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.

Teenager with abdominal pain and hematuria

US and CT of nutcracker syndrome — Transverse US of the abdomen (above) shows just to the left of midline compression of the left renal vein beween the superior mesenteric artery and aorta resulting in dilation of the proximal left renal vein. Axial CT with contrast of the abdomen (below) shows this more clearly.

The diagnosis was nutcracker syndrome.

Teenager from Africa with a positive Quantiferon test

CXR and CT of pulmonary tuberculosis — CXR PA and lateral (above) shows prominence of the superior mediastinum and left hilum. Axial CT with contrast of the chest (below) shows extensive left hilar and subcarinal lymphadenopathy.

The diagnosis was tuberculosis pneumonia.

School ager with respiratory distress

CXR and CT of prominent thymus — CXR AP (above) shows an abnormal soft tissue density to the left of the spine in the left suprahilar region. Axial CT with contrast of the chest (below) shows in the anterior mediastinum an enlarged thymus which is homogenous in appearance and without any focal lesions.

The diagnosis was prominent thymus.

Teenager with trauma to the knee 1 month ago who is now developing new symptoms of knee pain with knee movement

Radiograph of myositis ossificans — AP (left) and lateral (right) radiographs of the knee show an area of diffuse calcification in the muscles anterior and medial to the distal femur.

The diagnosis was myositis ossificans.

Female preschooler with pelvic pain

CT of ovarian teratoma causing ovarian torsion. — Axial (above left), sagittal (above right) and coronal (below) CT without contrast of the abdomen show a large thick walled, fluid-filled, unilocular mass just above and to the right of the bladder which contains focal areas of fat density material and calcific density material. There is a small amount of ascites.

The diagnosis was ovarian teratoma causing ovarian torsion.

Newborn with difficulty feeding

Upper GI of congenital esophageal stenosis — CXR (left) shows a dilated air-filled structure just to the right of the spine. AP (middle) and lateral (right) images from an upper GI exam show two fixed focal areas of narrowing in the distal esophagus causing dilation of the esophagus proximal to those areas of narrowing.

The diagnosis was congenital esophageal stenosis.

Teenager with respiratory distress and blood coming from the endotracheal tube

CXR and CT of pulmonary hemorrhage — CXR AP (above) shows bilateral diffuse asymmetrical airspace opacities which are more confluent in the right lung. There is a moderate in size right pleural effusion. Coronal CT with contrast of the chest (below) also shows right lower lobe atelectasis caused by the pleural effusion.

The diagnosis was pulmonary hemorrhage.

Teenager with chronic neurologic impairment who has fever and constipation

CT of stercoral colitis — Axial CT with contrast of the abdomen (above) shows marked diffuse wall thickening and mucosal enhancement of the transverse colon. Wall thickening and mucosal enhancement is also present but less pronounced in the descending colon on the coronal CT (below left) and rectum (below right). The colon is filled with a marked amount of stool from the cecum to the rectum.

The diagnosis was a marked amount of chronic constipation resulting in stercoral colitis.

Teenager with a malignant bone tumor who has headaches and vomiting

CT of brain metastasis from osteosarcoma — Axial CT without contrast of the brain shows a large dense lesion in the posterior aspect of the right cerebral hemisphere which has high density calcification along its most posterior aspect. The lesion is surrounded by low density vasogenic edema.

The diagnosis was brain metastasis in a patient with osteosarcoma.

Toddler with lethargy

MRI of atypical teratoid rhabdoid tumor — Sagittal T1 MRI without contrast of the brain (above left) shows a large, isointense, heterogenous but primarily solid mass arising in the region of the pineal gland. On axial T2 MRI without contrast (above right) the mass is also isointense but has some cysts within it. Axial DWI MRI (below left) shows diffusion restriction in the mass while axial T1 MRI with contrast (below right) shows heterogenous enhancement of the mass.

The diagnosis was atypical teratoid rhabdoid tumor.

