School ager with acute lymphoblastic leukemia and abdominal pain

CT of typhlitis — Axial CT with IV and oral contrast of the abdomen shows marked thickening of the wall of the cecum. The remainder of the colon was unremarkable.

The diagnosis was typhlitis in a patient with acute lymphoblastic leukemia.

School ager after motor vehicle accident

CT of liver laceration — Axial CT with contrast of the abdomen shows a low density triangular shaped lesion in the middle of the liver.

The diagnosis was liver laceration.

Premature newborn with past history of necrotizing colitis who is having difficulty stooling

Enema of post necrotizing enterocolitis stricture of the colon — AP image from an enema (left) shows a transition zone in the lower right of the image from a narrow sigmoid colon to a more dilated descending colon above it. Spot image from the enema (right) shows the narrowed colonic lumen filled with contrast connecting those two parts of the colon.

The diagnosis was a stricture of the descending colon after necrotizing enterocolitis.

Infant with projectile vomiting

Color US of Whirlpool sign of malrotation with midgut volvulus — Transverse color US of the upper abdomen in the midline (above) shows the mesenteric vessels swirling around themselves (Whirlpool sign). The superior mesenteric vein was above the superior mesenteric artery. Upper GI exam (below) shows the duodenal jejunal junction to be to the left of the spine but to be lower in position than the duodenal bulb and the proximal jejunum appears to spiral downwards away from it.

The diagnosis was malrotation with midgut volvulus.

Infant with 2 days of abdominal pain, vomiting, and currant jelly stools

AXR of small bowel obstruction due to ileocolic intussusception — AXR supine (above left) shows multiple dilated loops of small bowel and AXR upright (above right) shows multiple air-fluid levels. There is no air in the colon. AP image from an air enema (below) shows a soft tissue mass outlined by air in the hepatic flexure which was then easily reduced to the ileocecal valve on the first attempt but could not be reduced further on subsequent attempts. In the operating room the terminal ileum and cecum were found to be necrotic and were resected.

The diagnosis was small bowel obstruction caused by ileocolic intussusception.

Infant with projectile vomiting

AXR and US of hypertrophic pyloric stenosis — AXR AP (left) shows a hugely distended air-filled stomach with distal bowel gas. Sagittal US of a posteriorly positioned pylorus (right) shows the pyloric channel to be lengthened (25 mm) and the pyloric muscle to be thickened (4 mm). The anechoic gallbladder is positioned anteriorly to the pylorus.

The diagnosis was hypertrophic pyloric stenosis.

Teenager with fever of unknown origin

Small bowel follow through exam of Crohn disease of the terminal ileum — AXR from a small bowel follow through exam (left) shows diffuse narrowing of the terminal ileum and separation of the loops of terminal ileum due to mesenteric fat infiltration. Spot image of the terminal ileum (right) shows a nodular and cobblestone appearance to the narrowed loops of the terminal ileum.

The diagnosis was Crohn disease.

Newborn with absent anus and stool coming out of the vagina

US of low anorectal malformation — CXR AP (left) shows a hemivertebra at L1 causing spinal curvature convex left. Transverse US of the pelvis (above right) shows in the midline anteriorly an anechoic fluid-filled bladder with a round echogenic stool-filled rectum posterior to it while a transverse US of the perineum (below right) shows a very short distance between the calipers superiorly on the skin and inferiorly on the anterior wall of the rectum.

The diagnosis was low anorectal malformation and congenital scoliosis.

Female teenager with right lower quadrant and pelvic pain, normal WBC and a negative pregnancy test

US of hemorrhagic ovarian cyst — Sagittal transabdominal US of the pelvis shows a diffusely hyperechoic mass in the right adnexa that was within the right ovary.

The diagnosis was hemorrhagic ovarian cyst.

Female teenager with pelvic pain, normal WBC and a negative pregnancy test

US of simple ovarian cyst — Transverse transabdominal US of the pelvis (above) shows a round anechoic mass that is inferior to the bladder and to the left of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature.

The diagnosis was a simple ovarian cyst.

Female teenager with right lower quadrant pain, normal WBC and a negative pregnancy test

US of simple ovarian cyst — Transverse transabdominal US of the pelvis (above) shows a round mass of mixed echogenicity that is inferior to the bladder and to the right of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature with several much smaller cysts around it.

