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.

Teenager with a liver lesion

Axial and coronal CT with contrast of the abdomen arterial phase imaging (left) shows an enhancing round lesion in the dome of the liver that has a central scar which fills in on the portal venous phase imaging and becomes isodense with the surrounding liver parenchyma (center). Axial T1 MRI with Eovist (hepatocyte specific) contrast of the abdomen in the arterial phase (right upper) again shows the enhancing round lesion with a central scar that fills in the portal venous phase imaging (right center) and then retains its contrast on the delayed phase imaging (right lower).

The diagnosis was focal nodular hyperplasia.

School ager with abdominal pain

AXR of constipation — AXR AP shows a marked amount of stool in the ascending colon that decreases somewhat in the transverse and descending colon but that massively distends the rectum to fill almost the entire pelvis.

The diagnosis was constipation.

Preschooler with abdominal pain

AXR and small bowel follow through of ascariasis — AXR AP (left) shows numerous round soft tissue densities projecting throughout the small bowel centrally located within the abdomen. AXR AP from a small bowel follow through (right) shows numerous linear tubular filling defects within the small bowel.

The diagnosis was ascariasis.

School ager with vomiting when eating

CXR and upper GI of achalasia — CXR PA and lateral (above) shows a dilated esophagus with an air-fluid level within it. AP and lateral images from an upper GI (below) show an extremely dilated esophagus with fluid-fluid level within it that terminates in a beak at the gastroesophageal junction.

The diagnosis was achalasia.

Teenager with abdominal pain and vomiting with a narrowed terminal ileum

Gross pathological image of Chron's disease — Gross pathological image of the terminal ileum shows markedly thickened intestinal wall and adherent pericolonic fat (“fat-wrapping”).

The diagnosis was Crohn disease.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of gastrointestinal polyps

Teenager with bloody diarrhea

Enema of pseudopolyps in ulcerative colitis — AP AXR (left) and magnified AP spot image of the splenic flexure (right) from a double contrast barium enema shows a large number of small polypoid lesions throughout the colon with the space between the polyps appearing to be denuded and ulcerated.

The diagnosis was pseduopolyps in a patient with ulcerative colitis.

Teenager with abnormal pigmentation around the mouth

Small bowel follow through of Peutz-Jeghers syndrome — AP (left) and lateral (right) spot images from an upper GI show several round filling defects in the proximal jejunum, the most notable being in the left-most aspect of the AP image.

The diagnosis was a hamartomatous polyp in a patient with Peutz-Jeghers syndrome.

School ager with rectal bleeding

Small bowel follow through of juvenile polyp — Spot image of the jejunum from a small bowel follow through shows a polypoid filling defect in the center of the bowel lumen whose stalk attaches to the bowel mucosa.

The diagnosis was juvenile polyp.

Teenager with rectal bleeding

Enema of familial adenomatous polyposis — AP spot image of the hepatic flexure of the colon from a double contrast barium enema shows contrast coating multiple polypoid lesions which arise from the mucosal surface of the colon and extend into the colonic lumen.

The diagnosis was adenomatous polyps in a patient with familial adenomatous polyposis.

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View the illustrated DDX of gastrointestinal polyps

Newborn with vomiting and a palpable abdominal mass

Surgical image of duodenal duplication — Surgical image shows a cystic mass attached to the inner surface of the C-loop of the duodenum from just distal to the pylorus to slightly proximal to the region of the ampulla of Vater. The distal antrum is visible in the upper left corner of the incision and the gall bladder is visible in the right corner of the incision between the liver and the mass.

The diagnosis was duodenal duplication.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of inflammatory bowel disease

Teenager with abdominal pain

BE of ulcerative colitis — AXR AP from a barium enema (left) shows the loss of haustral markings in the colon (lead pipe sign). The magnified view (right) suggests the presence of multiple fine mucosal ulcerations.

The diagnosis was ulcerative colitis.

Teenager with abdominal pain

BE of ulcerative colitis — AP spot image of the rectosigmoid colon from a barium enema shows multiple fine mucosal ulcerations.

The diagnosis was ulcerative colitis.

Teenager with poorly controlled inflammatory bowel disease

CT of Crohn's disease with fistula and abscess — Axial CT with contrast of the abdomen shows a thick-walled mass that is filled with air and oral contrast that is located medial to the oral contrast-filled thickened ascending colon and above the right psoas muscle. An extensive amount of inflammatory change is seen in the mesenteric fat in the right lower quadrant.

The diagnosis was Crohn disease with a fistula to an abscess above the right psoas muscle.

Teenager with abdominal pain

Small bowel follow through of Crohn's disease — AXR AP from a small bowel follow through shows bowel fold thickening in the proximal ileum in the left lower quadrant and bowel lumenal narrowing in the mid ileum in the midline that continues to the terminal ileum in the right lower quadrant.

The diagnosis was Crohn disease.

Our DDX For This Week Is

View the illustrated DDX of inflammatory bowel disease

Newborn with failure to pass a nasogastric tube

Pathologic image of esophageal atresia — Pathological image taken from the posterior aspect of the specimen shows a dilated proximal esophageal pouch superiorly that abruptly transitions to a more narrow in diameter distal esophageal segment.

The diagnosis was esophageal atresia.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of gastrointestinal complications of bone marrow transplantation

School ager with acute lymphblastic leukemia and abdominal pain

US of typhlitis — Transverse (above) and sagittal (below) US of the cecum show marked thickening of the wall of the cecum which is lying above the right psoas muscle.

The diagnosis was typhlitis in a patient with acute lymphocytic leukemia.