School ager with right lower quadrant pain

US of infectious colitis — Transverse US of the cecum (to the left of the image) shows circular circumferential thickening of colonic wall and a hyperechoic submucosal layer.

The diagnosis was infectious colitis.

Teenager with fever, elevated WBC and right lower quadrant pain

US of acute appendicitis — Sagittal US of the right lower quadrant shows a noncompressible blind ending J-shaped tubular structure (in the upper half of the image) with a transverse diameter of 8 mm with periappendiceal hyperechogenicty of the periappendiceal fat.

The diagnosis was acute appenditicis.

Teenager with chronic right lower quadrant pain

UGI and SBFT of Crohn disease — Spot images of the terminal ileum from an upper GI small bowel follow through show diffuse luminal narrowing of the terminal ileum associated with mucosal ulceration along with a nodular and cobblestone appearance to the terminal ileum.

The diagnosis was Crohn disease.

Toddler with abdominal pain and vomiting

AXR and US of ileocolic intussusception — AXR AP (left) shows a non-obstructive bowel gas pattern and a round soft tissue mass in the right upper quadrant obscuring the inferior margin of the liver (Currarino sign). Transverse US of the mass (right) shows it to have a hyperechoic center and a hypoechoic rim (Target sign). The mass was successfully reduced, recurred and was rereduced successfully.

The diagnosis was ileocolic intussusception.

Teenager with a liver mass

CXR of lung metastases in fibrolamellar hepatocellular carcinoma — CXR AP shows multiple large round non-calcified lesions in the lungs bilaterally.

The diagnosis was lung metastases in a patient with fibrolamellar hepatocellular carcinoma.

Infant with short stature

Radiograph of the hands in diastrophic dysplasia — AP radiograph of the hand shows abducted (hitchhiker) thumb, irregular deformity and shortening of the phalanges and metacarpal bones, and bifid second through fourth middle phalanges.

The diagnosis was diastrophic dysplasia.

Toddler with short stature

Radiograph of feet in diastrophic dysplasia — AP radiograph of the feet (above) shows irregular deformity and shortening of the metatarsal bones. Crescent-shaped flattened epiphyses are present. Forefoot varus, hindfoot varus and hindfoot equinus (below) are also present.

The diagnosis was diastrophic dysplasia and clubfoot.

School ager with diffuse scrotal hyperesthesia and pain

MRI of arachnoid cyst of the sacrum — Sagittal color doppler US of the left (above left) and right (below left) testicles shows normal appearing color doppler flow to each testicle which was confirmed on spectral dopper US. Sagittal T2 MRI without contrast of the lumbar spine (right) shows a large cylindrical structure filling the sacral spinal canal from S1-S5 whose signal intensity followed cerebrospinal fluid on all sequences.

The diagnosis was arachnoid cyst of the sacrum.

Infant with pus draining from the umbilicus

US of urachal cyst — Sagittal (above) and transverse (below) US of the infraumbilical region in the midline shows a round structure superior and anterior to the bladder that is primarily hypoechoic in appearance with an echogenic center.

The diagnosis was an infected urachal cyst.

School ager in a motor vehicle accident

CT of renal laceration — Axial CT with contrast of the abdomen shows a laceration in the posterior aspect of the left kidney. There is isodense fluid in the left perirenal and pararenal spaces.

The diagnosis was left renal laceration with perirenal and pararenal hematomas.

School ager with right scrotal pain

US of epididimo-orchitis — Sagittal grayscale US (left) shows a morphologically normal appearing right epididymis and testicle while the color doppler US (right) shows increased flow to the right testicle.

The diagnosis was right orchitis.

Teenager in motor vehicle accident with altered mental status

CT of diffuse axonal injury — Axial CT without contrast of the brain obtained initially (left) shows loss of delineation of the cortical sulci and ventricular system. Axial CT without contrast obtained two days later (right) now also shows a round focus of hyperdensity at the right parietal gray matter white matter junction.

