Infant with bilateral leukocoria

MRI of bilateral retinoblastoma — Axial T1 MRI with contrast of the orbits shows solid enhancing masses arising from the posterior aspect of the globes bilaterally. There was no extension into the optic nerves.

The diagnosis was bilateral retinoblastoma.

Preschooler with proptosis of the right orbit

MRI of retinoblastoma — Axial T1 without contrast (above left), coronal T2 (above right), axial T1 (below left) and coronal T1 (below right) MRI with contrast of the orbits show a large heterogenous solid mass arising from the posterior aspect of the right globe that enhances with contrast. There was no extension to the right optic nerve.

The diagnosis was retinoblastoma.

Toddler with small orbits

Axial (above) and coronal (below) CT with contrast of the orbits show bilaterally small orbits containing small optic nerves and small extraocular muscles. There is also bilaterally calcification in the center of the vitreous of the globes and colobomatous cysts inferolaterally within the orbits.

The diagnosis was microphthalmia and coloboma.

Toddler with an orbital mass

CT of orbital dermoid — Coronal (above) and axial (below) CT with contrast of the orbits show a right superolateral rounded low density mass that is not causing any bone erosion.

The diagnosis was orbital dermoid.

Toddler with an orbital mass

CT of orbital dermoid — Axial CT without contrast of the orbits in soft tissue (above) and bone windows (below) show a left superomedial rounded low density mass that is not causing any bone erosion.

The diagnosis was orbital dermoid.

Infant with an orbital mass

CT of dacrocystocele — Axial (above) and coronal (below) CT without contrast of the orbits show a left inferomedial low density bilobed mass extending from the left medial canthus through the lacrimal duct into the left inferior nasal cavity.

The diagnosis was dacrocystocele.

Our DDX For This Week Is

View the illustrated DDX of orbital masses.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery in the center of the image. The small bowel (to the left) is dusky in color.

The diagnosis was malrotation with midgut volvulus.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of supratentorial brain tumors.

Toddler with left arm weakness

CT and MRI of supratentorial primitive neuroectodermal tumor — Axial CT without contrast of the brain (above left) shows an ill-defined large heterogenous right periventricular mass causing midline shift to the left. Axial T2 (above right) and T1 MRI without contrast (below left) of the brain show the mass to be fairly well circumscribed, primarily solid with some cystic components, and to show heterogenous enhancement on axial T1 MRI with contrast (below right).

The diagnosis was primitive neuroectodermal tumor.

Teenager with seizures

MRI of mesial temporal sclerosis — Coronal T2 (above) and FLAIR (below) MRI of the brain shows atrophy and sclerosis represented by bright T2 signal of the left hippocampus which also showed low metabolism on PET imaging.

The diagnosis was mesial temporal sclerosis.

Toddler with hemiplegia

MRI of hemimegalencephaly — Axial T2 MRI of the brain shows the left cerebral hemisphere to have diffusely thickening of the cortical ribbon and a decreased amount of white matter.

The diagnosis was hemimegalencephaly.

School ager with increasing headaches

MRI of gliomatosis cerebri — Three contiguous axial FLAIR MRI images (above left, above right, below left) show a high signal intensity infiltrative mass without much mass effect centered in the left frontal lobe which crosses the corpus callosum into the right front lobe and right central white matter. Axial T1 MRI with contrast of the brain (below right) shows the mass to have faint enhancement.

The diagnosis was gliomatosis cerebri due to anaplastic astrocytoma.

School ager with seizure

MRI of ganglioglioma — Coronal T2 (above left), FLAIR (above right) and T1 MRI with contrast (below) of the brain show a round cystic lesion in the medial aspect of the left temporal lobe that has an enhancing mural nodule superiorly.

The diagnosis was gangliglioma.

School ager with seizures

MRI of focal cortical dysplasia — Axial T2 (above left), axial FLAIR (above right) and coronal T1 (below) MRI without contrast of the brain show an abnormal gyral pattern of cortical grey matter in the infero-medial aspect of the right frontal lobe that on the axial images is seen to nearly reach the anterior-most aspect of the anterior horn of the right lateral ventricle.

The diagnosis was focal cortical dysplasia.

Teenager with papilledema and vision loss

MRI of supratentorial ependymoma — Axial (above left) and coronal (above right) T1 MRI without contrast of the brain show a right hemispheric high signal intensity mass with mural nodules that is causing some mass effect to the left. The mass was also of high signal intensity on T2 MRI. Axial (below left) and coronal (below right) T1 MRI with contrast of the brain show enhancement of the mural nodules.

The diagnosis was ependymoma.

Infant with febrile seizure

CT and MRI of desmoplastic infantile glioma — Axial (above left) and coronal (above right) CT without contrast of the brain show a mass in the left temporal lobe that medially has a higher density solid component and laterally has a lower density cystic component. The mass is surrounded by low density vasogenic edema and is causing some midline shift to the right. Axial (below left) and coronal (below right) T1 MRI with contrast of the brain show homogenous contrast enhancement of the solid portion of the mass.

The diagnosis was desmoplastic infantile ganglioglioma.

Our DDX For This Week Is

View the illustrated DDX of supratentorial brain tumors.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the midgut (superiorly) to be dusky in color.

The diagnosis was malrotation with midgut volvulus.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of branchial cleft cysts.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of cystic neck masses.

Toddler with purulent drainage from the right neck

CT of second branchial cleft cyst — Axial (left) CT with contrast of the neck shows a round, low density mass on the right with rim enhancement anterior to the right sternocleidomastoid muscle and inferior to the angle of the mandible and posterior to the right submandibular gland that has a sinus tract to the skin best seen on the coronal CT (right).

The diagnosis was second branchial cleft cyst.

Toddler with an infected neck mass

CT of fourth branchial cleft cyst — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the neck degraded by motion artifact shows a round, low density mass in the neck inferior to the hyoid bone and anterior to the thyroid gland that is just to the left of midline that has rim enhancement. Endoscopy subsequently showed a tract to the left pyriform sinus.

The diagnosis was fourth branchial cleft cyst.

Our DDX For This Week Is

View the illustrated DDX of branchial cleft cysts.

Our DDX For This Week Is

View the illustrated DDX of cystic neck masses.