Preschooler with febrile seizure and abdominal pain

CT and US of renal abscess — Axial (left upper) and coronal (right upper) CT with contrast of the abdomen shows a round low density lesion in the lower pole of the left kidney. Transverse (lower left) and sagittal (lower right) color doppler US of the the left kidney shows the round lesion in the lower pole to be solid and avascular in nature.

The diagnosis was renal abscess.

Preschooler with colicky abdominal pain

US of pancreatitis caused by pancreatic duct stone — Transverse US of the pancreatic head (above) shows just to the right of midline a round echogenic lesion with posterior shadowing in the center of the pancreatic head while transverse US of the pancreatic body (below) shows a dilated pancreatic duct throughout the body of the pancreas.

The diagnosis was a large stone in the pancreatic head portion of the pancreatic duct causing pancreatic duct obstruction and pancreatitis.

Toddler with a left abdominal mass

US and MRI of nephroblastomatosis — Sagittal (above left) and transverse (above right) US images of the left kidney show it to be enlarged and echogenic in appearance with little recognizable normal renal parenchyma. Axial T2 (lower left), T1 (lower middle) and T1 post contrast (lower right) MR images of the right kidney shows a small round lesion that is hyperintense on T2, isointense on T1, and that does not enhance after the administration of contrast. Two additional identical appearing lesions were seen in the right kidney.

The diagnosis was Wilms tumor of the left kidney and nephrogenic rests from nephroblastomatosis in the right kidney.

Toddler with a connective tissue disease

CXR of Marfan syndrome — CXR AP shows a prominent aortic arch and left lateral border of the aorta due to aortic ectasia.

The diagnosis was Marfan Syndrome.

Preschooler with right upper quadrant pain and jaundice

US of gallbladder hydrops in Kawasaki's disease

The diagnosis was Kawasaki disease causing hydrops of the gallbladder.

Female infant with a bulge in the left inguinal canal

US of canal of Nuck hydrocele — Sagittal (above) and transvere (below) US images of the left inguinal canal show an oval, anechoic, non-peristalsing lesion in the left inguinal canal.

The diagnosis was canal of Nuck hydrocele.

Teenager with enuresis

US of urethral trauma — Transverse US of the prostatic urethra (upper left) shows a small round echogenic lesion with posterior shadowing in the center of the prostatic urethra which was not seen in the transverse US of the penile urethra (upper right). Sagittal US of the bladder (lower left) shows an echogenic lesion with posterior shadowing in the posterior aspect of the bladder that on transverse US of the bladder (lower right) resolved into two separate echogenic lesions with posterior shadowing.

The diagnosis was urethral trauma due to a metal axle from a toy car the patient had inserted into his urethra years before which had perforated the bladder creating a colovesical fistula and caused development of two bladder stones.

Newborn with prenatal hydronephrosis

US of Tamm Horsfall proteins — Sagittal US of the kidneys shows multiple echogenic lesions in the renal pyramids bilaterally which resolved on a repeat ultrasound performed one month later.

The diagnosis was Tamm Horsfall proteins.

School ager with anti-NMDA encephalitis

US and CT of ovarian teratoma in NMDA encephalitis — Sagittal US of the pelvis (upper left) shows the right ovary to be enlarged and to contain an echogenic lesion within it superiorly. Axial (upper right) and coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows an enlarged right ovary in the midline of the pelvis anterior to the rectum which has multiple low density lesions within it.

The diagnosis was ovarian teratoma.

Infant with a urinary tract infection who was difficult to catheterize

VCUG of prostatic utricle in hypospadias — AP (above) and lateral (below) images from a voiding cystourethrogram shows a large oval structure posterior to the posterior urethra that fills with contrast during voiding and which represents a large prostatic utricle.

The diagnosis was a prostatic utricle cyst in a patient with hypospadias.

Newborn with ambiguous genitalia

US of congenital adrenal hyperplasia — Sagittal (above) and transverse (below) US of the kidneys shows enlarged hypoechoic lesions superior to the kidneys which have a triangular shape on sagittal images and a cerebriform shape on transverse images.

