Newborn with a sacral dimple

Clinical image of a dermal sinus tract — Clinical image shows a sacral dermal sinus tract in the midline just above the gluteal cleft.

The diagnosis was normal position of the conus in a patient without a tethered cord.

Newborn with a sacral dimple

Clinical image of a sacral dimple — Clinical image shows a round sacral dimple in the midline just above the gluteal cleft.

The diagnosis was a tethered cord.

Newborn with a hard swollen right scrotum

Surgical image of testicular torsion — Surgical image shows a purple and necrotic appearing right testicle and a normal appearing and well-perfused left testicle.

The diagnosis was right testicle torsion.

Newborn with a hard swollen right scrotum

Clinical image of testicular torsion — Clinical image shows an enlarged right scrotum.

The diagnosis was right testicle torsion.

Newborn with a hard swollen right scrotum

Surgical image of testicular torsion — Surgical image shows a purple and necrotic appearing right testicle and a normal appearing and well-perfused left testicle.

The diagnosis was right testicle torsion.

Newborn with a palpable right-sided abdominal mass

Surgical image of retroperitoneal teratoma — Gross pathological image shows a large heterogenous mass that was cystic to palpation.

The diagnosis was retroperitoneal teratoma.

Newborn with a palpable right-sided abdominal mass

Gross pathology image of retroperitoneal teratoma — Gross pathological image shows a large heterogenous mass that was cystic to palpation.

The diagnosis was retroperitoneal teratoma.

Premature newborn now 1 month old with a patent ductus arteriosus

CXR of PDA clip on left mainstem bronchus — Preoperative CXR AP (above left) shows mild cardiomegaly and increased pulmonary vascularity. Postoperative CXR AP (above right) shows interval placement of a rather large clip on the ductus arteriosus. There is interval development of complete collapse of the left lung. CXR AP obtained after remove of the clip (below) shows interval reexpansion of the left lung.

The diagnosis was accidental clipping of the left mainstem bronchus along with the patent ductus arteriosus.

School ager injured in an accident inside a grain silo

Radiograph of bowing fractures of the tibia and fibula — AP radiograph of the right femur (left) shows a complete fracture of the femur. AP radiograph of the right tibia and fibula (right) shows the tibia and fibula to be bowed in appearance.

The diagnosis was bowing fractures of the tibia and fibula and complete fracture of the femur.

Newborn with a palpable ridge along their forehead

Radiograph of metopic craniosynostosis — AP radiograph of the skull shows hypotelorism with quizzical eye deformities present bilaterally.

The diagnosis was metopic craniosynostosis.

Teenager with proximal muscle weakness and a heliotrope rash

MRI of dermatomyositis — Coronal (above) and axial (below left) T2 MRI of the pelvis along with axial T2 MRI of the thighs (below right) shows diffuse, bilateral, symmetrical bright signal in the visualized muscles representing intramuscular edema in the quadratus lumborum, gluteal, and proximal thigh hamstring muscles.

The diagnosis was dermatomyositis.

Newborn with left hydronephrosis on prenatal US

US of ureteropelvic junction obstruction — Sagittal US of the right kidney (above) shows a single renal collecting system with no evidence of hydronephrosis. Sagittal US of the left kidney (below) show a single renal collecting system that has a moderate amount of hydronephrosis. The left renal pelvis is also moderately dilated. There was no left hydroureter.

The diagnosis was left ureteropelvic junction obstruction.

Preschooler with recurrent abdominal pain

CT and US of recurrent ileocolic intussusception caused by juvenile polyps — Axial CT with contrast of the abdomen (above) at initial presentation shows a large round soft tissue mass in the region of the ascending colon that has alternating circles of soft tissue density and fat density which give it a target sign appearance. Transverse US of the abdomen obtained two weeks later (below) shows recurrence of a nearly identical appearing soft tissue mass in the region of the ascending colon that has alternating circles of decreased and increased echogenicity giving it a target sign appearance.

The diagnosis was initially ileocolic intussusception which had been reduced successfully but had recurred two weeks later and which again was reduced successfully. Surgical exploration subsequently revealed multiple juvenile polyps acting as the lead point for the recurrent ileocolic intussusception.

Young adult with chronic cough and hemoptysis

CXR of pulmonary hemorrhage after cystic fibrosis — CXR AP and lateral show bilaterally hyperexpanded lungs with a coarse interstitial pattern, bronchial wall thickening and bilateral lower lobe bronchiectasis. The opacity in the medial aspect of the right lower lobe was new when compared to prior serial CXRs.

