Newborn with respiratory distress

CXR of transient tachypnea of the newborn — CXR AP on the first day of life (left) shows normal lung volumes with prominent interstitial infiltrates bilaterally in the lungs and a small right pleural effusion with fluid in the minor fissure of the right lung. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates with a small amount of pleural effusion remaining in the minor fissure of the right lung.

The diagnosis was transient tachypnea of the newborn.

School ager who is having difficulty using their central venous line

Central line injection of a fibrin sheath on a central venous catheter — AP image from a central line injection shows the distal part of the catheter is thicker than the rest of the catheter. Contrast was never seen to exit the tip of the catheter but instead was seen to exit the catheter from a position 2 cm above the tip of the catheter.

The diagnosis was central venous catheter malfunction in the form of a fibrin sheath along the distal catheter.

School ager with left scrotal pain

US of torsion of the appendix testis — Sagittal US of the left scrotum at presentation (above) shows a round lesion of heterogenous echogenicity superior to the left testicle. Sagittal US of the left scrotum 2 weeks later (below) shows the lesion has decreased in size and become uniformly echogenic.

The diagnosis was torsion of the appendix testis.

Toddler with an unusual appearing hand

Radiograph of symbrachydactyly — AP (left) and lateral (right) radiographs of the forearm and hand shows an absence of all the bones in the hand. There are nubbins of soft tissue where the phalanges should be. The radius and ulna are bowed.

The diagnosis was symbrachydactyly.

Preschooler 1 year after medical and surgical treatment for a posterior fossa tumor

MRI of spinal drop metastases in medulloblastoma — Sagittal (left and middle) T1 MRI with contrast of the spine shows diffuse enhancement along the cerebellar folia and the anterior and posterior aspects of the entire spinal cord. Axial T1 MRI with contrast of the spine (right) shows the enhancement to be somewhat nodular in nature around the spinal cord.

The diagnosis was recurrent medulloblastoma resulting in drop metastases to the spinal cord.

School ager who had a Nissen fundoplication 5 years ago and is now retching

Upper GI of para Nissen herniation after Nissen fundoplication — AP (left) and lateral (right) images from an UpperGI exam show the impression of the Nissen fundoplication wrap on the superior border of the stomach beneath the diaphragm. However, part of the stomach has herniated through the Nissen fundoplication to a position above the diaphragm.

The diagnosis was Nissen fundoplication malfunction in the form of a para Nissen herniation.

Teenager with shoulder pain after an all terrain vehicle accident

Radiograph of clavicle fracture — AP radiographs of the clavicle show a comminuted and angulated fracture of the mid clavicle.

The diagnosis was clavicle fracture.

Newborn with respiratory distress

US of intracerebral hemorrhage due to extracorporeal membrane oxygenation — CXR AP (above) shows the tip of the nasogastric tube in the left hemithorax. The punctate radiopaque tip of the arterial ECMO catheter projects near the aortic arch. The punctate radiopaque tip of the venous ECMO catheter projects in the right atrium. The endotracheal tube tip projects between the clavicles and the carina.

Coronal (below left) and sagittal (below right) US of the brain shows a round well-circumscribed echogenic lesion adjacent and inferior to the posterior horn of the right lateral ventricle.

The diagnosis was intracerebral hemorrhage as a complication of extracorporeal membrane oxygenation in a patient with a left-sided congenital diaphragmatic hernia.

Infant with a central venous catheter placed 6 months ago that now cannot be infused through

CXR of central venous catheter migrating out of the superior vena cava over time — CXR AP obtained at placement (above left) shows the tip of the central venous catheter in the superior vena cava. CXR AP obtained 2 months after placement (above right) shows the tip of the central venous catheter to have migrated slightly back in the interval. CXR AP obtained 4 months after placement (below left) shows the tip of the central venous catheter to have migrated slightly further back in the interval. CXR AP obtained 6 months after placement (below right) shows the tip of the central venous catheter to have migrated out of the superior vena cava entirely.

The diagnosis was central venous catheter malfunction in the form of the catheter migrating slowly out of the superior vena cava.

Teenager with left scrotal pain

US of testicular microlithiasis — Sagittal US of the left testicle (above) and right testicle (below) shows numerous microcalcifications in the testicles bilaterally.

The diagnosis was testicular microlithiasis.

Teenager with joint pain

Hand radiograph of scleroderma — AP radiograph of the hand shows acroosteolysis of the second and third distal phalanges and faint soft tissue calcifications at the tips of the first, second and third distal phalanges.

The diagnosis was scleroderma.

Newborn with a seizure

MRI of Lhermitte-Duclos disease — Sagittal (above left), axial (above right) and coronal (below left) T1 MRI without contrast of the brain shows a round lesion centered in the vermis of the cerebellum that is displacing the fourth ventricle to the left. The lesion has hypointense thickened cerebellar folia giving it a striated appearance. The cerebellar folia are hyperintense on the axial T2 MRI (below). The lesion did not enhance.

The diagnosis was Lhermitte-Duclos disease.

Teenager after an inappropriate ingestion

AXR of a AA battery — AXR AP shows a radiopaque cylindrical object projecting over the stomach.

The diagnosis was gastrointestinal foreign body in the form of a AA battery.

