Premature newborn after peripherally inserted central catheter placement

CXR of pediatric PICC line tip in a left-sided superior vena cava — CXR AP shows the tip of the left upper extremity PICC line projecting over the heart and to the left of the spine.

The diagnosis was peripherally inserted central catheter malfunction with the tip of the PICC line in a persistent left superior vena cava which was confirmed on an ultrasound exam.

Teenager with a decreased urinary stream

Retrograde urethrogram of pediatric urethral stricture — Lateral image of the urethra from a retrograde urethrogram shows a persistent narrowing at the junction of the posterior urethra and bulbar urethra with the bulbar urethra being dilated.

The diagnosis was urethral stricture.

School ager who is having their bone age checked

Radiograph of pediatric lunotriquetral coalition — AP radiograph of the hand shows fusion of the lunate and triquetrum carpal bones.

The diagnosis was lunotriquetral carpal coalition.

Teenager with sore throat for 1 week who is now having difficulty breathing

CT of pediatric peritonsillar abscess — Axial (left) and coronal (right) CT with contrast of the head and neck show a round mass with a low density center and a thick enhancing rim that is lateral to the left palatine tonsil and which is causing mass effect on the airway.

The diagnosis was left peritonsillar abscess.

Premature newborn with increasing residuals

Radiograph of pneumatosis intestinalis in necrotizing enterocolitis — The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.

The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.

School ager who fell on an outstretched hand and has elbow pain

Radiograph of pediatric elbow fracture of coronoid process of ulna — Lateral radiograph of the elbow shows elevation of the anterior and posterior fat pads of the elbow. There is a very small bone fragment just superior to the coronoid process of the ulna.

The diagnosis was elbow fracture of the coronoid process.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR AP shows hazy ground glass opacity throughout the left lung. The right lung is hyperexpanded and has multiple circular bubbly and branching interstitial lucencies that radiate from the right hilum.

The diagnosis was pulmonary interstitial emphysema in the right lung.

Newborn with respiratory distress

CXR of normal position of arterial venous ECMO catheters — CXR AP shows multiple loops of small bowel that are minimally filled with air in the lower left hemithorax. There is mediastinal shift to the right. The tip of the arterial canula placed from the right carotid artery projects over the aortic arch while the tip of the venous canula placed from the right internal jugular vein projects over the right atrium. There are two chest tubes in the right hemithorax.

The diagnosis was normal position of the arterial canula and venous canula in a patient on extracorporeal membrane oxygenation due to left congenital diaphragmatic hernia.

School ager with nausea and vomiting

US and MAG3 nuclear medicine scan of orthotopic ureterocele — Transverse US of the bladder (above left) shows a round cystic lesion in the base of the bladder. Sagittal US of the bladder (above right) shows to the left of the image an extremely dilated left ureter and to the right of the image again the round cystic lesion in the base of the bladder. Sagittal image of the left renal fossa (below left) shows non-visualization of the left kidney. Nuclear medicine MAG3 scan (below right) shows a normal right kidney, non-visualization of the left kidney, and a round photopenic defect in the bladder.

The diagnosis was left non-functioning kidney with left hydroureter and a left orthotopic ureterocele.

Teenager with right lower extremity swelling

MRI of pediatric cellulitis of the lower extremity — Two non-contiguous axial T2 MRI images of the right lower extremity show diffuse circumferential high T2 signal in the subcutaneous tissues and along the deep fascial plane. There were no abscesses seen.

The diagnosis was cellulitis of the lower extremity.

Teenager with fever and odynophagia

CT of intratonsillar abscess of right palatine tonsil — Axial (left), coronal (above right) and sagittal (below right) CT with contrast of the head and neck show a low density fluid collection in the right palatine tonsil that is surrounded by a thin enhancing rim of tissue. The airway is widely patent.

The diagnosis was intratonsillar abscess of the right palatine tonsil.

Newborn with bloody stools

AXR of pneumatosis intestinalis in necrotizing enterocolitis — AXR AP shows curvilinear appearing air in the wall of the descending colon.

The diagnosis was pneumatosis intestinalis of the descending colon in a patient with necrotizing enterocolitis.

School ager who fell on an outstretched hand and now has elbow pain

Radiograph of pediatric capitellum fracture of the elbow — AP (left), oblique (middle) and lateral (right) radiographs of the elbow show a fracture line through the capitellum which is displaced anteriorly and superiorly along the humerus which is best shown on the lateral radiograph, which also shows elevation of the anterior and posterior fat pads of the elbow.

The diagnosis was elbow fracture of the capitellum.

Newborn with respiratory distress

CXR of pediatric Group B streptococcus pneumonia — CXR AP shows normal lung expansion with fine interstitial infiltrates bilaterally.

