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School ager with long standing headaches who just had a VP shunt placed

Radiograph and CT of copper beaten skull
AP and lateral radiographs of the skull (above) show throughout skull vault prominence of convolutional markings from gyral impressions on the inner table of the skull, which is also well demonstrated on the axial CT without contrast of the brain (below).

The diagnosis was copper beaten skull caused by long-standing hydrocephalus in a patient with aqueductal stenosis.

A patriotic toddler with increasing stridor over time

Pathological image of an esophageal foreign body
Lateral radiograph of the airway (left) shows a radiopaque foreign body in the cervical esophagus which is associated with a large amount of retropharyngeal soft tissue swelling. Gross pathological image (right) shows a metal flag-shaped pin that was endoscopically retrieved from the patient’s esophagus.

The diagnosis was gastrointestinal foreign body which had been present for a long period of time.

Preschooler with epigastric discomfort, especially when laying down to go to bed at night, who had a loop of bowel behind the sternum incidentally noted on a CXR

Surgical image of Morgagni hernia
Surgical image shows an anterior midline defect in the diaphragm, measuring 7 cm in width by 3 cm in depth. The transverse colon was herniated through this defect into the retrosternal space and had been reduced before this image was obtained.

The diagnosis was Morgagni hernia.

Preschooler who stools out of her vagina and rectum and is known to have a duplicated colon

Surgical image of colonic duplication
Surgical image shows the duplicated colon at the level of the sigmoid colon with the two colonic lumens running side by side. The mucosa was removed from the duplicated colon from the level of its sigmoid colon to the vaginal orifice. The duplicated colon was then anastomosed to the normal colon at the level of the normal colon’s sigmoid colon.

The diagnosis was colonic duplication.

Newborn with bilious vomiting and a double bubble sign on AXR

Surgical image of duodenal atresia
In the operating room the duodenum was seen to taper between its second and third portions. A nasogastric tube could not be advanced past this area of tapering. There appeared to be a membrane obstructing the duodenum at this point. A duodenotomy was performed which confirmed the presence of a thick membrane completely obstructing the duodenum. Bile was seen above and below this membrane. The bile was coming from one papilla above the membrane and one papilla below it. Surgical image shows the superior retractor distracting the proximal duodenum and the inferior retractor distracting the distal duodenum. The obstructing membrane is seen between the retractors. The obstructing membrane was then incised.

The diagnosis was duodenal atresia.

Infant with left otitis media and left neck swelling

CT of coalescent mastoiditis
Axial and coronal CT with contrast of the neck with soft tissue windows (above) show extensive left cervical adenopathy and inflammation. Axial CT with contrast of the neck with bone windows (below) show bilateral complete opacification of the mastoid air cells and subtle erosive changes in the anterior aspect of the left temporal bone. There were no intracranial findings.

The diagnosis was left coalescent mastoiditis.

School ager with pus draining from the right ear

CT of coalescent mastoiditis with intracranial abscess
Axial CT with contrast of the brain with bone windows (left) shows opacification and destruction of the right mastoid air cells while axial CT with contrast of the brain with soft tissue windows (right) shows a large low density ring enhancing lesion in the right cerebral hemisphere that is causing midline shift to the left.

The diagnosis was right coalescent mastoiditis with an intracranial abscess.