Newborn with an anterior abdominal wall defect

Clinical image of gastroschisis — Clinical image shows a dilated stomach (above center) and small bowel (below center) which are not enclosed by a sac.

The diagnosis was gastroschisis.

School ager who started coughing while eating pizza

Bronchoscopic image of airway foreign body — Bronchoscopic image at the level of the carina (above) shows a blue foreign body in the left mainstem bronchus which was pulled out of the airway (middle) and upon removal was found to be a blue crayon (below).

The diagnosis was airway foreign body in the left mainstem bronchus.

Preschooler with a nasal mass

Clinical image of frontonasal encephalocele — Clinical images show a large mass in the midline of the face which is enlarging the nose.

The diagnosis was frontonasal encephalocele.

Newborn with Trisomy 21 and large residuals with feeding

Surgical image of duodenal atresia — Surgical image shows the dilated first part of the duodenum in the center of the image and the normal caliber second part of the duodenum being held between the forceps. There was a 5 cm gap between the first and second parts of the duodenum.

The diagnosis was duodenal atresia.

Premature newborn with respiratory distress

Pathology image of Wilson Mikity syndrome / bronchopulmonary dysplasia — Post-mortem gross pathological image of both lungs (above) shows the lungs to have an irregular surface due to the presence of multiple cysts in the lungs. Magnified image (below) better shows the heterogenous nature of the cysts in the lung.

The diagnosis was Wilson Mikity syndrome / bronchopulmonary dysplasia.

Toddler with a right-sided abdominal mass

Pathology image of Wilms tumor and renal crossed fused ectopia — Post-mortem gross pathological images obtained anteriorly (on the left) and posteriorly (on the right) show a mass in the upper pole of the right kidney. The upper pole of the left kidney is fused to the lower pole of the right kidney.

The diagnosis was Wilms tumor in a patient with renal crossed fused ectopia.

Infant with respiratory distress

Normal inspiratory and expiratory CXR — Initial CXR AP (left) shows the heart to be enlarged and the pulmonary vascularity to be congested and there are low lung volumes. Repeat CXR AP obtained 5 minutes later in inspiration (right) shows the heart to be normal in size and the pulmonary vascularity is not congested and there are normal lung volumes.

The diagnosis was normal expiratory and inspiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

Preschooler with a central venous catheter that will no longer draw back

CXR of central venous catheter fracture — CXR AP when the catheter was placed one year ago (left) shows the tip of the catheter at the cavoatrial junction in correct position. CXR AP today (right) shows the catheter is now fractured and discontinuous and has embolized into the right atrium.

The diagnosis was central venous catheter fracture.

Preschooler with diarrhea

Small bowel follow through of giardiasis — AP image from late in a vintage small bowel follow through exam shows thickening of the mucosal folds in the duodenum and jejunum. There is also luminal narrowing and dilution of the barium and segmentation of the barium column in the jejunum. The ileum appears normal.

The diagnosis was giardiasis.

Toddler with a sacral dimple

MRI of lipoma of the filum terminale and tethered cord — Sagittal T1 MRI without contrast of the lumbar spine (left) shows hyperintense signal in the conus medullaris which lies low in position at the level of L2-L3. Axial T1 MRI through the conus (right) better shows the hyperintense signal in the conus which is the same signal intensity as the subcutaneous fat.

The diagnosis was lipoma of the filum terminale and tethered cord.

Teenager with knee pain after trauma

Radiograph of Segond fracture — AP radiograph of the left knee shows a lateral avulsion fracture of the tibial plateau.

The diagnosis was Segond fracture.

Newborn with a hard swollen right scrotum

US of testicle torsion — Transverse grayscale US of the testicles (above) shows the right testicle to be larger and more heterogenous in echotexture than the normal left testicle. Transverse color doppler US of the testicles (below) shows no flow in the right testicle and normal flow in the left testicle, findings which were confirmed on spectral doppler US (not provided).

The diagnosis was right testicle torsion.

Young adult with newly rising ammonia levels after bone marrow transplant

US of sinusoidal obstruction syndrome — Spectral doppler US of the left, middle and right hepatic veins from 2 days ago (left) shows them to be of normal caliber and to have normal appearing phasicity. Spectral doppler US of the left, middle, and right hepatic veins today (right) shows the hepatic veins to be compressed and difficult to see and to have spectral broadening and loss of phasicity. The flow velocity in the main portal vein had decreased by 50% between the two exams.

The diagnosis was sinusoidal obstruction syndrome.

