Newborn with respiratory distress on ECMO

CXR of malposition ECMO catheter in patient with congenital diaphragmatic hernia — CXR shows normal position of the arterial catheter tip in the aortic arch and abnormal position of the venous catheter tip (represented by a radio-opaque point) in the superior vena cava. Further advancement of the tip into the right atrium is necessary. Multiple cystic structures are present in the left hemithorax. The lungs are densely opacified.

The diagnosis was extracorporeal membrane oxygenation catheter malposition with the venous catheter tip in the superior vena cava in a patient with left sided congenital diaphragmatic hernia containing stomach and loops of bowel.

Preschooler with thoracolumbar kyphosis

Radiograph of hands in Morquio syndrome — AP radiograph of the hands shows bilaterally wide metacarpals, irregular carpal bones and metaphyseal flaring in the distal radius and ulna.

The diagnosis was Morquio syndrome.

Preschooler with vomiting

UGI and CT of left aortic arch with aberrant right subclavian artery — AP image from an upper GI exam (above left) shows a left sided aortic arch and an indentation running at an angle from left to right across the upper esophagus. Lateral image from an upper GI exam (above right) shows a posterior indentation across the upper esophagus. Axial CT with contrast of the chest (below) shows an aberrant artery coursing anterior to the vertebral body and posterior to the aerated trachea and collapsed esophagus.

The diagnosis was left aortic arch with aberrant right subclavian artery.

Female infant with a purple mass protruding from her vagina

US and IVP of prolapsed ectopic ureterocele — Sagittal US of the vaginal mass (above left) shows it to be cystic in nature. Sagittal US of the right kidney (middle left) shows moderate hydronephrosis of the upper and lower poles of a duplicated renal collecting system. Sagittal US of the left kidney (below left) shows marked hydronephrosis of the upper pole and moderate hydronephrosis of the lower pole of a duplicated renal collecting system. Excretory phase of a vintage intravenous pyelogram (right) shows on the right a moderately hydronephrotic duplicated renal collecting system and on the left an obstructed nonopacified nonfunctional upper pole collecting system which displaces the opacified functional moderately hydronephrotic lower pole collecting system inferolaterally (drooping lily sign).

The diagnosis was prolapsed ectopic ureterocele from the upper pole of the left kidney in a patient with bilateral duplicated kidneys.

School ager with a small deformed right chest

CXR of Poland syndrome — CXR shows thinning of the soft tissues over the right chest and relative increased lucency of the right hemithorax when compared to the left hemithorax.

The diagnosis was Poland syndrome of the right chest wall.

Infant with vomiting

Surgical image of pyloromyotomy — Surgical image shows that while stabilizing the pylorus between the thumb and forefinger, a shallow incision is made and then the musculature of the pylorus is bluntly split.

The diagnosis was hypertrophic pyloric stenosis.

Newborn with vomiting and abdominal mass

Surgical image of duodenal duplication — Surgical image shows a mass attached to the inner surface of the C-loop of the duodenum from just distal to the pylorus to slightly proximal to the region of the ampulla of Vater with the transverse colon draped underneath it.

The diagnosis was duodenal duplication.

Teenager after a motorcycle accident whose CXR showed a widened mediastinum

CT of thoracic aortic injury — Axial CT with contrast of the chest at the level of the aortic arch (above left) shows a large amount of fluid in the superior mediastinum while subsequent lower slices (above right and below left) show an intimal flap in the descending aorta. Sagittal CT (below right) shows a pseudoaneurysmal dilation of the aorta beginning at the aortic isthmus.

The diagnosis was thoracic aortic injury.

Female teenager with hirsuitism and virilization

CT of adrenocortical carcinoma — Axial CT with contrast of the abdomen shows a large solid mass mass in the left adrenal gland that has heterogenous enhancement.

The diagnosis was adrenocortical carcinoma.

Preschooler after an episode of near drowning

CXR of non-cardiogenic pulmonary edema due to near drowning — CXR AP shows bilateral perihilar infiltrates in a butterfly wing distribution.

The diagnosis was non-cardiogenic pulmonary edema due to near drowning.

Teenager who after bumping their leg 1 year ago has had a painful lump in the shin

Radiograph of osteosarcoma of the tibia — AP radiograph of the tibia and fibula (left) with a magnified view (right) shows a lesion in the diaphysis of the tibia with permeative cortical destruction and associated periosteal reaction and a Codman’s triangle.

The diagnosis was osteosarcoma of the tibia.

Infant with a murmur

3DCT of post ductal coarctation of the aorta — 3D CT with contrast of the chest shows a significant focal narrowing of the proximal descending aorta distal to the origin of the left subclavian artery.

The diagnosis was post ductal coarctation of the aorta.

Preschooler with a palpable midline abdominal mass

AXR and US and CT of rhabdomyosarcoma of the bladder — AXR (above left) shows a soft tissue mass in the mid abdomen displacing the bowel loops superiorly. Transverse and sagittal US of the mass (below left) show a solid, homogenous, lobulated mass. Axial CT with contrast of the abdomen (below right) shows a large heterogeneous mass in the mid to left abdomen with a low density center and swirling enhancement. There was a suggestion of direct tumor invasion into the right rectus muscle anteriorly (above right) and the bladder inferiorly.