The diagnosis was cystic fibrosis with new pulmonary hemorrhage in the right lower lobe.

Teenager who was hit by a car while riding his go cart

CXR and CT of chylous pericardial effusion — CXR AP (above) shows the heart to be enlarged and to have a water bottle shape. Axial CT with contrast of the chest (below) shows a large amount of high density fluid in the pericardial space.

The diagnosis was chylous pericardial effusion due to rupture of the thoracic duct.

Infant who has been abused

Radiograph of growing skull fracture / leptomeningeal cyst — Initial lateral radiograph of the skull (above) shows a stellate skull fracture in the parietal bone. Some of the skull fragments are also diastatic, or spread apart. Followup lateral radiograph of the skull obtained 3 weeks later (below) shows a widening distance between several of the skull fragments.

The diagnosis was growing skull fracture, also known as a leptomeningeal cyst.

Infant with a sacral dimple

MR of normal position of the conus medullaris — Sagittal T2 MRI of the lumbar spine (left) shows the tip of the conus medullaris to lie at the level of L1-L2. Sagittal T1 without contrast MRI (right) shows the low signal intensity posterior dermal sinus tract running linearly from the sacral dimple at the skin to the coccyx.

The diagnosis was normal position of the conus medullaris.

Teenager who while wrestling heard a popping noise and now has right sided sternal pain

3D CT of posterior sternoclavicular joint dislocation — CT 3D reconstruction without contrast of the sternoclavicular joints viewed from anteriorly (above) and from underneath (below) shows widening of the right sternoclavicular joint space when compared to the left sternoclavicular joint space. The right clavicular head is also displaced posteriorly when compared to the left sternoclavicular head.

The diagnosis was right posterior sternoclavicular joint dislocation.

School ager with periumbilical pain

CT of obliterated urachal remnant — Axial (above) and sagittal (below) CT with contrast of the pelvis shows a small oval solid soft tissue mass in the midline of the anterior wall / dome of the bladder.

The diagnosis was an obliterated urachal remnant.

Teenager who swallowed a foreign body

AXR of chain necklace gastrointestinal foreign body — AXR AP (above) shows a radiopaque foreign body in the cecum. Endoscopic image (below left) shows the foreign body within the cecum. Gross pathological image (below right) shows the foreign body to be a chain necklace.

The diagnosis was gastrointestinal foreign body.

School ager with a chronic cough

CXR, CT, angiogram of pulmonary sequestration — Axial CT without contrast of the chest (above) shows an ill-defined solid soft tissue mass in the posterior and medial aspect of the left lower lobe. CXR AP (below left) shows a double density sign projecting to the left of the spine over the medial aspect of the cardiac silhouette. AP image from the arterial phase of an angiogram (below right) shows the left lower lobe mass has an arterial supply arising from the subdiaphragmatic aorta.

The diagnosis was left lower lobe pulmonary sequestration.

School ager with supraventricular tachycardia resulting in cardiac arrest

CXR of supraventricular tachycardia — CXR AP shows mild cardiomegaly with bilateral perihilar lung opacities with a batwing appearance.

The diagnosis was supraventricular tachycardia resulting in cardiogenic pulmonary edema.

Teenager with ankle pain after being tackled

CT of a triplane fracture of the ankle — Coronal (left) and sagittal (right) CT 2D reconstructions without contrast 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.

The diagnosis was a triplane fracture of the ankle (Salter Harris Type IV fracture).

Toddler with a runny nose and right orbital swelling

CT of sinusitis with preseptal cellulitis and a subperiosteal abscess — Axial CT with contrast of the orbits (above) shows opacification of the ethmoid sinuses and sphenoid sinus along with right preseptal soft tissue swelling. There is a fluid collection with rim enhancment medially next to the wall of the right ethmoid sinus which is better seen on the coronal CT (below).

The diagnosis was sinusitis with preseptal cellulitis and a subperiosteal abscess.

Toddler with a palpable bump on the back of the head just to the left of midline

MRI of soft tissue hemangioma of the scalp — Axial T2 MRI without contrast of the brain (above) shows a well defined lesion in the subcutaneous tissues just to the left of midline that has heterogenous signal intensity. The lesion shows primarily low signal intensity on axial T1 MRI without contrast (below left) and enhances markedly and fairly uniformly on axial T1 MRI with contrast and fat saturation (below right).

The diagnosis was soft tissue hemangioma.