School ager with respiratory distress

Inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

The diagnosis was normal inspiratory and expiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

Teenager who had thoracic surgery a week ago and now has sepsis

MRI of infective endocarditis of the brain and CT of infective endocarditis of the spleen and kidneys — Coronal T1 MRI with contrast of the brain (above) shows multiple small enhancing lesions in the brain and one large ring enhancing lesion in the right hemisphere of the brain. Coronal CT with contrast of the abdomen (below) shows multiple peripheral low density wedge shaped lesions in the spleen and both kidneys.

The diagnosis was infective endocarditis leading to cerebral abscess and splenic abscess and renal abscess.

Toddler with abdominal pain

AXR of ileus — AXR supine (left) shows the stomach and small bowel and colon to be air filled and dilated to the level of the rectum. AXR upright (right) shows multiple air fluid levels in the small bowel and colon.

The diagnosis was ileus.

Premature newborn with apnea and bradycardia

US of cerebellar hemorrhage — Coronal US of the brain (above) shows round areas of increased echogenicity in the cerebellar hemispheres, left larger than right which are also seen on the sagittal US of the left cerebellum (lower left) and right cerebellum (lower right). The ventricular system was dilated due to bilateral intraventricular hemorrhage (not pictured).

The diagnosis was bilateral neonatal cerebellar hemorrhage.

Preschooler with a right orbital mass

MR of orbital myofibroma — Coronal T1 MRI without contrast of the orbits (left) and coronal T2 MRI (middle) shows a round soft tissue mass superior and lateral to the right orbit that is isointense on both sequences and that on coronal T1 MRI with contrast (right) is seen to enhance uniformly and intensely.

The diagnosis was myofibroma.

Newborn with an abdominal mass

US of retroperitoneal teratoma — AXR (left) shows faint calcifications in the middle aspect of the right abdomen. Transverse US (above right) and sagittal US (below right) of the right lower quadrant shows a large primarily cystic mass with some solid components that is medial to and inferior to the right kidney.

The diagnosis was retroperitoneal teratoma.

Teenager with abdominal pain and increased WBC and CRP

CT of splenic volvulus — Axial CT with contrast of the upper abdomen in the portal venous phase (above left) shows the spleen is absent from the left upper quadrant and is instead seen in the midline of the pelvis (above right). Coronal (below left) and sagittal (below right) CT in the delayed phase show the spleen to be in the midline of the pelvis above the bladder. The splenic vascular pedicle had a whirlpool appearance (not provided).

The diagnosis was splenic volvulus.

Infant with respiratory distress

Difference between pediatric inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

The diagnosis was normal inspiratory and expiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

Newborn with increasing respiratory distress after subclavian venous catheter placement for total parenteral nutrition (TPN) 2 days ago

CXR of pericardial effusion due to malposition of central line in the pericardial space — CXR AP (left) shows the tip of the newly placed left subclavian venous catheter to project deep within the right atrium while the cardiac silhouette is normal in size. CXR AP 2 days later (right) shows the catheter tip unchanged in position while the cardiac silhouette has increased markedly in size in the interval. Cardiocentesis returned TPN.

The diagnosis was subclavian venous catheter malposition in the pericardial space resulting in a pericardial effusion and cardiac tamponade.

Newborn with respiratory distress

UGI of esophagotrachea — CXR AP (left) shows the endotracheal rube tip in the midline to be low in position while the nasogastric tube tip projecting to the left of it is high in position. AP image from an esophagram obtained after the nasogastric tube had been advanced into the distal esophagus (above right) shows simultaneous opacification of the trachea in the midline and the bilateral mainstem bronchi along with esophagus to the left of the trachea. Lateral image from the esophagram (below right) shows the communication between the esophagus and trachea to be long in length.

The diagnosis was esophagotrachea.

School ager with headaches and visual disturbances

CT of pineoblastoma — Axial (above left), coronal (above right) and sagittal (below) CT without contrast of the brain shows a large, round, high density mass in the region of the pineal gland causing obstructive hydrocephalus and transependymal flow of cerebrospinal fluid. The right frontal intracranial air on the axial image is due to recent placement of a ventriculoperitoneal shunt.

The diagnosis was pineoblastoma.

Teenager with left throat pain and a left throat mass for 3 months

MRI of liposarcoma — Axial (above left) and sagittal (above right) TI MRI without contrast of the face shows a high signal intensity mass in the left pharyngeal and masticator and parotid spaces that is displacing the palatine tonsils and airway. Coronal T1 MRI with contrast with fat supression (below left) and without fat supression (below left) shows the mass to not enhance. The mass follows fat signal on all sequences.

The diagnosis was liposarcoma.