The diagnosis was rhabdomyosarcoma arising from the dome of the bladder.

Teenager with hemoptysis and large weight loss over 6 months

CXR and CT of lung metastases from embryonal cell carcinoma of testicle — CXR PA and lateral (above) shows a large round solid lesion in the right upper lobe. Axial CT without contrast of the chest (below left) shows a large solid lesion in the right upper lobe and a small solid lesion in the left upper lobe posteriorly. There is an additional solid lesion in the right lower lobe (below right).

The diagnosis was lung metastases due to embryonal cell carcinoma of the testicle.

School ager with shortness of breath

CXR and CT of pericardial effusion due to histoplasmosis — CXR AP (above left) shows a large cardiac silhouette and an abnormal contour to the right superior mediastinum. Coronal CT with contrast of the chest (above right) shows a huge fluid collection in the pericardial space and a conglomeration of cystic lymph nodes in the right superior mediastinum. Axial CT (below) shows the pericardial fluid collection completely surrounding the heart and left lower lobe atelectasis.

The diagnosis was pericardial effusion due to histoplasmosis.

Toddler with urinary tract infection

IVP of bilateral duplicated kidneys and ectopic ureteroceles — Post void excretory phase image from an intravenous pyelogram exam shows bilateral duplication of the kidneys. Within the collapsed bladder are two round filling defects.

The diagnosis was bilateral duplicated kidneys with bilateral ectopic ureteroceles.

Preschooler with heartburn after eating

UGI and CT of left aortic arch with aberrant right subclavian artery — Lateral image from an UGI exam (above left) shows a persistent posterior indentation on the proximal esophagus. Sagittal CT with contrast of the chest (above right) shows an aberrant artery located posterior to the esophagus and anterior to a vertebral body. Axial CT (below) shows the right subclavian artery to be arising aberrantly from the aorta and coursing anterior to the vertebral body and posterior to the aerated trachea and collapsed esophagus.

The diagnosis was left aortic arch with aberrant right subclavian artery.

Preschooler with kyphosis

Radiograph of gibbus deformity of the spine in Morquio syndrome — Lateral radiograph of the spine shows central beaking of the anterior aspect of the vertebral bodies resulting in a short-segment thoracolumbar kyphosis (gibbus deformity). There is also diffuse flattening of the vertebral bodies (platyspondyly).

The diagnosis was Morquio syndrome.

Newborn with decreased pulses in the lower extremities

3D CT of preductal coarctation of the aorta — 3D CT with contrast of the aorta viewed posteriorly (left) shows diffuse narrowing of the aortic arch until its junction with the descending aorta. 3D CT viewed anteriorly (right) shows a huge patent ductus arteriosus joining into the descending aorta.

The diagnosis was coarctation of the aorta that was preductal and thus ductal dependent.

Toddler with moderate to marked right hydronephrosis on ultrasound

IVP of ureteropelvic junction obstruction due to a crossing vessel — AP image from the excretory phase of an intravenous pyelogram (above) shows a normal left renal collecting system and a markedly dilated right renal collecting system. No contrast was seen in the right ureter. AP image from a retrograde pyelogram (below) shows a markedly dilated right renal collecting system and a narrowing and tortuosity to the proximal right ureter.

The diagnosis was right ureteropelvic junction obstruction due to a crossing vessel.

School ager who started coughing while eating pizza 1 week ago and now is febrile

CXR of chronic airway foreign body in left mainstem bronchus — CXR AP shows extensive atelectasis and consolidation in the lingula and left lower lobe with tracheal and mediastinal shift to the left. There is a small left pleural effusion.

The diagnosis was a chronic airway foreign body in the left mainstem bronchus which on bronchoscopy was found to be a crayon.

Toddler with chronic stridor

CT of pulmonary sling causing tracheal stenosis — Axial CT with contrast of the chest shows the left pulmonary artery arising from the right pulmonary artery and then coursing posterior to the trachea and anterior to the esophagus, causing focal narrowing of the trachea at this level.

The diagnosis was pulmonary sling causing tracheal stenosis.

Preschooler male with acute urinary retention

US and CT of rhabdomyosarcoma of the prostate. — Sagittal US of the pelvis (above) shows an anechoic distended bladder superiorly and an echogenic mass posterior and inferior to the bladder. Axial CT with contrast of the pelvis (below) shows a round heterogenous necrotic mass in the center of the pelvis that is displacing the bladder superior and anteriorly.

The diagnosis was rhabdomyosarcoma of the prostate.

School ager with 1 week of abdominal pain and shortness of breath

CXR and US of pericardial effusion due to histoplasmosis — AXR (above left) shows hepatomegaly and an enlarged cardiac silhouette. CXR (above right) shows a water-bottle appearance to the cardiac silhouette and bilateral pleural effusions and bilateral hilar lymphadenopathy. Transverse US of the heart (below) shows a large anechoic fluid collection in the pericardial space.

The diagnosis was pericardial effusion due to histoplasmosis.

Preschooler with abnormal gait

Pelvis radiograph of Morquio syndrome — AP radiograph of the pelvis shows bilateral flattening of the proximal femoral epiphyses with bilateral subluxation and dislocation of the femoral heads.

The diagnosis was Morquio syndrome.