Newborn with an anterior abdominal wall defect

Clinical image of Pentalogy of Cantrell — Clinical image shows the umbilical cord entering an omphalocele sac. The apex of the heart can be seen under the superior portion of the sac. The upper portion of the heart is covered by skin but the sternum is split.

The diagnosis was Pentalogy of Cantrell.

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Newborn with respiratory distress

CXR of esophageal intubation — CXR AP (above) shows the endotracheal tube tip projecting over the left side of the spine and a distended stomach. CXR AP (below) after re-intubation shows the endotracheal tube tip projecting over the right side of the spine and a nasogastric tube projecting over the left side of the spine in the position of the formerly placed endotracheal tube.

The diagnosis was esophageal intubation.

Premature newborn who has just been intubated

CXR of endotracheal tube in the esophagus in a patient with respiratory distress syndrome — CXR AP shows an endotracheal tube with its tip projecting beneath the carina and not over either mainstem bronchus and a distended stomach. There are diffuse ground glass opacities present throughout the lungs. CXR lateral shows the endotracheal tube to be posterior to the trachea and in the esophagus.

The diagnosis was esophageal intubation along with respiratory distress syndrome.

Infant who has just been intubated

CXR of esophageal intubation — CXR AP (above) shows nasogastric tube with its tip within a distended stomach. An endotracheal tube is present to the right of the nasogastric tube and is projecting over an air-distended esophagus. There is near-complete atelectasis of the right lung. CXR AP (below) after reintubation now shows the endotracheal tube to the left of the nasogastric tube and interval resolution of the esophageal and gastric distension.

The diagnosis was esophageal intubation causing massive distension of the esophagus and stomach.

Premature newborn with worsening respiratory distress after intubation

CXR of endotracheal tube in the right mainstem bronchus and pneumothorax in a patient with respiratory distress syndrome — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. There is diffuse lucency in the right hemithorax which is also surrounding the right upper lobe.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus causing a right pneumothorax along with respiratory distress syndrome.

Premature newborn with respiratory distress

CXR of endotracheal tube in the right mainstem bronchus in a patient with respiratory distress syndrome — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the right upper lobe with no mediastinal shift. There are diffuse ground glass opacities present throughout the lungs.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus along with respiratory distress syndrome.

Preschooler in status epilecticus who is difficult to ventilate during transport

CXR of endotracheal tube in the esophagus — CXR AP shows an endotracheal tube with its tip projecting over the left side of the spine with its tip beneath the carina. There is complete atelectasis of the left lung with mediastinal shift to the left. The stomach is massively distended with air.

The diagnosis was esophageal intubation causing massive gastric distension.

Infant with respiratory distress after begin re-intubated

CXR of endotracheal tube in the right mainstem bronchus and after it is pulled back — CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position just above the carina with subsequent near-complete re-expansion of the left lung.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

Newborn with respiratory distress

CXR of endotracheal tube in the right mainstem bronchus and after it is pulled back — CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with mediastinal shift to the left. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position between the clavicles and the carina with subsequent complete re-expansion of the left lung.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

Infant after being re-intubated

CXR of endotracheal tube in right mainstem bronchus — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe but no mediastinal shift.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

School ager with altered mental status requiring intubation

CXR of an endotracheal tube in the right mainstem bronchus — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe and mediastinal shift to the left.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

Newborn with meconium beneath the vocal cords noted during intubation

CXR of a highly positioned endotracheal tube in a patient with meconium aspiration syndrome — CXR AP shows the tip of the endotracheal tube to be above the thoracic inlet. The lungs are hyperinflated and there are coarse interstitial infiltrates bilaterally.

The diagnosis was an endotracheal tube positioned too high along with meconium aspiration syndrome.

Premature newborn with respiratory distress

CXR of correctly positioned endotracheal tube in a patient with respiratory distress syndrome — CXR AP shows the tip of the endotracheal tube to be between the clavicles and carina. The lungs are hypoinflated and there are symmetrical ground glass opacities present bilaterally.

The diagnosis was an endotracheal tube in appropriate position along with respiratory distress syndrome.

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View the illustrated DDX of endotracheal tube malfunction

Newborn with an anterior abdominal wall defect diagnosed on prenatal US

Clinical image of omphalocele — Clinical image shows a large sac containing liver and other viscera with the umbilical cord originating from the sac.

The diagnosis was omphalocele.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of anterior abdominal wall defects

Newborn with a defect of the lower abdominal wall

AXR of cloacal exstrophy — AXR AP shows diastasis of the symphysis pubis and multiple spinal segmentation defects while the AXR lateral shows a small amount of bowel herniated anterior to the abdomen and inferior to the umbilicus along with a large skin covered spinal dysraphism posteriorly and a radioopaque marker being held in place over where the anus should be.

The diagnosis was cloacal exstrophy with bladder exstrophy, anorectal malformation and spinal segmentation anomalies.

Newborn with a defect of the lower abdominal wall

AXR of bladder exstrophy — AXR shows diastasis of the symphisis pubis.

The diagnosis was bladder exstrophy.

Newborn with a midline defect including a split anterior half of the sternum, a thoracoabdominal ectopic cordis, and an omphalocele

CXR of Pentalogy of Cantrell — CXR and AXR shows the cardiac margin to be absent below the level of the diaphragm. The left lung is hyperlucent compared to the right. There is a paucity of bowel gas within the abdomen and centralization of bowel loops

The diagnosis was Pentalogy of Cantrell and ascites.

Newborn with an anterior abdominal wall defect diagnosed on prenatal US

AXR of omphalocele — Lateral AXR shows multiple loops of bowel encased within a sac outside of the abdomen. The abdominal cavity is small.

The diagnosis was omphalocele.

Newborn with an anterior abdominal wall defect diagnosed on prenatal US

CXR of gastroschisis — CXR shows multiple loops of bowel without an encasing sac wrapped in gauze outside of the abdomen to the right side of the patient. The abdominal cavity is small.

The diagnosis was gastroschisis.

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View the illustrated DDX of anterior abdominal wall defects

Newborn with an anterior abdominal wall defect on prenatal ultrasound

Surgical image of gastroschisis — Surgical image shows the abdominal wall defect with stomach and small bowel protruding out of the abdomen, with no surrounding membranous sac.

The diagnosis was gastroschisis.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of feeding tube malfunction