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.

Newborn with a nasal mass

Clinical image of nasal teratoma — Clinical image shows a purple nasal mass, cystic in consistency, attached by a 2 cm stalk to the entire nasal tip.

The diagnosis was nasal teratoma.

Newborn with renal mass on prenatal ultrasound

Gross pathology image of mesoblastic nephroma — Gross pathological image shows a large, round, solid renal mass after resection.

The diagnosis was mesoblastic nephroma.

Newborn with a large soft tissue mass on the back

Surgical image of infantile fibrosarcoma — Surgical image shows an en bloc excision of the mass along with the overlying skin.

The diagnosis was infantile fibrosarcoma.

Infant with vomiting

Surgical image of pyloromyotomy — Surgical image shows the pyloric muscle being spread, exposing the mucosa.

The diagnosis was hypertrophic pyloric stenosis.

Newborn with vomiting and a palpable abdominal mass

Gross pathology image of duodenal duplication — Gross pathological image shows an intact cystic mass that had been attached to the inner surface of the C-loop of the duodenum. Two orifices to the duodenal lumen can be seen along the inferior edge of the specimen.

The diagnosis was duodenal duplication.

Teenager with abdominal pain and vomiting

Gross pathology image of Crohn disease — Gross pathological image shows the terminal ileum to be thickened with mesenteric fat surrounding it. The appendix (to the left) is normal.

The diagnosis was Crohn disease.

Newborn with an absent anal orifice

Surgical image of anorectal malformation — Surgical image shows the rectum opened posteriorly through a posterior sagittal incision. A small catheter (in the center) is shown coursing through a rectourethral fistula.

The diagnosis was anorectal malformation.

Newborn status post left upper extremity PICC placement

CXR of PICC line in the aorta — CXR AP shows an umbilical arterial catheter in the aorta whose tip is at the level of the T8 vertebral body and a left upper extremity PICC which courses parallel to the umbilical arterial catheter and whose tip projects at the level of T8 as well.

The diagnosis was peripherally inserted central catheter malfunction with the tip of the catheter in the descending aorta.

School ager with chest pain after motor vehicle accident

CXR of rib fracture and pleural cap — CXR AP shows a discontinuity at the lateral aspect of the left second rib. There is a pleural cap at the apex of the left hemithorax.

The diagnosis was rib fracture of the second rib. CT of the chest was negative for thoracic aortic injury.

School ager with asymmetric pulses in the upper and lower extremities

CT of post-ductal coarctation of the aorta — Sagittal CT (above left) and 3D CT (above right) with contrast of the chest show significant narrowing of the proximal descending aorta distal to the origin of the left subclavian artery. Anterior 3D CT (below left) shows dilated bilateral collateral internal mammary arteries and posterior 3D CT (below right) shows dilated bilateral collateral 3rd-8th intercostal arteries.

The diagnosis was post-ductal coarctation of the aorta.

Infant with a urinary tract infection

US and VCUG of duplicated kidney with everting ectopic ureterocele — Sagittal US of the upper pole of the left kidney (above left) shows a duplicated kidney with hydronephrosis of the upper pole collecting system. Sagittal US of the bladder (above right) shows a large cystic structure at the base of the bladder. AP image of the bladder (below left) obtained at the start of filling of the bladder during a voiding cystourethrogram (VCUG) shows a large filling defect in the 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 left of the bladder.

The diagnosis was a left duplicated kidney with an everting left ectopic ureterocele.

Newborn with a right chest mass on prenatal ultrasound

CXR of diaphragmatic hernia — CXR shows opacification of the right hemithorax with several air filled loops of bowel within it and mediastinal shift to the left.

The diagnosis was right-sided congenital diaphragmatic hernia.

Premature newborn after umbilical arterial catheter placement

Radiograph of low-lying umbilical arterial catheter — CXR shows the tip of the umbilical arterial catheter to be at the level of the L2 vertebral body.

The diagnosis was umbilical arterial catheter malfunction with the tip of the catheter being low in position.

Newborn with bilateral adrenal masses on prenatal ultrasound which were decreasing in size over time

US of bilateral adrenal hemorrhage — AXR (above) shows faint linear calcification in the adrenal glands bilaterally. Sagittal US of the left adrenal gland (below left) and right adrenal gland (below right) show the adrenal glands to be slightly enlarged and to have central echogenic foci within them.

The diagnosis was resolving bilateral adrenal hemorrhage.

Teenager in a motor vehicle accident

CXR and CT of thoracic aortic injury — CXR AP (above left) shows a widened superior mediastinum. Axial CT with contrast of the chest shows an aortic laceration beginning at the level of aortic isthmus (above right) with a large amount of hemorrhage in the mediastinum which continues downward (below left) until the aorta is almost completely occluded by thrombus (below right).

The diagnosis was thoracic aortic injury.

Teenager with blue sclera

Radiograph of basilar invagination in osteogenesis imperfecta — Lateral radiograph of the cervical spine shows the tip of the dens extends well above Chamberlain’s line.

The diagnosis was basilar invagination due to osteogenesis imperfecta.