Newborn with an anterior abdominal wall defect

Clinical image of bladder exstrophy — Clinical image shows the anterior abdominal wall is not fused inferiorly and that the bladder is not fused anteriorly and is everted and extending through the anterior abdominal wall defect.

The diagnosis was bladder exstrophy.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Infant with drainage of urine through the umbilicus

VCUG of patent urachus and urachal diverticulum — Lateral image from a voiding cystourethrogram performed by catheterizing the site of urine drainage at the patient’s umbilicus shows contrast filling the bladder and urethra as well as a large diverticulum at the dome of the bladder that nearly extends to the patient’s anterior abdominal wall.

The diagnosis was patent urachus and a urachal diverticulum.

Toddler with drainage of stool from the umbilicus

Meckel’s scan of Meckel's diverticulum — AP delayed image (left) from a Tc-99m pertechnetate scan (Meckel’s scan) shows a focal round concentration of radiotracer in the right lower quadrant superior and lateral to the midline bladder which is seen in the middle of the lower abdomen superior to the bladder on the lateral (right) delayed image.

The diagnosis was Meckel’s diverticulum with a patent omphalomesenteric duct.

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Teenager with bloody diarrhea

Pathological image of colonic pseudopolyps in ulcerative colitis — Pathological image of the colon shows colonic pseudopolyps.

The diagnosis was ulcerative colitis.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Teenager with left scrotal mass

US of varicocele — Sagittal greyscale US of the left scrotum (upper left) shows a serpiginous appearing mass in the superior aspect of the scrotum which during a Valsalva maneuver (upper right) increases in size. Sagittal color US of the left scrotum (lower left) shows the mass to be composed of blood vessels that have increasing venous flow seen through them during a Valsalva maneuver (lower right).

The diagnosis was varicocele.

Teenager with a palpable left scrotal mass

US of embryonal cell testicle tumor — Transverse US of the scrotum (above) shows a focal hypoechoic lesion along the medial border of the left testicle which on the sagittal US of the left testicle (below) appears to have an echogenic posterior aspect, representing calcification.

The diagnosis was embryonal cell testicle tumor.

Male infant with a mass in the right groin

US of spermatic cord hydrocele — Sagittal US of the right inguinal canal and scrotum shows an oval anechoic fluid collection in the inguinal canal that did not communicate with the peritoneum (to the left) and a small amount of anechoic fluid around the right testicle.

The diagnosis was an encysted hydrocele of the spermatic cord and a small hydrocele of the right scrotum.

Infant with a swollen left scrotum

US of bilateral hydroceles — Transverse (above) and sagittal (below) US of the scrotum shows a small amount of anechoic simple fluid around the right testicle and a large amount of anechoic simple fluid around the left testicle.

The diagnosis was bilateral hydroceles, left greater than right.

Infant with bilateral scrotal masses

AXR of bilateral inguinal hernias — AXR AP shows large air-filled loops of bowel within the scrotum bilaterally.

The diagnosis was bilateral inguinal hernias.

Teenager with left cryptorchidism

CT of intraabdominal testicle — Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows an oval isodense soft tissue mass located inferior and lateral to the left kidney.

The diagnosis was left undescended testicle in an infrarenal location.

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School ager with appendectomy 3 months ago, now with abdominal pain and vomiting

Surgical image of small bowel obstruction due to abdominal adhesions — Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.

The diagnosis was small bowel obstruction due to abdominal adhesions.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Infant with bilateral prenatal hydronephrosis

US of ureteropelvic junction obstruction — Sagittal US of the right kidney (upper left) and left kidney (upper right) shows bilateral mild to moderate hydronephrosis. AP image from the excretory phase of an intravenous pyelogram shows bilateral moderately dilated renal collecting systems with normal appearing bilateral ureters.

The diagnosis was bilateral ureteropelvic junction obstruction.

Preschooler with an abdominal mass

MRI of multilocular cystic nephroma — Sagittal US of the left kidney (above) shows a multicystic renal mass involving most of the left kidney. Coronal (lower left) and axial (lower right) T1 MRI with contrast of the abdomen shows the left renal mass to contain multiple thin septations and to have no solid component.

The diagnosis was multilocular cystic nephroma.

Preschooler referred with “stomach cysts”

US of multicystic dysplastic kidney — Sagittal US of the right kidney (above) shows it to contain multiple cysts, of varying size, that do not communicate and there is a paucity of renal parenchyma. Sagittal US of the left kidney (below) shows it to be normal.

The diagnosis was right multicystic dysplastic kidney.

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School ager who fell off his bike and has abdominal pain

Surgical image of small bowel perforation — Surgical image shows an ileal perforation with the forceps placed through the perforation.

The diagnosis was small bowel perforation secondary to bowel trauma

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Toddler with presumed urinary tract infection

MRI of Wilms tumor — Sagittal US of the left kidney (upper left) shows a round hyperechoic lesion in the lower pole of the kidney. Axial T2 MRI without contrast of the abdomen (upper right) and coronal T1 MRI without (lower left) and with (lower right) contrast of the abdomen shows a well-circumscribed, solid T1 hypointense and T2 isointense mass in the lower pole of the left kidney that enhances minimally.

The diagnosis was Wilms tumor of the left kidney.

Toddler with a fever

US of acute pyelonephritis / acute lobar nephronia — Sagittal US of the right kidney (above) shows an ill-defined hypoechoic mass in the right upper pole that is obscuring the normal outline of the echogenic fat in the renal hilum. The mass was hypoperfused on color and power doppler US. AP image from a voiding cystourethrogram (below) shows bilateral vesicoureteral reflux, grade II on the left and grade III on the right

The diagnosis was acute pyelonephritis in a patient with vesicoureteral reflux.

School ager with bilateral abdominal masses

CT of Burkitt lymphoma of kidney — Coronal T1 MRI without contrast of the abdomen (upper left) shows bilateral enlarged kidneys which after the administration of contrast (upper right) is seen to be due to multiple non-enhancing renal masses. Transverse US of the liver (below) shows a round hypoechoic mass in the liver, superior and to the left of the gall bladder.

The diagnosis was Burkitt lymphoma with renal and liver involvement.