Teenager with an abdominal mass

Axial CT without contrast of the abdomen shows the right kidney to be normal in size and to contain multiple small low density lesions that when measured demonstrate negative Hounsfield units. The left kidney, which is massively enlarged, also contains multiple small low density lesions as well as one extremely large low density lesion in its anterior aspect.

The diagnosis was angiomyolipoma of the kidneys in a patient with tuberous sclerosis.

Premature newborn with abdominal distension and clinical deterioration

Surgical image of necrotizing enterocolitis — Surgical image shows the bowel was white and necrotic throughout its entire length from the duodenum to the colon. There was no salvageable bowel.

The diagnosis was total necrosis of the intestines due to necrotizing enterocolitis.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of pelvic mass

Toddler with constipation and urinary retention

BE of presacral neuroblastoma — Lateral image from a barium enema performed after an intravenous pyelogram (below) shows anterior displacement and compression of the bladder (to the left of the image) and rectum (in the middle of the image) by a presacral mass. The scout image (above) showed the mass was not calcified.

The diagnosis was presacral neuroblastoma.

Preschooler with abdominal pain

CT of infected urachal cyst — Axial (left) and sagittal (right) images from a CT with contrast of the abdomen shows a midline cystic lesion with a thick enhancing wall and surrounding inflammatory change just inferior to the umbilicus that appears to course to the dome of the bladder on the sagittal image.

The diagnosis was an infected urachal cyst.

Female school ager with left lower quadrant abdominal pain and an abdominal mass

US and CT of ovarian dysgerminoma with torsion — Transverse and sagittal US of the pelvis (above) shows an echogenic and inhomgenous solid mass superior to the bladder. Neither ovary could be visualized. Axial CT with contrast of the abdomen shows a solid non-enhancing midline mass. The mass was found to be tossed in the operating room.

The diagnosis was an ovarian dysgerminoma which was found to be torsed in the operating room.

Female school ager with abdominal pain

CT of ovarian cystadenoma — Axial, coronal and sagittal images from a CT with contrast of the abdomen shows a large cystic mass with thin separations on the right side of the abdomen above the bladder. The uterus and left ovary were unremarkable.

The diagnosis was ovarian cystadenoma

Female infant with pelvic mass

US of hematocolpos — Transverse (above) and sagittal (below) US of the pelvis shows a large cystic structure filled with complex fluid posterior to the bladder which is visible on the right side of the sagittal image. The uterus was identified and was unremarkable and therefore the cystic structure was felt to represent a distended vagina.

The diagnosis was hydrocolpos.

Male preschooler with urinary retention

CT of prostatic rhabdomyosarcoma — Axial CT with contrast of the abdomen shows a soft tissue mass arising from between the bladder and rectum that is invading into the posterior wall of the bladder, resulting in filling defects within the bladder.

The diagnosis was genitourinary rhabdomyosarcoma arising from the prostate and invading the bladder.

School ager with suspected congenital anomaly of the urinary tract

IVP of pelvic kidney — AP image from the excretory phase of a vintage intravenous pyelogram shows a normal position of the right kidney in the right renal fossa. The left renal fossa is empty and the left kidney can be found in the left pelvis, over the left side of the sacrum.

The diagnosis was an ectopic kidney in the pelvis.

Our DDX For This Week Is

View the illustrated DDX of pelvic mass

Toddler with an abdominal mass in the right upper quadrant

Surgical image of mesenchymal hamartoma — Surgical image shows a massive tumor in the left medial segment of the liver after it has been delivered. The left lateral segment of the liver and the right lobe of the liver appeared normal and this was confirmed by intraoperative ultrasound. The patient underwent a left medial segment hepatectomy.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of bladder outlet obstruction

School ager with progressive abdominal distension and abdominal pain over the last month and new onset urinary retention

CT of constipation causing bladder outlet obstruction — Coronal (left) and sagittal (right) images from a CT with IV and oral contrast of the abdomen shows a hugely distended bladder whose dome nearly touches the inferior margin of the liver. There is a marked amount of stool throughout the colon, especially in the rectum where a fecaloma is pinching off the bladder neck and urethra.

The diagnosis was constipation causing bladder outlet obstruction.

Infant with urinary retention and constipation

Barium enema of presacral sacrococcygeal teratoma — Lateral image from a barium enema shows displacement of the rectum anteriorly by a presacral mass which is eroding into the rectum and causing the extravasation of a small amount of contrast from the rectum posteriorly.

The diagnosis was sacrococcygeal teratoma.

Toddler with recently noted urinary retention

IVP and CT of rhabdomyosarcoma of the bladder — AP image from the excretory phase of a vintage intravenous pyelogram (above) shows bilaterally normal appearing renal collecting systems and ureters. There is a multilobulated circumferential filling defect in the base of the badder. Axial CT with contrast of the abdomen shows the mass to almost complete fill the base of the bladder.

The diagnosis was rhabdomyosarcoma of the bladder.

Newborn with marked bilateral hydronephrosis on prenatal US

VCUG of posterior urethral valves — AP image from a voiding cystourethrogram (above) shows bilateral grade 5 vesicoureteral reflux, right greater than left, and a narrow pinecone-shaped bladder in the inferior midline aspect of the image. Lateral image of the urethra taken during the voiding phase of the voiding urethrogram (below) shows marked dilation of the posterior urethra and a thin lucent membrane at the transition zone where the urethra assumes a more normal caliber.

The diagnosis was posterior urethral valves causing bilateral grade V vesicoureteral reflux.

Our DDX For This Week Is

View the illustrated DDX of bladder outlet obstruction

Newborn infant of a diabetic mother who has failed to pass meconium

Clinical image of meconium plug — Clinical image shows a contiguous plug of meconium that was expelled by the patient after a water-soluble contrast enema.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of acute scrotum

Toddler with an acutely enlarged and blue right scrotum

US of hydrocele — Transverse and sagittal US of the right scrotum (above) shows a large anechoic fluid collection around the right testicle and epididymis. Sagittal US of the left scrotum (below) for comparison shows no fluid collection around the normal appearing left testicle.

The diagnosis was a large right hydrocele.

School ager with an acutely enlarged right scrotum

US of hydrocele — Sagittal US of the left scrotum (above) is unremarkable while sagittal US of the right scrotum (below) shows a large anechoic fluid collection surrounding the right testicle.

The diagnosis was right hydrocele.

Toddler with right scrotal pain who had suffered non-accidental trauma

CT of testicular hematoma — Axial CT with contrast of the abdomen (above) shows a heterogenous appearance to the enlarged right testicle which is surrounded by an edematous scrotal sac. Sagittal US of the right scrotum (below) again shows the thickened edematous scrotal sac, the heterogenous testicle, and an anechoic fluid collection surrounding the testicle.

The diagnosis was testicular hematoma surrounded by a reactive hydrocele and a scrotal hematoma secondary to trauma.

Infant with enlarged left scrotum and elevated AFP

US of testicular yolk sac tumor — Transverse color doppler US of the scrotum (above) shows the left testicle is hypervascular and much larger in size than the right testicle. Sagittal US of the left testicle (below) shows the testicular enlargement is due to a large round mass in the superior aspect of the testicle that is discrete from the normal testicle inferiorly.

The diagnosis was yolk sac tumor of the testicle.

Infant with acute right groin swelling

US of inguinal hernia — Sagittal US of the right scrotum shows a normal appearing right testicle (to the right of the image) that is displaced inferiorly in the scrotal sac by a large mass composed of multiple tubular structures that demonstrated peristalsis on real-time imaging.

The diagnosis was inguinal hernia.