The diagnosis was congenital adrenal hyperplasia.

Teenager with urinary tract infection

CT of autosomal dominant polycystic kidney disease — Axial CT with contrast of the abdomen shows multiple variably sized round low density lesions in the bilateral kidneys.

The diagnosis was autosomal dominant polycystic kidney disease.

Teenager with decreased renal function

US of autosomal dominant polycystic kidney disease — Sagittal US of both kidneys shows multiple large round anechoic lesions in the bilateral kidneys.

The diagnosis was autosomal dominant polycystic kidney disease.

Teenager with intractable back pain

US of pancreatoblastoma — Transverse US of the abdomen shows a large solid mass in the pancreatic head encasing the hypoechoic portal-mesentero venous junction in the center of the image.

The diagnosis was pancreatoblastoma.

School ager with right lower quadrant pain and elevated white blood cell count

CT of omental infarction — Axial CT with contrast of the abdomen shows diffuse mesenteric fat stranding which is most prominent along the right side of the abdomen. The appendix (not pictured) measured 7-8 mm in diameter and was considered via measurement to be indeterminate for acute appendicitis.

The diagnosis was omental infarction which was seen along with a normal appendix in the operating room.

Infant with vomiting and failure to thrive

Upper GI of organoaxial volvulus — AP image from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach.

The diagnosis was organoaxial gastric volvulus.

Teenager with an incidentally noted paraspinal mass on a CXR

Upper GI of organoaxial gastric volvulus and hiatal hernia — Early AP (above left) and later AP (above right) and lateral (below) images from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach. The stomach is also noted to have slid through the esophageal hiatus into the chest.

The diagnosis was organoaxial gastric volvulus in a patient with a hiatal hernia.

Infant with cough and vomiting

Upper GI of organoaxial gastric volvulus — Early AP (above left) and later AP (above right) and lateral (below) images from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach.

The diagnosis was organoaxial gastric volvulus.

Teenager with left arm tingling

CT angiogram of Takayasu arteritis of the subclavian artery — CT angiogram of the chest with 3D reconstruction shows diffuse narrowing of the left subclavian artery beginning at its origin along with diffuse narrowing of the left vertebral artery beginning at its origin.

The diagnosis was Takayasu arteritis.

Teenager with abdominal pain

CT of azygos continuation of the inferior vena cava — Coronal CT with contrast of the abdomen (below) shows interruption of the infrahepatic inferior vena cava which then communicates with the hemiazygos vein to the left of the spine which then via dilated azygos and hemiazygos venous collaterals alongside the vertebral body on the axial CT (above) ultimately drain into the superior vena cava.

The diagnosis was azygos continuation of the inferior vena cava.

School ager with cough and fever

CXR of COVID-19 pneumonia — CXR AP shows bilateral diffuse ground glass opacities in the mid to lower lungs. No lymphadenopathy or pleural effusions were seen.

The diagnosis was COVID-19 pneumonia.

Newborn with an anterior abdominal wall defect

Clinical image of bladder exstrophy — Clinical image shows the anterior abdominal wall is not fused inferiorly and that the bladder is not fused anteriorly and is everted and extending through the anterior abdominal wall defect.

The diagnosis was bladder exstrophy.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of umbilical drainage

Infant with drainage of urine through the umbilicus

VCUG of patent urachus and urachal diverticulum — Lateral image from a voiding cystourethrogram performed by catheterizing the site of urine drainage at the patient’s umbilicus shows contrast filling the bladder and urethra as well as a large diverticulum at the dome of the bladder that nearly extends to the patient’s anterior abdominal wall.

The diagnosis was patent urachus and a urachal diverticulum.

Toddler with drainage of stool from the umbilicus

Meckel’s scan of Meckel's diverticulum — AP delayed image (left) from a Tc-99m pertechnetate scan (Meckel’s scan) shows a focal round concentration of radiotracer in the right lower quadrant superior and lateral to the midline bladder which is seen in the middle of the lower abdomen superior to the bladder on the lateral (right) delayed image.

The diagnosis was Meckel diverticulum with a patent omphalomesenteric duct.