Teenager who has eaten something they should not have eaten

AXR of ingested AA batteries in the stomach — AXR AP shows two radiopaque cylindrical objects in the abdomen in the region of the stomach.

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

Teenager hit by a car while riding their bike

Radiograph and CT of secondary accessory ossification center of vertebral body mimicking cervical spine fracture — Lateral radiograph of the cervical spine (left) shows a small ossific fragment anterior and superior to the C6 vertebral body. There is no prevertebral swelling and the alignment of the cervical spine is normal. Sagittal CT without contrast of the cervical spine (right) shows that the ossific fragment is well corticated.

The diagnosis was a secondary ossification center of the cervical spine mimicking a cervical spine fracture.

Newborn post intubation

CXR of left mainstem bronchus intubation — CXR AP shows the tip of the endotracheal tube is in the left mainstem bronchus. There is complete opacification of the right hemithorax.

The diagnosis was endotracheal tube malfunction with the tip of the endotracheal tube in the left mainstem bronchus resulting in complete atelectasis of the right lung.

School ager with ventriculoperitoneal shunt in clinic for routine followup

AXR of VP shunt migration from abdomen to chest — AXR taken 1 year ago (left) shows the VP shunt to be radiographically intact and its tip is coiled in the pelvis. AXR taken today (right) shows the VP shunt migrated out of the abdomen into the left chest and its tip is in the left costrophrenic angle.

The diagnosis was ventriculoperitoneal shunt malfunction due to shunt tip migration into the chest.

Teenager with abdominal pain and hematuria

CT of nutcracker syndrome — Axial CT with contrast of the abdomen shows stenosis of the proximal left renal vein with associated dilation of the distal left renal vein due to compression of the left renal vein between the superior mesenteric artery and aorta. There were no gonadal collaterals

The diagnosis was nutcracker syndrome.

School ager with a crooked stance

Radiograph of hemihypertrophy due to Parkes Weber syndrome — AP radiograph of the lower extremity shows a valgus deformity of the lower extremities. In addition, the soft tissues of the right thigh and calf are twice as thick as the soft tissues of the left thigh and calf.

The diagnosis was hemihypertrophy of the right lower extremity due to Parkes Weber syndrome.

Teenager with a C5-C6 fracture dislocation after a motor vehicle accident

MRA of vertebral artery dissection after trauma — MRA with contrast of the neck in AP (left) and left oblique (middle) and right oblique (right) projections shows the right vertebral artery arises from the right subclavian artery and courses normally to where it enters the basilar artery. The left vertebral artery arises from the left subclavian artery but then is only faintly visualized along its course until it reconstitutes where it enters the basilar artery.

The diagnosis was occlusion of the left vertebral artery from C2 to C7 due to dissection of the left vertebral artery.

Preschooler who has eaten something they should not have eaten

AXR of rare earth construction magnets in the stomach — AXR AP (left) and AXR lateral (right) show 4 radiopaque linear objects that are joined together in the mid abdomen.

The diagnosis was gastrointestinal foreign body in the form of 4 rare earth construction set magnets that are joined together.

School ager who fell from a horse and has pain in the middle of the right arm

Radiograph of bowing fracture of radius — AP (above) and lateral (below) radiographs of the right forearm show the radius is bowed in appearance when compared to the straightness of the ulna. No obvious fracture is seen.

The diagnosis was bowing fracture of the radius.

School ager post intubation

CXR of endotracheal tube in left mainstem bronchus — CXR AP (left) shows the tip of the endotracheal tube projecting over the left mainstem bronchus. CXR AP (middle) shows the tip of the endotracheal tube projecting over the right mainstem bronchus. CXR AP (right) shows the tip of the endotracheal tube projecting above the carina.

The diagnosis was endotracheal tube malfunction with the endotracheal tube placed initially in the left mainstem bronchus, then in the right mainstem bronchus and finally in the trachea above the carina.

School ager with a ventriculoperitoneal shunt and new neck pain

Radiograph of breakage of VP shunt tubing in the neck — Lateral radiograph of the skull taken 7 years ago (above) shows the VP shunt to be intact inferior to the lucent shunt reservoir. Current lateral radiograph of the skull (below) shows a discontinuity in the ventriculoperitoneal shunt inferior to the lucent shunt reservoir due to a breakage of the shunt tubing.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of a breakage of the tubing in the neck.

Infant with a renal mass on prenatal ultrasound

CT of mesoblastic nephroma, cellular subtype — Coronal CT with contrast of the abdomen (below) shows a solid mass with variable enhancement with cystic components within the right kidney. Axial CT (above) shows the cystic component of the mass extends to the midline. No claw sign is present. The left kidney is normal.

The diagnosis was mesoblastic nephroma, cellular type.

School ager with a myelomeningocele who is insensate in the lower extremities who had left varus derotation osteotomy surgery 2 months ago and now has new left thigh swelling

Radiograph of congenital insensitivity to pain resulting in exuberant periosteal reaction — AP (left) and lateral (right) radiographs of the left femur show a normal post operative appearance to the left hip plate and screws. There is exuberant periosteal reaction present along the femur. There is an irregular lucency in the distal femoral metaphysis.

The diagnosis was congenital insensitivity to pain resulting in exuberant periosteal reaction from an undiagnosed nondisplaced distal femur fracture.

Teenager whose ventriculoperitoneal shunt was revised 1 month ago who now has a new headache and redness along the anterior abdominal wall.

CT of a CSFoma / cerebrospinal fluid pseudocyst in the anterior abdominal wall — Axial (above) and coronal (below) CT with contrast of the abdomen shows a round low density fluid collection in the subcutaneous tissues of the right anterior abdominal wall with inflammatory changes noted around the fluid collection. In the center of the fluid collection is a coiled ventriculoperitoneal shunt.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of a CSFoma in the anterior abdominal wall due to VP shunt tip migration out of the abdomen.

Toddler who has eaten something they should not have eaten

AXR of 3 coins in the stomach that are stuck together and mimicking a button battery — AXR AP shows a radiopaque foreign body in the fundus of the stomach which has a combination of beveled edges and step offs.

The diagnosis was gastrointestinal foreign body which was presumed to be a button battery but upon endoscopic removal was found to be a nickel and two smaller penny coins that were stuck together and mimicking a button battery.

Teenager who was hit hard during a hockey game who now has right chest pain

CT of sternoclavicular joint dislocation — 3D CT without contrast of the chest viewed anteriorly (above) shows normal alignment of the left sternoclavicular joint and malalignment of the right sternoclavicular joint. 3D CT viewed from above (below) shows the right clavicular head is displaced posteriorly to the manubrium of the sternum when compared to the left clavicular head.

The diagnosis was right posterior sternoclavicular joint dislocation.

Infant with chronic lung disease post intubation

The diagnosis was endotracheal tube malfunction with the tip of the endotracheal tube in the left mainstem bronchus in a patient with chronic lung disease.