Teenager with headache and tremors

CT and MR of cavernous malformation — Coronal (above left) and axial (below right) CT without contrast of the brain shows a slightly hyperdense, round, poorly circumscribed lesion in the right frontal lobe. Coronal T1 MRI without contrast of the brain (above right) shows the lesion to have a popcorn appearance with small round lesions of various signal intensities. Axial gradient echo MRI (below right) shows the lesion to be surrounded by a very low signal intensity ring.

The diagnosis was cavernous malformation containing mixed blood products with a hemosiderin ring.

Infant with sepsis after being taken off of ECMO

CT of abdominal abscess in an infected hematoma — Axial (above) and coronal (below) CT with contrast of the abdomen shows an isodense oval fluid collection inferior to the liver and superior and lateral to the right kidney.

The diagnosis was abdominal abscess in an infected hematoma which was a complication of extracorporeal membrane oxygenation.

School ager in a motor vehicle accident with back pain

CT of Chance fracture in lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior wedging of the L1 and L2 vertebral bodies and a horizontal fracture through the spinous process of the L1 vertebral body. 3D CT from the left (middle) and right (right) show bilateral L1-L2 facet distraction resulting in a focal kyphosis at L1-L2.

The diagnosis was Chance fracture of the lumbar spine.

School ager with fever and cough for 1 week

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the lingula that is obscuring the left heart border (silhouette sign) which on the CXR lateral (right) is seen to be projecting over the heart.

The diagnosis was lingular bacterial pneumonia.

Infant with suspected vascular ring on an upper GI exam

CT of intrathoracic kidney — Coronal CT with contrast of the chest (above left) shows the left kidney in the lower left thorax with its vascular pedicle coursing away from it inferiorly. Sagittal CT (above right) shows the kidney had ascended into the chest through the foramen of Bochdalek. Axial CT (below) again shows the kidney in the left hemithorax.

The diagnosis was intrathoracic kidney.

Infant with seizures and kinky appearing hair

MRA of tortuous intracranial vessels in Menkes disease — Coronal MIP MRA with contrast of the brain (above) shows tortuosity of the bilateral middle and anterior cerebral arteries and vertebrobasilar system which is also appreciated on the axial MIP MRA (below).

The diagnosis was Menkes disease.

Preschooler with constipation and anal stenosis on physical exam

CT and MRI of Currarino syndrome — 3D CT of the pelvis (left) shows near complete absence of the lower sacrum with the sacrum having a sickel shape on the right. Midline sagittal T2 MRI of the lumbar spine (middle) shows the conus medullaris to be low in position terminating at L5. Off center sagittal T2 MRI (right) shows a small round low signal intensity lesion anterior to the S2 vertebral body.

The diagnosis was caudal regression syndrome in the form of Currarino syndrome with anal stenosis, a sickle shaped and hypoplastic sacrum, and a presacral mass in the form of an anterior myelomeningocele.

Toddler with intermittent abdominal distension

Small bowel follow through of protein losing enteropathy — AP image from a small bowel follow through exam shows diffuse fold thickening throughout the small bowel which is more prominent in the jejunum than in the ileum.

The diagnosis was protein losing enteropathy.

Teenager with back pain after motor vehicle accident

CT of multiple compression fractures in the lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior compression fractures of the T12 thru L3 vertebral bodies with corresponding loss of height in each which is more subtly appreciated on the 3D CT (right).

The diagnosis was multiple anterior compression fractures of the lumbar spine.

School ager with fever and left chest pain

CXR of bacterial pneumonia in left lower lobe — CXR PA (left) shows a dense opacity over the heart obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the CXR lateral (right) shows the opacity is located posteriorly over the lower thoracic spine (spine sign).

The diagnosis was bacterial pneumonia in the posterior aspect of the left lower lobe.

Preschooler with cough and fever

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a retrocardiac opacity which on the CXR lateral (right) is seen to be located over the lower spine resulting in a spine sign.

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

Infant with prenatal hydronephrosis

US and MAG3 scan of horseshoe kidney — Transverse midline US of the lower abdomen (above) shows renal parenchymal tissue in the midline just anterior to the spine representing the fused lower poles of both kidneys. MAG3 scan (below) shows radiotracer uptake in the bilateral kidneys as well as in their fused lower poles.

The diagnosis was horseshoe kidney.

Preschooler with right knee swelling after a tick bite

Radiograph of lyme arthritis of the knee — Lateral radiograph of the knee shows a large suprapatellar joint effusion.