School ager with neck pain after motor vehicle accident

CT and MRI of a cervical spine fracture through the left synchondrosis of the C1 vertebral body. — Axial (above left) and coronal (above right) CT without contrast of the cervical spine shows a relative slight diastasis of the left synchrondrosis of the C1 vertebral body when compared to the right synchondrosis. Axial T2 MRI without contrast of the cervical spine shows bright signal in the left synchrondosis (below left) of the C1 vertebral body and anterior to the left synchondrosis (below right).

The diagnosis was fracture of the cervical spine through the left synchondrosis of the C1 vertebral body.

Toddler with a central venous catheter that is difficult to infuse through and difficult to draw back from

Central catheter injection of thrombus at the tip of a central venous catheter — Scout image from a fluoro exam (left) shows the catheter is radiographically intact with its tip in the brachiocephalic vein. Images obtained during contrast injection (center and right) show contrast filling and outlining an irregularly shaped object at the tip of the catheter.

The diagnosis was central venous catheter malfunction due to a large thrombus at the tip of the catheter.

Newborn with an abdominal mass

CT of retroperitoneal teratoma — Axial (above), coronal (below left), and sagittal (below right) CT with contrast of the abdomen shows a large left-sided abdominal mass which arises from the retroperitoneum and crosses the midline and which displaces the left kidney inferiorly and posteriorly. The mass is heterogenous in nature and contains fat, is predominantly solid but has some cystic components, and it enhances minimally.

The diagnosis was retroperitoneal teratoma.

Teenager with lightheadedness and dizziness when their head is turned to the right or the left

MRA of otational vertebral artery occlusion syndrome of the right vertebral artery — Coronal 3D MRA without contrast of the neck with the head turned to the left (above left) and right (below left) shows focal narrowing of the right vertebral artery V3 segment in both positions. Coronal 3D MRA with contrast with the neck in a neutral position (right) shows a normal appearance to the vertebral arteries.

The diagnosis was rotational vertebral artery occlusion syndrome of the right vertebral artery.

Newborn with a brain cyst on prenatal ultrasound

MRI of intraventricular simple cyst — Axial (above left) and coronal (above right) T2 MRI and sagittal T1 MRI without contrast (below) of the brain show a thin walled round structure without septations in the posterior horn of the right lateral ventricle that follows cerebrospinal fluid signal characteristics on all MRI sequences.

The diagnosis was intraventricular simple cyst.

Teenager seen to ingest three non-food objects

AXR of battery and lead pencil in the stomach — AXR AP shows two radiopaque cylindrical objects in the abdomen. There is a faintly radiopaque thin straight object coursing from the T12-L1 intervertebral disk space to the left and ending just above the superior most cylindrical object.

The diagnosis was gastrointestinal foreign body in the form of two AA batteries and a lead pencil.

Newborn who has been abused

Radiograph and CT of Hangman cervical spine fracture — Lateral radiograph of the cervical spine (left) shows a large amount of prevertebral soft tissue swelling. There are fractures through the bilateral pedicles of the C2 vertebral body resulting in anterior translation of the C2 vertebral body on the C3 vertebral body. Sagittal CT without contrast of the cervical spine through the left (above center) and right (above right) pedicles better demonstrates the fractures through them as does the axial CT through the C2 vertebral body (below right).

The diagnosis was Hangman cervical spine fracture due to child abuse.

Infant on venous-venous extracorporeal membrane oxygenation after cardiac surgery with new bilateral pleural effusions

US of hemothorax as a complication of extracorporeal membrane oxygenation — CXR AP (above) shows correct position of the ECMO venous-venous catheter tip near the junction of the right atrium and the inferior vena cava. There are bilateral pleural effusions most prominently seen in the apex of the lungs. Transverse US of the right hemithorax (below left) shows echogenic pleural fluid lateral to the atelectatic right lower lobe. Sagittal US of the left hemithorax (below right) shows echogenic pleural fluid inferior to the atelectatic left lower lobe and superior to the spleen.

The diagnosis was correct position of the venous-venous ECMO catheter and bilateral hemothorax as a complication of extracorporeal membrane oxygenation.

Toddler with a newly placed central venous catheter that can be infused through but cannot be drawn back from

Radiograph of central venous cathetertip flush against the wall of the superior vena cava — CXR AP (above) shows the tip of the central venous catheter to be flush against the wall of the superior vena cava. Image taken during contrast injection of the central venous catheter (below) show the tip of the catheter has moved away from the wall of the superior vena cava during injection.

The diagnosis was pediatric central venous catheter malfunction because the tip of the catheter is flush against the wall of the superior vena cava.

Newborn with prenatal hydronephrosis

US of Tamm Horsfall proteins — Sagittal US of the kidneys shows multiple round echogenic foci in the renal pyramids bilaterally.

The diagnosis was Tamm Horsfall proteins.

Teenager with foot pain

Foot radiograph of psoriatic arthritis — AP radiographs of the feet show interphalangeal ankylosis and joint subluxation at the middle and distal interphalangeal joints in multiple phalanges bilaterally.

The diagnosis was psoriatic arthritis.

School ager with acute back pain and gait instability

MRI of myxopapillary ependymoma of the spinal cord — Sagittal T1 MRI without contrast (left), T2 MRI (center), and T1 MRI with contrast (right) of the lumbar spine shows an intradural extramedullary cylindrical solid mass that is arising from the filum terminale and which shows minimal enhancement. On T2 MRI (center) the mass has a triangular area of low signal intensity along its superior border (cap sign).

The diagnosis was a myxopapillary ependymoma of the spinal cord.