Premature newborn with a large sacral mass

Radiograph of sacrococcygeal teratoma — AXR shows a large soft tissue mass arising in the region of the sacrum.

The diagnosis was sacrococcygeal teratoma.

Infant who has just had a PICC line placed

Radiograph of PICC line in right renal vein — AXR shows a left lower extremity PICC line whose tip projects in the region of the right renal vein.

The diagnosis was peripherally inserted central venous catheter malfunction with the tip of the PICC line being in the right renal vein.

Toddler with an abnormal gait

Pelvis radiograph of spondyloepiphyseal dysplasia — AP radiograph of the pelvis shows delayed development of the femoral epiphyses bilaterally and overall there is flattening of the femoral heads.

The diagnosis was spondyloepiphyseal dysplasia.

Preschooler with a central venous catheter that infuses but does not draw back

Radiology case of fibrin sheath — Image from a central line study after the injection of a small amount of contrast (left) shows that the distal portion of the catheter is thicker in diameter than the proximal portion of the catheter. Image obtained after the injection of a small amount of additional contrast (right) shows contrast flowing not from the tip of the catheter but rather contrast flowing from the right side of the catheter just above where the catheter thickening begins in the left image.

The diagnosis was central venous catheter malfunction due to the presence of a fibrin sheath.

Toddler with a right-sided abdominal mass

MRI of Wilms tumor — AXR (above left) shows displacement of the bowel out of the right side of the abdomen. Sagittal US of the right kidney (above right) shows a large right renal mass that spares the upper pole of the right kidney. Coronal T1 MRI with contrast of the abdomen (below left) shows a large mass that is heterogenous in appearance that arises from the lower pole of the right kidney and that is demonstrating a claw sign superiorly. Axial T2 MRI (below right) again shows the heterogenous nature of the mass due to hemorrhage and necrosis.

The diagnosis was Wilms tumor.

Toddler with progressive respiratory distress and no history of foreign body ingestion

CXR of congenital lobar emphysema — CXR AP and lateral show overinflation of the right upper lobe that is herniating across the midline.

Teenager in a motor vehicle accident with chest pain

Angiogram of thoracic aortic injury — Early (left) and late (right) images from an angiogram of the aorta show a focal aneurysmal dilation of the aorta which begins at the aortic isthmus.

The diagnosis was thoracic aortic injury.

Teenager after a motor vehicle accident

CT of ovarian cyst — Axial CT with contrast of the pelvis shows a distended contrast-filled bladder in the center of the image and contrast in the distal left ureter adjacent to the normal left ovary and contrast in the distal right ureter adjacent to the right ovary which contains a round low density lesion in its center. There is also a small amount of physiologic free fluid in the pelvis

The diagnosis was right ovarian cyst.

Infant who has just had a right lower extremity PICC line removed which upon measuring was seen to be shorter than it should have been

Lower extremity radiograph of retained PICC line fragment — AP radiograph of the right lower extremity shows a retained fragment of a PICC line in the posterior soft tissues of the right calf.

The diagnosis was peripherally inserted catheter malfunction with a retained fragment of the removed PICC line in the right calf.

Newborn with a small thorax

Pelvis radiograph of thanatophoric dysplasia — AP radiograph of the pelvis shows flattening of the vertebral bodies. The femora bilaterally have a telephone receiver appearance.

The diagnosis was thanatophoric dysplasia.

School ager who just had an old left central venous catheter removed and a new right central venous catheter placed

CXR of retained central venous catheter fragment — CXR AP shows the tip of the new right central venous catheter to be in the superior vena cava. Also seen is a short piece of catheter in the left brachiocephalic vein.

The diagnosis was central venous catheter malfunction with a retained fragment of the removed left central venous catheter in the left brachiocephalic vein.

Preschooler with right scrotal pain

Color doppler US of epididymitis — Sagittal color doppler US of the right scrotum shows increased flow to the right epididimis compared to the flow in the right testicle, which was shown to be present on spectral doppler US.

The diagnosis was right epididymitis.

Preschooler post motor vehicle accident who was subsequently noted to have a history of epigastric pain while lying down

CXR of Morgagni hernia — AP radiograph of the thoracic spine (left) shows a loop of bowel containing haustra in the lower chest just above the diaphragm. CXR lateral (right) shows a loop of bowel in the anterior chest.

The diagnosis was Morgagni hernia.

Newborn with complex congenital heart disease

CT of umbilical venous catheter in normal position — Sagittal CT with contrast of the chest shows the umbilical venous catheter to course through the umbilical vein into the liver to the left portal vein to the ductus venosus to the left hepatic vein to the inferior vena cava with its tip near the junction of inferior vena cava and the right atrium.