The diagnosis was lyme arthritis.

Teenager with a left neck mass

CT of second branchial cleft cyst — Axial (above), coronal (below left), and sagittal (below right) CT with contrast of the neck show a thin walled low density mass anterior to the left sternocleidomastoid muscle and posterior to the left submandibular gland. Superiorly the mass goes to the angle of the mandible and inferiorly the mass goes to the hyoid bone.

The diagnosis was second branchial cleft cyst.

Newborn with respiratory distress

Upper GI and small bowel follow through of ileal stenosis — AXR AP (above) shows a distended abdomen with multiple dilated loops of bowel including an asymmetrically dilated loop of bowel in the right upper quadrant. Delayed images from an UGI small bowel follow through exam (below left) shows contrast entering this dilated loop which is in the distal ileum and eventually passing through this dilated loop and filling the appendix (below right).

The diagnosis was ileal stenosis.

Preschooler with forearm pain after a fall

Radiograph of greenstick fracture of the radius and bowing fracture of the ulna — AP (left) and lateral (right) radiographs of the forearm show an incomplete non-displaced fracture through one cortical surface with angulation in the mid-diaphysis of the radius. The AP radiograph also shows the ulna to be bowed in appearance.

The diagnosis was greenstick fracture of the radius and a bowing fracture of the ulna.

School ager with cough and fever

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the left mid lung that is obscuring the left heart border while on the CXR lateral (right) the opacity is seen to overlie the heart.

The diagnosis was bacterial pneumonia in the lingula.

Toddler with sickle cell disease and fever

CXR of bacterial pneumonia in right upper lobe — CXR PA (left) shows an opacity in the right upper lobe which on the CXR lateral (right) is seen to be located posteriorly causing a spine sign.

The diagnosis was bacterial pneumonia in the posterior segment of the right upper lobe in a patient with sickle cell disease. The organism was bacillus non-anthrax.

Teenager with pelvic pain

CT of hematometrocolpos due to vaginal atresia — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the pelvis show a distended fluid-filled bladder anterior to an extremely distended fluid-filled uterus and vagina. The fluid in the uterus and vagina was of higher density than the fluid in the bladder.

The diagnosis was hematometrocolpos due to vaginal atresia.

Preschooler with a right chest wall mass

US of lipoma of chest wall — Transverse (above) and sagittal (below) US of the chest wall show a solid well circumscribed mass in the subcutaneous tissue with heterogenous echogenicity that overall is isoechoic to adjacent fat and which did not have increased vascularity.

The diagnosis was lipoma.

Infant with multiple congenital anomalies

MRI of Blake pouch cyst — Sagittal (left) and axial (right) T1 MRI without contrast of the brain shows cystic dilation of the fourth ventricle.

The diagnosis was Blake pouch cyst.

Teenager with an untreated lysosomal storage disease

MRI of Gaucher disease — Coronal T1 MRI without contrast (left) and T2 MRI (right) of the femurs shows a heterogeneous appearance to the bone marrow of the femurs due to diffuse marrow infiltration. The femurs have a mildly reduced constriction of diaphysis and flaring of metaphysis due to undertubulation, giving them the appearance of an Erhlemeyer flask.

The diagnosis was Gaucher disease.

School ager with pain at the base of the fifth metatarsal after injuring their foot

Radiograph of fracture of the apophysis of the fifth metatarsal — AP (left) and oblique (right) radiographs of the foot show fragmentation of the apophysis of the fifth metatarsal and displacement of it away from the fifth metatarsal.

The diagnosis was fracture of the apophysis of the fifth metatarsal.

Teenager with fever and hemoptysis

CXR and CT of bacterial pneumonia in the left lower lobe — CXR PA (above left) shows an opacity in the medial left lower lobe that obscures the medial left hemidiaphragm. CXR lateral (above right) shows a spine sign over the lower thoracic vertebral bodies. Axial CT without contrast of the chest (below left) shows a dense infiltrate in the posterior aspect of the left lower lobe while the sagittal CT (below right) again shows the infiltrate to be located inferiorly and posteriorly in the chest.

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

School ager with upper respiratory infection and decreased right breath sounds

CXR of bacterial pneumonia of right middle lobe — CXR PA (left) shows a dense opacity in the middle of the right lung that obscures the right heart border which on the CXR lateral (right) is located over the heart.

The diagnosis was bacterial pneumonia of the medial segment of the right middle lobe.