Teenager with a palpable right scrotal lesion

US of epididymal cyst — Sagittal US of the scrotum shows a round lesion in the epididymis that does not have septations but does have complex fluid within it.

The diagnosis was epididymal cyst.

Toddler who has been seen to be eating paint chips

Radiographs of lead poisoning — AP radiographs of the lower extremities show dense transverse lines in the proximal and distal metaphyses of the femora, tibiae and fibulae bilaterally.

The diagnosis was lead poisoning.

School ager with a ventriculoperitoneal shunt with vomiting, diplopia, abdominal pain and newly dilated lateral ventricles

CT of CSFoma / cerebrospinal fluid pseudocyst — Axial CT with contrast of the abdomen (above) shows the VP shunt anteriorly in the abdomen coursing through a multiloculated fluid collection on the left side of the abdomen. Coronal CT (below left) shows multiple dilated loops of proximal small bowel while the sagittal CT (below right) shows the fluid collection to have at least 3 locules.

The diagnosis was a ventriculoperitoneal shunt malfunction in the form of a CSFoma.

Preschooler with a history of a foreign body ingestion

Radiograph of a button battery in the stomach — AXR AP (left) shows a round radiopaque object in the region of the pylorus of the stomach that has a lucent halo around it. Zoomed up image of the object (right) better shows the lucent halo.

The diagnosis was gastrointestinal foreign body in the form of a button battery.

Teenager who is immediately post reduction of an anterior shoulder dislocation

Radiograph of Hill-Sachs deformity after anterior shoulder dislocation — Post-reduction AP (left) and Stryker (right) radiographs of the right shoulder show a defect in the posterolateral aspect of the humeral head.

The diagnosis was a Hills-Sachs deformity in a patient who had had an anterior shoulder dislocation.

Preschooler with a cough and fever

CXR and chest CT of pulmonary tuberculosis — CXR AP (above) shows prominence of the left hilum. Axial CT without contrast of the chest in soft tissue windows (below left) shows left hilar lymphadenopathy while the lung windows (below right) show next to the left hilar lymphadenopathy an infiltrate with a tree-in-bud pattern in the posterior left lung.

The diagnosis was tuberculosis pneumonia.

Newborn with respiratory syncytial virus pneumonia who is post intubation

CXR of endotracheal tube in right mainstem bronchus — CXR AP shows the tip of the endotracheal tube to be in the right mainstem bronchus. There is hyperaeration of the right lung.

The diagnosis was endotracheal tube malfunction in the form of intubation of the right mainstem bronchus in a patient with respiratory synctial virus pneumonia.

Newborn with an anterior abdominal wall defect

AXR of bladder exstrophy — AP radiograph of the abdomen (left) shows diastasis of the symphysis pubis. Lateral radiograph of the abdomen (right) shows a soft tissue mass protruding anteriorly out of the pelvis.

The diagnosis was bladder exstrophy.

Teenager with worsening back pain

MRI of tuberculous osteomyelitis of the spine — Sagittal T1 without contrast (above left) and T2 (above middle) MRI of the spine shows destruction of an intervertebral disc space and near-complete collapse of a vertebral body at the thoracolumbar junction with an associated kyphotic deformity. Sagittal T1 with contrast MRI (above right) shows a rim enhancing subligamentous fluid collection anterior to the vertebral body. Axial T1 with contrast MRI (below left) better shows the subligamentous fluid collection anterior to the vertebral body while a lower axial image (below right) shows a large rim enhancing abscess in the left posas muscle.

The diagnosis was tuberculous osteomyelitis causing discitis and a left psoas abscess.

School ager with a ventriculoperitoneal shunt who has had abdominal pain for a week and a headache for a day

CT of CSFoma / Cerebrospinal fluid pseudocyst — Axial CT without contrast of the abdomen shows a VP shunt in the anterior right abdomen that is coursing between two low density fluid collections and whose tip is in the fluid collection nearest to the midline.

The diagnosis was a ventriculoperitoneal shunt malfunction in the form of a CSFoma.

Toddler who is choking on something

CXR of button battery ingestion in a patient with a Morgagni hernia — CXR AP (above left) shows a round radiopaque object with a halo of lucency around it in the neck and there is a dense opacity in the medial aspect of the right lower lobe. CXR lateral (above right) shows the round object to be in the esophagus posterior to the airway and there is a loop of bowel coursing up from the abdomen to the chest anterior to the heart. Axial (below left) and sagittal (below right) CT without contrast of the chest shows the loop of bowel anterior and medial in location in the right chest to have haustra and therefore to be colon.

The diagnosis was a gastrointestinal foreign body in the form of a button battery in the esophagus in a patient who also had a Morgagni hernia.

Teenager who pivoted the wrong way while playing sports and now has right knee pain

Radiograph of patellar dislocation — AP radiograph of the knee (left) shows lateral dislocation of the patella which is confirmed on the Merchant view (right). The lateral view (center) also shows the patella is not in its normal location.

The diagnosis was patella dislocation.

