Teenager with a palpable left scrotal mass

US of embryonal cell testicle tumor — Transverse US of the scrotum (above) shows a focal hypoechoic lesion along the medial border of the left testicle which on the sagittal US of the left testicle (below) appears to have an echogenic posterior aspect, representing calcification.

The diagnosis was embryonal cell testicle tumor.

Male infant with a mass in the right groin

US of spermatic cord hydrocele — Sagittal US of the right inguinal canal and scrotum shows an oval anechoic fluid collection in the inguinal canal that did not communicate with the peritoneum (to the left) and a small amount of anechoic fluid around the right testicle.

The diagnosis was an encysted hydrocele of the spermatic cord and a small hydrocele of the right scrotum.

Infant with a swollen left scrotum

US of bilateral hydroceles — Transverse (above) and sagittal (below) US of the scrotum shows a small amount of anechoic simple fluid around the right testicle and a large amount of anechoic simple fluid around the left testicle.

The diagnosis was bilateral hydroceles, left greater than right.

Infant with bilateral scrotal masses

AXR of bilateral inguinal hernias — AXR AP shows large air-filled loops of bowel within the scrotum bilaterally.

The diagnosis was bilateral inguinal hernias.

Teenager with left cryptorchidism

CT of intraabdominal testicle — Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows an oval isodense soft tissue mass located inferior and lateral to the left kidney.

The diagnosis was left undescended testicle in an infrarenal location.

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School ager with appendectomy 3 months ago, now with abdominal pain and vomiting

Surgical image of small bowel obstruction due to abdominal adhesions — Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.

The diagnosis was small bowel obstruction due to abdominal adhesions.

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Infant with bilateral prenatal hydronephrosis

US of ureteropelvic junction obstruction — Sagittal US of the right kidney (upper left) and left kidney (upper right) shows bilateral mild to moderate hydronephrosis. AP image from the excretory phase of an intravenous pyelogram shows bilateral moderately dilated renal collecting systems with normal appearing bilateral ureters.

The diagnosis was bilateral ureteropelvic junction obstruction.

Preschooler with an abdominal mass

MRI of multilocular cystic nephroma — Sagittal US of the left kidney (above) shows a multicystic renal mass involving most of the left kidney. Coronal (lower left) and axial (lower right) T1 MRI with contrast of the abdomen shows the left renal mass to contain multiple thin septations and to have no solid component.

The diagnosis was pediatric cystic nephroma.

Preschooler referred with “stomach cysts”

US of multicystic dysplastic kidney — Sagittal US of the right kidney (above) shows it to contain multiple cysts, of varying size, that do not communicate and there is a paucity of renal parenchyma. Sagittal US of the left kidney (below) shows it to be normal.

The diagnosis was right multicystic dysplastic kidney.

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School ager who fell off his bike and has abdominal pain

Surgical image of small bowel perforation — Surgical image shows an ileal perforation with the forceps placed through the perforation.

The diagnosis was small bowel perforation secondary to bowel trauma

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View the illustrated DDX of solid renal mass

Toddler with presumed urinary tract infection

MRI of Wilms tumor — Sagittal US of the left kidney (upper left) shows a round hyperechoic lesion in the lower pole of the kidney. Axial T2 MRI without contrast of the abdomen (upper right) and coronal T1 MRI without (lower left) and with (lower right) contrast of the abdomen shows a well-circumscribed, solid T1 hypointense and T2 isointense mass in the lower pole of the left kidney that enhances minimally.

The diagnosis was Wilms tumor of the left kidney.

Toddler with a fever

US of acute pyelonephritis / acute lobar nephronia — Sagittal US of the right kidney (above) shows an ill-defined hypoechoic mass in the right upper pole that is obscuring the normal outline of the echogenic fat in the renal hilum. The mass was hypoperfused on color and power doppler US. AP image from a voiding cystourethrogram (below) shows bilateral vesicoureteral reflux, grade II on the left and grade III on the right

The diagnosis was acute pyelonephritis in a patient with vesicoureteral reflux.

School ager with bilateral abdominal masses

CT of Burkitt lymphoma of kidney — Coronal T1 MRI without contrast of the abdomen (upper left) shows bilateral enlarged kidneys which after the administration of contrast (upper right) is seen to be due to multiple non-enhancing renal masses. Transverse US of the liver (below) shows a round hypoechoic mass in the liver, superior and to the left of the gall bladder.

The diagnosis was Burkitt lymphoma with renal and liver involvement.

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Teenager with a cystic abdominal mass

Surgical image shows a large thin-walled cystic structure arising from the mesentery of the small bowel.

The diagnosis was mesenteric cyst.

School ager with right flank pain

Axial (left) and coronal (right) CT without contrast of the abdomen and pelvis shows mild enlargement of the right kidney and a round calcified lesion at the right ureterovesical junction.

Toddler with urinary tract infection

Excretory phase image from an intravenous pyelogram shows marked dilation of the left renal collecting system and marked dilation of the left ureter throughout its course when compared to the right ureter. No vesicoureteral reflux was seen on a voiding cystourethrogram.

The diagnosis was left congenital megaureter.

Toddler with hypercalcemia

Sagittal US of the left and right kidneys shows echogenic medullary pyramids bilaterally and mild right hydronephrosis.

The diagnosis was nephrocalcinosis and a mild left ureteropelvic junction obstruction.

Newborn with abnormal prenatal ultrasound

Sagittal US of the right kidney shows a lobulated renal contour along the anterior aspect of the right kidney. The left kidney was absent.

The diagnosis was renal fetal lobulations in a patient with a solitary right kidney.

School ager with gross hematuria who is post bone marrow transplant and has received cyclophosphamide

Transverse (above) and sagittal (below) US of the pelvis shows an extremely thick-walled bladder containing echogenic debris and clots.

The diagnosis was hemorrhagic cystitis due to cyclophosphamide therapy.

Female infant with a single perineal opening

Lateral view (left) from a colostogram (lower left contrast collection) shows a rectovesical fistula with contrast filling the patient’s bladder (upper left contrast collection). Oblique view from later in the study (right) shows a filled bladder with a competent bladder neck, a long urethra-urogenital sinus and possibly a rudimentary vagina.

The diagnosis was cloacal malformation.