordoma — Axial (above left) CT with contrast of the face shows a large expansile mass filling the sphenoid sinus that has punctate calcifications within it and that is thinning the surrounding bone. Sagittal CT (above right) shows the mass to be arising from the top of the clivus. Coronal T2 MRI (below left) shows the mass to be heterogeneously bright and to not have any intracranial extension. Axial T1 MRI with contrast (below right) show the mass does not enhance.

The diagnosis was clivus chordoma.

Infant with a nasal mass

CT of nasal glioma — Axial CT with contrast of the face in soft tissue (above left) and bone (above right) windows show a nasal mass of soft tissue density arising off of the dorsal aspect of the nose and splaying the nasal bones. Sagittal CT (below) shows there is no evidence of intracranial extension.

The diagnosis was nasal glioma.

Teenager with knee pain after twisting their knee while playing football

Radiograph of patellar dislocation — AP (above left) and lateral (above right) radiographs of the knee show the patella to be dislocated laterally and posteriorly and there is a small knee effusion. AP (below left) and lateral (below right) radiographs of the knee obtained post reduction show the patella now to be in its correct position.

The diagnosis was patellar dislocation.

Male toddler with a left groin mass

US of encysted hydrocele of spermatic cord — Sagittal (above) US of the left groin shows an anechoic fluid collection in the left inguinal canal that does not communicate with the peritoneal cavity above or the scrotum below. Transverse US (below) better shows the septation within the fluid collection.

The diagnosis was an encysted hydrocele of the spermatic cord.

Teenager with bloody stools

Enema of ulcerative colitis — AP image from an enema shows narrowing of the descending colon which was persistent along with fine mucosal ulcerations in the descending colon.

The diagnosis was ulcerative colitis.