Teenager with recurrent fevers

CT of pulmonary tuberculosis — Axial CT with contrast of the chest (above) shows a small thick-walled cavitary lesion in the left upper lobe along with some associated opacities peripheral to it as well as in the right upper lobe. MIP axial CT with contrast of the chest (below) shows the entire left lower lobe to be filled with tree-in-bud opacities. There is also a nodular opacity in the anterior right lung.

The diagnosis was tuberculosis pneumonia.

Infant with a cough whose whole family has postive PPD and Quantiferon tests

CXR of primary pulmonary tuberculosis — CXR AP and lateral show a dense infiltrate in the right middle lobe along with right hilar adenopathy.

The diagnosis was tuberculosis pneumonia.

Premature newborn with apnea and bradycardia

US and MRI of choroid plexus hemorrhage — Coronal (above left) and sagittal (above right) US of the brain show the right lateral ventricle to be filled with echogenic material and to be dilated. Axial GRE MRI without contrast of the brain obtained 1 month later (below) shows dark signal representing hemosiderin in the choroid plexus of the right lateral venticle. There is no hemosiderin in the right germinal matrix.

The diagnosis was right choroid plexus hemorrhage.

Teenager with ankle pain

Radiograph and CT of non ossifying fibroma — AP radiograph of the ankle (left) shows a metaphyseal lesion that is lucent with a thin sclerotic rim, a narrow zone of transition, and no periosteal reaction. The lesion is seen on coronal CT without contrast of the ankle (right) to be cortically based.

The diagnosis was non ossifying fibroma.

Female teenager with 2 weeks of abdominal pain

CT of ovarian cystadenoma — Coronal (left) and axial (right) CT with contrast of the abdomen show a large multiseptated mass superior to the bladder. The left ovary was normal while the right ovary was not clearly identified.

The diagnosis was ovarian cystadenoma.

Teenager with abdominal pain

US and MRI of focal nodular hyperplasia — Transverse US of the liver (above left) shows a round hyperechoic lesion in the liver. Coronal T2 MRI without contrast of the abdomen (above right) shows the lesion in the right lobe of the liver to have slightly increased signal intensity aside from the center of the lesion which has high signal intensity. Axial T1 MRI with contrast of the abdomen obtained in early phase imaging (below left) shows near uniform enhancement of the lesion aside from the center of the lesion while delayed phase imaging (below right) shows delayed stellate-like enhancement of the center of the lesion while the rest of the lesion is now isointense to liver.

The diagnosis was focal nodular hyperplasia.

School ager with chronic stridor who had been intubated earlier in life

Radiograph of tracheal granuloma — AP radiograph of the airway shows a subglottic mass arising from the right wall of the trachea causing airway narrowing at the level of third and fourth cervical vertebral bodies.

The diagnosis was tracheal granuloma.

Infant with a ventriculoperitoneal shunt who has projectile vomiting

CT of overshunting of the ventricular system — Axial CT without contrast of the brain show a ventriculoperitoneal shunt entering from a right parietal approach whose tip projects over the anterior horn of the right lateral ventricle. The ventricular system is completely collapsed and cannot be seen.

School ager with parasomnias and gait disturbance

MRI of diffuse midline glioma — Axial FLAIR MRI without contrast of the brain (above left) shows the pons to be enlarged and to have increased signal intensity throughout. There is also increased signal intensity in the medial aspect of the left temporal lobe. Going upwards in the brain (above right and below) the increased signal intensity is seen in the midbrain and in the left basal ganglia and thalamus.

The diagnosis was diffuse midline glioma.

Teenager with longstanding bilateral heel pain

Radiograph of Sever disease — Lateral radiographs of the left foot (above) and right foot (below) show dense calcaneal apophyses bilaterally which have been present on radiographs over the last 4 years. The calcaneal apophyses bilaterally are now nearly completely fused.

The diagnosis was bilateral Sever disease.

Newborn with abdominal muscle hypoplasia and bilateral cryptorchidism

AXR of prune belly syndrome — AXR AP shows bulging flanks bilaterally and low lung volumes bilaterally.

The diagnosis was prune belly syndrome.

School ager with cystic fibrosis and abdominal pain

CT of cystic fibrosis causing liver cirrhosis and pancreatic insufficiency — Coronal CT with contrast of the abdomen (above) shows a marked nodular contour to the liver and multiple dilated veins around the spleen. Coronal CT with contrast of the abdomen (below) shows diffuse fatty replacement of the pancreas.

The diagnosis was cystic fibrosis causing cirrhosis of the liver and esophageal varices and cystic fibrosis causing pancreatic insufficiency.

Newborn delivered via caesarean section with respiratory distress

CXR of transient tachypnea of the newborn — Initial CXR AP (above) shows normal lung expansion and fine interstitial infiltrates bilaterally. No pleural effusion is seen. CXR AP taken 1 day later (below) shows interval complete resolution of the previously seen fine interstitial infiltrates.

The diagnosis was transient tachypnea of the newborn.