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.

Preschooler with acute left scrotal pain

US of epidimo-orchitis — Sagittal and transverse greyscale US of the left testicle (above) show a heterogenous appearance of the left testicle. Sagittal color doppler US of the left testicle shows increased blood flow to the left testicle and there was also increased blood flow to the left epididymis (not pictured).

The diagnosis was left epididimo-orchitis.

Preschooler with acute onset of left scrotal pain

US of torsion of the appendix testis — Transverse (above) and sagittal (below) US of the left testicle shows a round, mixed echogenicity lesion superior and medial to the left testicle that had no flow on color and spectral doppler US. The left epididymis and left testicle were normal in appearance with normal appearing blood flow.

The diagnosis was torsion of the appendix testis on the left.

Teenager with acute left scrotal pain

US of testicular torsion — Sagittal color doppler US of the right testicle (above) shows the presence of color flow that had an arterial waveform on spectral doppler US. Sagittal color doppler US of the left testicle (below) shows the absence of color flow and no arterial waveforms could be found on spectral doppler US.

The diagnosis was left testicular torsion.

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Infant with non-bilious and bilious vomiting

Surgical image of Meckel's diverticulum — Surgical image shows shows multiple dilated loops of small bowel in the background with a sharp transition point seen in the center of the image in the terminal ileum where on its anti-mesenteric border a diverticulum is seen with an omphalomesenteric duct remnant coming off it. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus, resulting in a small bowel obstruction.

The diagnosis was Meckel diverticulum causing a small bowel volvulus and a small bowel obstruction.

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View the illustrated DDX of anomalies of renal formation

Preschooler with emesis

CT of reflux nephropathy and VCUG of vesicoureteral reflux — Coronal CT with contrast of the abdomen (left) shows a normal appearing left kidney and a shrunken right kidney with diffuse loss of renal parenchyma and scarring. AP image from a voiding cystourethrogram (right) shows left grade II vesicoureteral reflux and right grade IV vesicoureteral reflux.

The diagnosis was bilateral vesicoureteral reflux resulting in right reflux nephropathy.

Infant with urinary tract infection

US of duplicated kidney with ectopic ureterocele and hydroureteropyonephrosis — Sagittal US of the right kidney (upper left) shows a duplicated renal collecting system with the upper pole replaced by a round structure filled with echogenic material. Sagittal US of the right upper pole ureter (upper right) shows a tortuous ureter filled with echogenic material. Transverse US of the bladder (lower left) shows a round structure in the right side of the bladder that has echogenic material in its inferior portion and anechoic material in its superior portion. Sagittal US of the right ureter and bladder (lower right) shows the tortuous right ureter filled with echogenic material on the left side of the image and the rounded structure with the fluid-fluid level in the right side of the bladder.

The diagnosis was acute pyelonephritis in a duplicated kidney with an ectopic ureterocele with hydroureteropyonephrosis throughout the upper pole of the right kidney and right upper pole ureter and ureterocele.

Infant with suspected congenital anomaly of the urinary tract

IVP of renal agenesis — AP image from the nephrogram phase of a vintage intravenous pyelogram shows a dense nephrogram in the right renal fossa representing the right kidney with contrast draining down the right ureter and filling the bladder. There is no nephrogram noted in the left renal fossa.

The diagnosis was agenesis of the left kidney.

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Newborn with vomiting and a double bubble sign on prenatal ultrasound

Surgical image of jejunal stenosis — Surgical image shows the two retractors outlining a markedly dilated duodenum in the center of the image. The proximal jejunum is markedly stenotic where it joins to the duodenum at the duodenal-jejunal junction in the center of the image. The more distal jejunum is normal in caliber.

The diagnosis was jejunal stenosis.

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View the illustrated DDX of abnormalities of renal ascent

Infant with respiratory distress due to respiratory syncytial virus

CXR and CT of intrathoracic kidney — CXR AP (upper left) shows a rounded mass in the left lower lobe which appears posterior in location on the CXR lateral (upper right). Coronal and axial CT with contrast of the chest (below) shows the left kidney to be in the lower left hemithorax. In the operating room, a defect at the foramen of Bochdalek was noted and repaired after the kidney had been reduced into the abdomen.

The diagnosis was intrathoracic kidney due to congenital diaphragmatic hernia.

School ager with abdominal pain after motor vehicle collision

CT of horseshoe kidney — Axial CT with contrast of the abdomen shows the densely enhancing lower poles of the kidneys to be angulated medially (above) and to eventually fuse in the midline (below).

The diagnosis was horseshoe kidney.

School ager with congenital anomaly of the urinary tract

Angiogram of cross fused renal ectopia — AP image from a selective angiogram injection of the left renal artery shows fusion of the medial aspect of the left kidney, which has crossed the midline, to the medial aspect of the right kidney, causing the right kidney to be displaced laterally. A right hemivertebra is also present just above the T10 vertebral body.

The diagnosis was cross fused renal ectopia in a patient with a hemivertebra and vertebral body anomaly.

Teenager with abdominal pain

CT of pelvic kidney — Coronal image (above) from a CT with contrast of the abdomen shows a normal appearing kidney in the left renal fossa and the absence of a kidney in the right renal fossa. An axial image from the same exam (below) shows the right kidney to be located in the pelvis.

The diagnosis was pelvic kidney.

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View the illustrated DDX of abnormalities of renal ascent

Infant with vomiting and abdominal distension

Clinical image of currant jelly stools in intussusception — Clinical image shows currant jelly stools.

The diagnosis was ileocolic intussusception.

Infant with coughing and gagging when feeding

Upper GI of tracheal aspiration — Lateral image from an upper GI shows barium in the trachea anteriorly as well as in the pharynx and esophagus posteriorly.

Ultrapremature newborn with massive abdominal distension who has passed only a little meconium after 4 days

Enema of meconium obstruction of prematurity — AXR AP (above) shows massively dilated loops of bowel throughout the entire abdomen. AXR AP taken at the beginning of an enema performed with water-soluble contrast (lower left) shows meconium filling almost the entire colon. AXR AP taken later in the exam (lower right) shows reflux of contrast into massively dilated loops of small bowel. Several hours after the enema, the patient passed a large amount of meconium and the abdomen became completely decompressed.

Infant with an abdominal mass

MRI of inflammatory myofibroblastic tumor — Coronal T1 MRI without (upper left) and with (upper right) contrast of the abdomen shows a large well circumscribed bi-lobed solid mass that enhances homogeneously in the abdomen and that along with the axial T2 image (below) is shown to not arise from any of the solid organs of the abdomen.

School ager with retching

CXR and upper GI of hiatal hernia — CXR AP shows an air fluid level at the level of the diaphragm. Lateral spot image from an upper GI shows the fundus of the stomach sliding through the esophageal hiatus into the chest.

The diagnosis was hiatal hernia.

Preschooler with a purpuric skin rash and abdominal pain

Small bowel follow through of Henoch-Schonlein purpura — AXR AP (left) and spot image of the terminal ileum (right) from a small bowel follow through show bowel wall fold thickening (thumbprinting) throughout the jejunum and ileum.

The diagnosis was Henoch-Schonlein purpura.

Preschooler with reflux

Upper GI of esophagitis and esophageal stricture from gastroesophageal reflux — Lateral spot image from an upper GI shows multiple small ulcerations in the esophageal mucosa and a fixed tight narrowing of the distal esophagus in the middle of the image which never opened up during the exam. Gastroesohageal reflux was also demonstrated throughout the exam

The diagnosis was a distal esophageal stricture due to esophagitis from gastroesophageal reflux.