The diagnosis was diffuse cerebral edema and delayed appearance of diffuse axonal injury.

Newborn with a large posterior skull mass

Radiograph of encephalocele — Lateral radiograph of the skull shows a large round soft tissue mass arising from the base of the skull.

The diagnosis was occipital encephalocele.

School ager with fauns tail on the back

Myelogram of diastematomyelia — AP vintage conventional myelogram at the level of the thoracolumbar junction shows an oval filling defect in the center of the thecal sac.

The diagnosis was diastematomyelia.

Toddler with otitis media

CT of coalescent mastoiditis — Axial CT without contrast of the face (left) shows partial opacification of the ethmoid sinuses and complete opacification of the mastoid air cells bilaterally. The lateral wall of the left mastoid is irregular in contour. Axial CT without contrast (right) shows an inflammatory soft tissue mass around the left ear.

The diagnosis was bilateral mastoiditis with left coalescent mastoiditis.

School ager with cafe au lait spots and upper back pain

Tomogram of plexiform neurofibroma causing painful scoliosis — Coronal conventional tomogram of the thoracic spine shows a soft tissue mass in the apex of the right lung causing scalloping of the right side of the upper thoracic vertebral bodies and a scoliosis convex left.

The diagnosis was a paraspinal plexiform neurofibroma causing painful scoliosis in a patient with neurofibromatosis Type 1.

School ager with fauns tail on the back

CT of diastematomyelia — Axial CT without contrast of the lumbar spine shows a piece of bone bisecting the spinal canal.

The diagnosis was diastematomyelia.

School ager with several days of vomiting

CT and MRI of cerebellar astrocystoma — Axial CT without contrast of the brain (above) shows moderate dilation of the lateral, third and fourth ventricles. Axial T2 MRI without contrast of the brain (below left) shows a round focus of bright signal in the posterior medulla that on the sagittal T1 MRI post contrast (below right) shows it to be a non-enhancing mass in the floor of the fourth ventricle causing ventricular outlet obstruction.

The diagnosis was cerebellar astrocytoma.

Teenager with chronic right lower quadrant pain

Colonoscopy images of Crohn disease — Colonoscopy images of the terminal ileum show it to be diffusely thickened and to have a cobblestone appearance.

The diagnosis was Crohn disease.

Teenager with left chest pain

Pathology image of Ewing sarcoma of the rib — Gross pathological image after a chest wall and diaphragm resection shows the left seventh rib and part of the eighth rib with the tumor adherent to their inner surface. A portion of shiny white pleura is attached to the tumor and portions of lung are seen above and to the left of the tumor.

The diagnosis was Ewing sarcoma of the rib.

Newborn with right chest mass on prenatal ultrasound

Surgery image of congenital diaphragmatic hernia — Surgical image taken after reduction of a diaphragmatic hernia and repair of a right diaphragmatic defect shows the Gore-Tex patch (white) replacing the absent posterolateral portion of diaphragm.

The diagnosis was right congenital diaphragmatic hernia.

Newborn with nasal mass on prenatal US

Clinical image of nasal teratoma — Clinical image shows a purple mass arising from the nasal septum.

The diagnosis was nasal teratoma.

Infant with a small sinus in the right neck at the right sternocleidomastoid muscle that expresses secretions

Surgical image of second branchial cleft cyst — Surgical image shows excision of the sinus up to its origin in the tonsillar fossa with a probe inserted into the lumen of the sinus tract.

The diagnosis was second branchial cleft cyst.

Newborn with a sacral mass

Pathological image of sacrococcygeal teratoma — Gross pathological image shows a large heterogenous sacral mass after resection.

The diagnosis was sacrococcygeal teratoma.

Toddler with an abdominal mass

Surgical image of mesenchymal hamartoma — Surgical image of the under surface of the liver with the hila being dissected shows a large tumor in the left medial segment of the liver.

The diagnosis was mesenchymal hamartoma.