The diagnosis was a simple ovarian cyst.

Infant with abnormal facies and congenital heart disease

Surgery image of DiGeorge syndrome — Surgical image of the anterior mediastinum shows the thymus to be absent.

The diagnosis was DiGeorge syndrome.

Toddler with stridor and a barky cough

Endoscopy image of croup — Endoscopic image of the airway shows mild sublglottic edema.

The diagnosis was croup.

Infant with an echogenic lung mass on prenatal ultrasound

Pathology image of congenital pulmonary airway malformation — Gross pathological image of the sectioned left lung shows multiple large cystic lesions throughout the entire lung.

The diagnosis was congenital pulmonary airway malformation.

Preschooler with respiratory distress

Pathology image of bronchial atresia — Gross pathological image of a sectioned lung shows an oval dilated mucous filled airway (in the lower right aspect of the specimen) distal to an atretic bronchus.

The diagnosis was bronchial atresia.

Newborn with respiratory distress and skeletal dysplasia

Pathology image of asphyxiating thoracic dystropy — Post-mortem gross pathological image (above) shows a small volume thorax and hypoplastic lungs caused by ribs that are very short in length (below).

The diagnosis was asphyxiating thoracic dystrophy.

Newborn with a nasal mass

Pathology image of nasal teratoma — Gross pathological image shows a large, round, primarily solid mass which also had some cystic components.

The diagnosis was nasal teratoma.

Infant with history of ovarian cyst on prenatal ultrasound who had a right upper quadrant calcification on CXR

Surgery image of a normal ovary — Surgical image after resection of a torsed right ovary shows a normal left ovary (which is white) in the midline just above the retractor.

The diagnosis was in-utero ovarian torsion of the right ovary and a normal left ovary.

School ager with large and rapidly enlarging soft tissue mass involving his right arm and chest

Surgery image of malignant peripheral nerve sheath tumor — Surgical image through a right thoracotomy shows a large mass originating in the apex of the right chest. Normal lung can be seen in the upper right corner of the incision.

The diagnosis was malignant peripheral nerve sheath tumor in a patient with multiple plexiform neurofibromas who has neurofibromatosis Type 1.

Newborn with large soft tissue mass on the back

Pathology image of infantile fibrosarcoma — Gross pathological image after en bloc resection shows a large solid mass.

The diagnosis was infantile fibrosarcoma.

Infant with vomiting

Surgery image of pyloromyotomy — Surgical image shows the pylorus muscle split with bulging exposed mucosa.

The diagnosis was hypertrophic pyloric stenosis.

Infant who was difficult to intubate

CT of tracheal stenosis — Coronal CT without contrast of the chest shows the trachea to be narrowed over a length of 2 cm from the thoracic inlet downward. At its narrowest, the trachea measured only 2 mm in diameter. There was also narrowing of the proximal right mainstem bronchus at its origin.

The diagnosis was tracheal stenosis.

Infant with decreased stool output and fever

Enema of Hirshsprung enterocolitis — AXR AP (above) shows an obstructive bowel gas pattern with multiple dilated loops of small bowel. AP image from an enema (below left) shows the contour of the entire colon to have an irregular, serrated appearance. The terminal ileum was refluxed. Lateral image from the enema (below right) shows the diameter of the rectum to be less than the diameter of the sigmoid colon (recto-sigmoid inversion).

The diagnosis was Hirschsprung disease with concomitant Hirschsprung enterocolitis.

Infant with 2 days of bilious emesis

Air enema of ileocolic intussusception — AXR AP (left) shows a nonobstructive bowel gas pattern and a soft tissue mass over the spine, with its left border outlined by air in the transverse colon. AP image from an air enema (right) shows a large round soft tissue mass in the hepatic flexure that was successfully reduced, evidenced by a large amount of air being refluxed into the small bowel.

The diagnosis was ileocolic intussusception.

School ager post motor vehicle accident

CT of bearclaw laceration of the liver — Axial CT with contrast of the abdomen shows a low density bear claw shaped lesion in the right lobe of the liver that is lateral to and inferior to the gall bladder.

The diagnosis was liver laceration.