The diagnosis was normal position of the umbilical venous catheter with the tip near the junction of the inferior vena cava and the right atrium.

Infant with urinary tract infection

VCUG of an everting ectopic ureterocele — Sagittal US of the right (above left) and left (above right) kidneys shows parenchymal bars of tissue between the upper and lower poles of each kidney. Transverse US of the bladder (middle left) shows a round cystic structure on the right side of the bladder. Sagittal US of the bladder (middle right) shows the right ureter in continuity with the cystic structure within the bladder. AP image of the bladder (below left) obtained at the start of filling the bladder during a voiding cystourethrogram (VCUG) shows a round filling defect in the right base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows the previously seen filling defect in the base of the bladder has everted out of the bladder and now appears as a contrast filled structure to the right of the bladder.

The diagnosis was bilaterally duplicated kidneys with a right everting ectopic ureterocele.

Newborn after PICC placement

AXR of PICC line tip in spinal canal — AXR lateral (left) shows the tip of a right lower extremity PICC line looping back upon itself and projecting over the spinal canal. AXR AP (right) after reposition of the line shows the tip projecting over the inferior vena cava. The patient also has a large anterior abdominal wall defect containing loops of bowel which is covered by a membranous sac.

The diagnosis was peripherally inserted central venous catheter malfunction with the tip within the spinal canal in a patient with an ompahlocele.

Infant with a bowing deformity of the left upper extremity

Upper extremity radiograph of osteogenesis imperfecta — AP radiograph of the left upper extremity shows the left humerus to have a bowing deformity and several healing fractures within it. The left radius also has a bowing deformity.

The diagnosis was osteogenesis imperfecta.

Infant who is choking with feedings

UGI of double aortic arch — Lateral (right) image from an UGI exam shows a persistent posterior indentation on the mid-esophagus. There is associated narrowing of the trachea at the same level.

The diagnosis was double aortic arch causing a complete vascular ring.

Newborn with a cystic mass in the left kidney on prenatal US

US of duplicated kidney with multicystic dysplastic kidney in the lower pole — Sagittal US of the left kidney shows a normal appearing upper pole. The lower pole has two large cysts, of different sizes, that do not communicate.

The diagnosis was duplicated kidney with a multicystic dysplastic kidney in the lower pole of the left kidney.

Newborn with a left-sided chest mass on prenatal ultrasound

CXR of congenital diaphragmatic hernia — CXR AP shows complete opacification of the left hemithorax with mediastinal shift to the right and a small right pneumothorax. The arterial ECMO canula tip projects over the aortic arch and the venous ECMO canula tip projects over the right atrium. The nasogastric tube tip projects over the mid-esophagus.

The diagnosis was normal position of the extracorporeal membrane oxygenation catheters in a patient with left congenital diaphragmatic hernia.

Premature newborn after umbilical venous catheter placement

AXR of umbilical venous catheter tip in the superior vena cava — CXR AP shows the tip of the umbilical venous catheter to be in the superior vena cava. The tip of the umbilical arterial catheter projects at the level of the T6 vertebral body.

The diagnosis was umbilical venous catheter malfunction with the tip of the catheter in the superior vena cava.

Infant with a diaper that is never dry

VCUG of ectopic ureter inserting into the urethra — Sagittal US of the right kidney (above left) is normal while sagittal US of the left kidney (above right) shows a parenchymal bar between the upper and lower pole collecting systems. AP image of the bladder (below left) obtained during filling of the bladder during a voiding cystourethrogram (VCUG) shows right-sided vesicoureteral reflux into a dilated collecting system with the right ureter inserting normally into the base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows new left-sided grade I vesicoureteral reflux with the left ureter inserting into the urethra.

The diagnosis was a left duplicated kidney with an ectopic insertion of the left ureter into the urethra and right Grade III vesicoureteral reflux.

Teenager with a neck mass

Clinical image of follicular thyroid adenoma — Clinical images show a large nodule in the right lobe of the thyroid gland which was easily palpable.

The diagnosis was follicular thyroid adenoma.

Preschooler with midline neck mass

Surgery image of thyroglossal duct cyst — Surgical images show the mass (between the forceps) which had been intimately adherent to the mid-point of the hyoid bone and a central tract extending from the mass up to the foramen cecum.

The diagnosis was thyroglossal duct cyst.

Newborn with a nasal mass

Gross pathology image of nasal teratoma — Gross pathological cut image shows the irregular nature of the interior of the mass including cysts and cartilage.

The diagnosis was nasal teratoma.