Toddler with opsoclonus and myoclonus

CT and MRI of presacral neuroblastoma — Axial CT with contrast of the pelvis (above) shows (from top to bottom in the midline) contrast in the base of the bladder, contrast in the rectum which is deviated to the right, and a solid soft tissue mass anterior to the sacrum. Axial (below left) and sagittal (below right) T2 MRI without contrast of the pelvis shows the presacral mass to have high signal intensity.

The diagnosis was presacral neuroblastoma.

Infant with bilious vomiting

UGI of normal rotation of the bowel — AP image from an UGI exam (above) shows the duodenal jejunal junction to project to the left of the spine in its normal position. Later image from the exam (below) shows the jejunum to be on the right side, rather than the left side, of the abdomen.

The diagnosis was normal rotation of the bowel with no evidence of malrotation with midgut volvulus.

School ager in a motor vehicle collision

CXR and CT of pulmonary laceration — CXR AP (above) shows extensive opacification of the right middle and lower lobes with a small cystic structure in the middle. Axial CT with contrast of the chest (below) shows a multiseptated lesion containing air and blood in the right lower lobe.

The diagnosis was pulmonary laceration / traumatic hematopneumatocele.

School ager who fell off a table and then had the table fall on to them

CT of contusion of pancreas — Axial CT with contrast of the abdomen shows a heterogenous appearance to the pancreatic head (middle left and below left) which is also appreciated on the coronal image (above right) just medial to the contrast filled duodenum. There was a large amount of free fluid in the pelvis (below right)

The diagnosis was contusion of the pancreatic head.

School ager with right lower quadrant pain

CT of acute appendicitis — Axial CT with contrast of the abdomen shows in the right lower quadrant an extremely large, fluid-filled, tubular structure containing several punctate calcifications within it and having some inflammatory changes surrounding it.

The diagnosis was acute appendicitis with multiple appendicoliths.

School ager with a faun’s tail in the middle of the lower back

CT of diastematomyelia — Vintage AP tomogram obtained through the posterior elements of the lumbar spine (left) shows a linear piece of bone in the midline between the L3 and L4 vertebral bodies. Axial CT without contrast of the spine (right) through the L3/L4 disc space shows a piece of bone in the center of the spinal canal

The diagnosis was diastematomyelia.

Newborn with respiratory distress

CXR of asphyxiating thoracic dystrophy — CXR AP shows short ribs resulting in a small thoracic cavity. The spine was normal in appearance.

The diagnosis was asphyxiating thoracic dystrophy.

Infant with a faun’s tail on the midline of their back

Myelogram of diastematomyelia — AP image from a vintage lumbar myelogram exam after injection of contrast in the spinal canal shows an ovoid filling defect in the center of the spinal canal from L1 to L2.

The diagnosis was diastematomyelia.

School ager hit by a car while riding their bike

CT of pancreatic transection — Axial CT with contrast of the abdomen (above) shows a near-complete transection of the pancreatic body along with a large amount of free fluid deep in the pelvis (below)

The diagnosis was transection of the pancreatic body.

Toddler with abdominal pain and distension, hematuria and lethargy for 2 months

CT of Wilms tumor with lung metastases, liver metastases, and IVC invasion — Axial (above right), coronal (below middle) and sagittal (below right) CT with contrast of the abdomen shows a large heterogenous non-calcified mass that fills the entire left side of the abdomen. The inferior vena cava (to the right of the aorta) was distended with tumor thrombus. Multiple liver (above left) and lung (below left) lesions are also seen.

The diagnosis was Wilms tumor with liver metastases and lung metastases and invasion of the inferior vena cava.

School ager with heart murmur

CXR and CT of mediastinal teratoma — CXR AP and lateral (above) shows a large anterior mediastinal mass causing tracheal deviation to the right. Axial CT without contrast of the chest (below left) shows the mass to be low density and to contain calcium. Axial CT with contrast of the chest (below right) shows the mass to have rim enhancement and to be primarily fluid-filled.

The diagnosis was mediastinal teratoma.

Teenager with right lower quadrant pain

US of acute appendicitis — Transverse US of the right lower quadrant (above) shows a dilated, blind ending, non-compressible tubular structure (between the calipers) that is draped across the right psoas muscle and whose tip lies just above the right iliac vessels. Sagittal US of the right lower quadrant (below) showed the tubular structure to have a diameter of 9 mm

The diagnosis was acute appendicitis.

Teenager with headache, diplopia and balance problems

CT of pleomorphic xanthoastrocytoma — CT without contrast of the brain shows a large heterogenous mass in the anterior right hemisphere that has faint linear calcifications, a marked amount of surrounding edema, and mass effect to the left.

The diagnosis was pleomorphic xanthoastrocytoma.

Teenager with knee pain after motor vehicle collision

Radiograph of reverse Segond fracture and patellar dislocation — AP radiograph of the right knee shows an avulsion fracture of the medial proximal tibia and a dislocation of the patella laterally.