The diagnosis was Group B streptococcus pneumonia.

School ager with a ventriculoperitoneal shunt and a new headache

Radiograph of broken ventriculoperitoneal shunt tubing — AP radiograph of the skull (left) shows a break in the VP shunt tubing just above the right orbit. AXR (right) shows the remaining VP shunt tubing coiled in the pelvis.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing.

Teenager after motor vehicle accident

CT of renal laceration and suspected ureter transection — Axial CT with contrast of the abdomen (above left) shows an extensive laceration of the left kidney with an associated low density retroperitoneal hematoma surrounding the left kidney. Delayed lower axial image from the same CT exam (below left) shows extravasation of high density IV contrast around the left psoas muscle. 3D CT urogram performed the next day (right) again shows massive extravasation of IV contrast medial to the left kidney with non-visualization of the left ureter suggesting ureteral transection. The right kidney and ureter are normal. However, a retrograde urogram performed the next day showed the left ureter was not transected which allowed placement of a left ureteral stent.

The diagnosis was left kidney laceration and suspected left ureteral transection which was not confirmed on a retrograde pyelogram exam.

Teenager with a soft tissue mass between the first and second digits of the hand

Radiograph and US of venous malformation of the hand — AP radiograph of the hand (above) shows a large round laminated appearing calcified phlebolith between the first and second digits of the hand. Transverse US of the area of calcification (below) shows two laminated appearing clots of varying age.

The diagnosis was vascular malformation of the hand in the form of a venous malformation.

Infant whose anterior fontanelle appeared to close prematurely

Radiograph and CT of Wormian bone in the anterior fontanelle — AP radiograph of the skull (left) shows a bone in the region of the anterior fontanelle. 3D CT without contrast of the skull (right) shows a Wormian bone in the anterior fontanelle.

The diagnosis was Wormian bones with a Wormian bone in the anterior fontanelle.

Premature newborn after umbilical venous catheter placement

US of TPNoma due to umbilical venous catheter malposition — CXR AP (above) shows the tip of the umbilical venous catheter projecting over the left portal vein. Transverse (below left) and sagittal (below right) US of the left lobe of the liver obtained 4 months later shows hyperechoic branching lesions in the liver which are felt to be calcifications in the distal branches of the portal veins due to long term direct injection of total parenteral nutrition into the distal branches of the portal veins rather than into the inferior vena cava.

The diagnosis was TPNoma due to umbilical venous catheter malposition in the left portal vein.

Preschooler with elbow pain after being tackled

Radiograph of ossification centers of the elbow ossifying out of their normal order — AP (left) and lateral (right) radiographs of the elbow show ossification of the capitellum and internal (medial) epicondyle. The radial head is not yet ossified. No fracture or fat pad elevation is seen.

The diagnosis was no fracture of the elbow as the ossification centers of the elbow are ossifying out of their normal order as normally the radial head should ossify before the internal (medial) epicondyle according to the CRITOE mneumonic.

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. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates.

The diagnosis was transient tachypnea of the newborn.

Teenager with a VP shunt with a new headache

Radiograph of broken VP shunt tubing — AP radiograph of the neck (above) shows the VP shunt catheter is broken at the level of the mid-neck. Axial CT without contrast of the brain obtained one year ago (below left) shows the tip of the VP shunt in the left lateral ventricle and the ventricular system to be decompressed. Current axial CT without contrast (below right) shows the tip of the VP shunt to be in the left lateral ventricle and interval development of dilation of the ventricular system.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing causing interval development of hydrocephalus.

Newborn with a mass at the umbilicus

US of umbilical granuloma — Transverse (left) and sagittal (right) US of the umbilicus shows a round hyperechoic lesion with a hypoechoic rim near the umbilical stump.

The diagnosis was umbilical granuloma.

School ager with systemic lupus erythematosis with new left pleuritic chest pain

CXR of lupus pneumonitis — CXR AP (left) shows a fine interstitial infiltrate in the left lower lung that on the lateral CXR (right) is seen to be projecting over the spine.

The diagnosis was left lower lobe acute pneumonitis due to systemic lupus erythematosus.

Teenager with abdominal pain

MRI of schwannoma — AXR AP (above left) shows an incidental semi-circular left paraspinal mass next to the T10-T11 vertebral bodies. Axial T1 MRI without contrast of the thoracic spine (below left) shows an isointense round mass just to the left of the vertebral body. On axial T2 MRI (below center) the mass is hyperintense and on axial T1 MRI with contrast (below right) the mass enhances avidly and homogeneously. There was no spinal extension of the mass. On coronal T1 MRI with contrast (above right) the mass is again seen to be next to the T10-T11 vertebral bodies.

The diagnosis was schwannoma.