Infant with respiratory distress

CXR and specimen radiograph of mesenchymal hamartoma of the chest wall — CXR AP and lateral (above) show a cystic expansile lesion arising from the posterior aspect of the right 8th rib causing distortion of the adjacent bony thorax. Specimen radiograph (below) shows the partially calcified soft-tissue mass arising from the rib.

The diagnosis was mesenchymal hamartoma of the chest wall.

School ager with neurofibromatosis Type I and hypertension

US and angiogram of bilateral renal artery stenosis due to midaortic syndrome in a patient with Neurofibromatosis Type I — Spectral doppler US of the kidneys (above) shows tardus parvus waveforms in the renal arteries bilaterally. AP image from an abdominal angiogram (below) shows bilateral stenosis of the renal arteries at their origins and progressive narrowing of the mid abdominal aorta centered near the renal artery origins with sparing of the aortic bifurcation.

The diagnosis was bilateral renal artery stenosis due to midaortic syndrome in a patient with Neurofibromatosis Type I.

Preschooler with recurrent episodes of respiratory distress over several years

CXR of chronic granulomatous disease — Initial CXR AP (above) shows an opacity in the medial aspect of the right lower lobe which took a year to resolve radiographically. CXR AP obtained 2 years after the initial CXR (below left) shows a dense opacity in the medial aspect of the right upper lobe which was only slightly reduced in size on a CXR obtained a year later (below right).

The diagnosis was chronic granulomatous disease.

School ager with respiratory distress

CXR of pulmonary alveolar proteinosis — CXR AP shows bilateral diffuse and symmetrical interstitial infiltrates which are miliary in appearance.

The diagnosis was pulmonary alveolar proteinosis.

Preschooler with chronic respiratory distress and a long-standing abnormal CXR

CXR and CT of chronic airway foreign body in the form of a mucous plug — CXR AP and lateral (above) show an opacity in the left upper lobe that was stable over several months. Coronal CT with contrast of the chest (below) shows complete atelectasis of the left upper lobe. There is a soft tissue density present in the lumen of the left mainstem bronchus interrupting the continuity of the left mainstem bronchus. At bronchoscopy this was found to be a very thick mucous plug.

The diagnosis was chronic airway foreign body due to an impacted mucous plug.

Toddler who was seen to swallow something

AXR of gastrointestinal foreign body in the form of ingested rare earth magnets — AXR AP shows 13 small round radiopaque objects that are joined together in a chain.

The diagnosis was gastrointestinal foreign body in the form of a chain of rare earth magnets.

Teenager with syncope

CT of supratentorial astrocytoma — Axial CT without contrast of the brain shows a low density mass in the region of the pineal gland and left thalamus that has a punctate area of high density within it representing either calcification or hemorrhage. The mass is having mass effect on the third ventricle resulting in obstructive hydrocephalus and transependymal flow of cerebrospinal fluid.

The diagnosis was supratentorial astrocytoma.

School ager with abnormal appearing forearms

Radiograph of Madelung deformity — AP radiograph of the left forearm (left) shows shortening and bowing of the radius and positive ulnar variance. AP radiograph of the right forearm (right) shows shortening and bowing of the radius and negative ulnar variance.

The diagnosis was bilateral Madelung deformity.

Preschooler with abdominal pain

CT and ultrasound of a simple renal cyst — Axial (above left) and coronal (above right) CT with contrast of the abdomen show a round low density lesion in the upper pole of the right kidney. Sagittal US of the right kidney (below) shows an anechoic lesion in the upper pole of the right kidney that has a thin wall and no internal septations or calcifications.

The diagnosis was simple renal cyst.

School ager with respiratory distress which has not responded to medical therapy

CXR of carcinoid tumor of the chest — CXR AP and lateral show a dense consolidation in the right middle lobe.

The diagnosis was carcinoid tumor of the lung.

Teenager with chest pain

CT of spontaneous pneumothorax due to apical bleb — Axial CT with contrast of the chest at presentation (above) shows a large amount of air in the right pleural space which was subsequently treated with a chest tube. Coronal CT without contrast of the chest performed 1 week after presentation and after chest tube removal (below) shows a small bleb in the apex of the right lung.

The diagnosis was spontaneous pneumothorax due to an apical bleb.