The diagnosis was a reverse Segond fracture and patellar dislocation.

Newborn with a nasal mass on prenatal ultrasound

CT of nasal teratoma — Lateral radiograph of the skull (above) shows a large nasal mass. Axial CT without contrast of the skull (below) shows a large heterogenous mass extending via a thin stalk from the unopposed nasal bones that contained soft tissue, fat and calcified components. There was no intracranial extension.

The diagnosis was nasal teratoma.

Infant with projectile vomiting

US and UGI of malrotation with midgut volvulus — Transverse US of the pylorus (left) showed a normal appearing pylorus and showed the superior mesenteric vein to be directly above the superior mesenteric artery (the round structure with an echogenic rim in the center of the image), raising suspicion for malrotation. AP image from an UGI exam (right) shows the duodenal jejunal junction to be over the right pedicle of the spine and to be below the level of the duodenal bulb.

The diagnosis was malrotation with midgut volvulus.

Newborn with respiratory distress

CXR and UGI of tracheal atresia — CXR AP and lateral (above) shows a nasogastric tube with its tip in the mid-esophagus. AP image from an UGI exam performed by injecting the nasogastic tube (below left) shows simultaneous opacification of the tracheobroncial tree and esophagus. Lateral image from the UGI exam (below right) shows the atretic origin of the trachea (black arrow). The tip of the endotracheal tube (which is in the esophagus) is at approximately the same level.

The diagnosis was tracheal atresia.

School ager with respiratory distress

CXR of hydatid disease — CXR PA and lateral shows a large mass without calcification in the posterior aspect of the right lung which on cross sectional imaging was seen to be cystic in nature.

The diagnosis was hydatid disease.

School ager with right lower quadrant pain

CT of carcinoid tumor of the appendix — Axial CT with contrast of the abdomen (above) shows on top of the right psoas muscle and right iliac vessels in the right lower quadrant a dilated, fluid-filled tubular structure containing a calcification . Coronal CT (below) shows two calcifications within the tubular structure which is just medial to the cecum and surrounded by inflammatory changes.

The diagnosis was acute appendicitis with multiple appendicoliths. Pathological examination additionally revealed a carcinoid tumor of the appendix.

Preschooler with a midline neck mass

I-123 scan of thyroglossal duct cyst containing thyroid tissue — Anterior view of a I-123 thyroid scan shows tracer uptake in a single midline region that corresponds directly to the patient’s midline neck mass, without any demarcation of the lobes of the thyroid. There was no other thyroid uptake in the neck.

The diagnosis was thyroglossal duct cyst containing thyroid gland tissue.

Newborn with a small thorax

Radiograph of trident pelvis of asphyxiating thoracic dystrophy — AP radiograph of the lower extremities shows a trident pelvis and bowing of the lower extremities.

The diagnosis was asphyxiating thoracic dystrophy.

Preschooler with abdominal pain

CT of cystic Wilms tumor — Axial (left) CT with contrast of the abdomen shows a large cystic mass with septations in the left side of the abdomen. Coronal immediate image (above right) shows a claw sign proving the left kidney is the organ of origin of the mass. Coronal delayed image (below right) shows the mass has a mural nodule superiorly within it.

The diagnosis was cystic Wilms tumor.

Preschooler who hit their throat on the rim of a plastic chair and now has throat pain and hemoptysis

CT and UGI of esophageal perforation — Sagittal CT without contrast of the neck (left) shows pneumomediastinum anterior to the spine. Lateral image from an esophagram (right) shows contrast extravasating outside the esophagus at the level of C4.

The diagnosis was esophageal perforation due to blunt trauma.

Teenager with noisy breathing at night

CXR and CT of tracheobronchial papillomatosis — CXR AP (above left) shows multiple thin walled cystic and solid lesions in both lungs. Axial CT without contrast of the chest (right) shows multiple cystic and solid lesions in the lungs bilaterally. AP image of the airway (below left) shows a mural tracheal mass arising from the left side of the trachea which nearly completely occludes the airway.

The diagnosis was tracheobronchial papillomatosis.

Young adult with complex congenital heart disease and fever, fatigue and left upper quadrant pain

CXR and V/Q scan and CT of pulmonary embolism — CXR AP (above left) shows dextrocardia and an infiltrate in the left lower lobe. Anterior ventilation image from a V/Q scan (above middle) shows near-normal ventilation to the lungs. Posterior perfusion image from a V/Q scan (above left) shows markedly decreased perfusion to the left lung, with 95% of the perfusion going to the right lung. Coronal CT with contrast of the chest (below left) shows a massively enlarged left pulmonary artery with thrombus in its left lower lobe branches. Axial images (below middle and below right) show multiple peripheral infarcts in the left lower lobe.

The diagnosis was massive pulmonary embolism in the left pulmonary artery.