School ager with abdominal pain, diarrhea, and vomiting

AXR and CT and US of pseudomembranous colitis
AXR AP (above left) shows thickening of the haustra of the transverse colon (thumb printing). Axial CT with contrast of the abdomen (above right) shows diffuse thickening of the colon which is markedly thickened in the ascending colon compared to the descending colon. An accordion sign is demonstrated in the ascending colon. Sagittal (below left) and transverse (below right) US of the cecum show a diffusely thickened cecum.

The diagnosis was pseudomembranous colitis.

Newborn with failure to pass meconium

Surgical image of colonic atresia
Surgical images show numerous loops of small bowel which are dilated, thickened and inflamed along with an extremely dilated ascending colon which is at the lower part of the left image and to the left side of the right image. An area of atresia was identified at approximately the hepatic flexure. The downstream colon (not shown) had the appearance of a microcolon. On the right image, the forceps are on the dilated appendix.

The diagnosis was colonic atresia near the level of the hepatic flexure.

Infant with a right orbital mass

CT of neuroblastoma with orbital metastasis
Axial CT without contrast of the abdomen (above) shows a large mass that has faint calcifications within it that fills the entire left upper quadrant of the abdomen. Axial CT without (lower left) and with (lower right) contrast of the orbit shows a round soft tissue mass around the right pterygoid plate that enhances strongly with contrast.

The diagnosis was neuroblastoma of the right adrenal gland with metastasis to the right orbit.

Newborn with a distended abdomen

AXR of complicated meconium ileus / meconium peritonitis
AXR shows displacement of much of the bowel to the left lower quadrant of the abdomen. Faint cresenteric calcifications are seen arcing upwards and downwards on the right side of the abdomen while an oval-shaped calcified object is seen on the left side of the abdomen at the level of the L1 and L2 vertebral bodies. Nodular appearing calcifications are scattered throughout the abdomen.

The diagnosis was complicated meconium ileus. A large meconium pseudocyst was encountered in the operating room.

School ager with spinal dysraphism and a neurogenic bladder

AXR and US of bladder stone
AXR AP (above) shows two irregularly-shaped calcified objects projecting over the pelvis. Spinal dysraphism is noted in the sacrum. There is a cecostomy tube in the right lower quadrant. Sagittal US of the bladder (below) shows an echogenic mass within the inferior aspect of the bladder (to the right of the image) that has posterior shadowing.

The diagnosis was two bladder stones in a patient with neurogenic bladder.

Infant with 5 days of vomiting and abdominal distension who now has peritoneal signs and currant jelly stools

Surgical image of ileocolic intussusception
Surgical image shows an ileocolic intussusception extending into the mid ascending colon with a dusky terminal ileum (to the right) intussuscepting into the cecum (to the left). Note that the appendix (in the middle of the image) is intussuscepted with the ileum. The intussusception was reduced without great difficulty manually. No lead point was seen.

School ager with abdominal pain after trauma

CT and US of choledochal cyst
Axial CT with contrast of the abdomen (upper left) shows a large round low density structure inferior to the liver and separate from the gall bladder. Transverse and sagittal US of the liver show the round structure to be cystic and in communication with a dilated biliary tree. Delayed image (lower left) from a hepatobiliary scintigraphy exam shows concentration of radiotracer into the round structure which is slowly excreted into the bowel. AP image of an intraoperative cholangiogram (lower right) shows dilation of the intrahepatic and extrahepatic biliary tree with free flow of contrast into the bowel.

The diagnosis was choledochal cyst causing biliary obstruction.

Newborn with jaundice

hepatobiliary scintigraphy scan of biliary atresia
Immediate image (upper left) from a hepatobiliary scintigraphy exam performed after pre-treatment with phenobarbital shows good uptake of radiotracer in the liver with the 24 hour delayed image (upper right) showing no excretion of radiotracer into the bowel. Transverse US of the liver (lower left) shows the presence of a gallbladder. AP image of an intraoperative cholangiogram shows a dilated gallbladder (with some contrast extravasation outside of the gallbladder) and minimal visualization of the intrahepatic biliary tree and no visualization of the extrahepatic biliary tree.

The diagnosis was biliary atresia causing biliary obstruction.