School ager with left hip pain

Radiograph of ischiopubic synchondrosis asymmetry — Pelvic radiograph shows asymmetric enlargement of the left ischiopubic synchondrosis.

The diagnosis was ischiopubic synchondrosis asymmetry.

Infant with head trauma after motor vehicle accident

CT of atypical teratoid rhabdoid tumor — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the brain show an oval high density solid mass centered in the region of the pineal gland.

The diagnosis was atypical teratoid rhabdoid tumor.

School ager with sickle cell disease and abdominal pain

US of gangrenous cholecystitis — Sagittal (left) and transverse (right) US of the gallbladder show the gallbladder to be filled with sludge and debris. The gallbladder wall is thickened and in one area was felt to be discontinuous. There were multiple gall stones present in the common bile duct (not pictured).

The diagnosis was gangrenous cholecystitis due to choledocholithiasis in a patient with sickle cell disease.

Preschooler whose brother fell on her arm while playing on a trampoline

Radiograph of supracondylar elbow fracture. — Lateral radiograph of the elbow shows a transverse lucent line above the condyles of the distal humerus. There is elevation of the posterior fat pad.

The diagnosis was supracondylar elbow fracture.

Preschooler with leukemia who is febrile

CXR of bacterial pneumonia in right upper lobe — CXR PA (left) shows a triangular dense opacity in the lateral aspect of the right upper lobe that on the CXR lateral (right) is seen to be posterior in location.

The diagnosis was bacterial pneumonia in the posterior segment of the right upper lobe.

Teenager with cough and fever

CXR of bacterial pneumonia in the lingula — CXR AP (left) shows dense opacity in the lower left lung that is obscuring the left heart border and causing a silhouette sign. CXR lateral (right) shows a dense triangular opacity anterior over the heart.

The diagnosis was bacterial pneumonia in the lingula.

School ager with hematuria who has lymphoma and is being treated with cyclophosphamide

CT of cyclophosphamide induced cystitis with a large blood clot in the bladder — Axial CT with contrast of the pelvis (above) shows mild thickening of the wall of the bladder which has a large oval mass within it that has a whorled appearance. Transverse US of the bladder (below) shows a large round echogenic lesion with a whorled appearance located posteriorly in the bladder.

The diagnosis was cyclophosphamide induced cystitis with a large blood clot in the bladder.

School ager with end stage renal disease

Radiograph of secondary hyperparathyroidism with a brown tumor of the fifth metacarpal — AP radiograph of the hand shows a lytic lesion in the fifth metacarpal with coarsening of the trabeculae and periosteal reaction along the radial aspect of the middle phalanges.

The diagnosis was secondary hyperparathyroidism with a brown tumor of the fifth metacarpal.

Toddler with a hair tuft at the cranial vertex

MRI of atretic cephalocele — Sagittal T2 MRI of the brain shows in the subcutaneous tissue at the vertex of the skull a subgaleal lipomatous and cystic lesion in close approximation to a persistent falcine sinus.

The diagnosis was atretic cephalocele.

School ager with abdominal pain

Radiograph of pneumatosis intestinalis of the colon — Initial AXR (left) shows linear appearing air throughout the wall of the ascending colon. AXR obtained 4 hours later (middle) shows cystic as well as linear appearing air throughout the wall of the ascending colon. AXR obtained 12 hours later (right) again shows cystic as well as linear appearing air throughout the wall of the ascending colon.

The diagnosis was pneumatosis intestinalis of the colon.

School ager with elbow pain after fall on to outstretched hand

Radiograph of supracondylar elbow fracture — AP radiograph of the elbow (left) shows a transverse lucent line in the distal humerus above the condyles. Lateral radiograph of the elbow (right) shows marked elevation of the anterior and posterior fat pads.

The diagnosis was supracondylar elbow fracture.

School ager with cough and fever

CXR of bacterial pneumonia in the lingula — CXR AP (left) shows dense opacity in the lower left lung that is obscuring the left heart border and causes a silhouette sign. CXR lateral (right) shows a dense oval opacity anterior over the heart.

The diagnosis was bacterial pneumonia in the lingula.

School ager after feeding tube placement

CXR of feeding tube tip in the left mainstem bronchus — CXR AP shows the tip of the feeding tube projecting over the left mainstem bronchus.

The diagnosis was feeding tube malfunction in the form of the tip of the feeding tube being in the left mainstem bronchus.

School ager with difficulty voiding

Retrograde urethrogram of Cowper duct syringocele and stricture of the membranous urethra — Lateral image from a retrograde urethrogram exam shows a short tubular tract filled with contrast inferior to the contrast filled urethra. There is also a persistent long narrowing in the membranous urethra.

The diagnosis was Cowper duct syringocele in a patient with a stricture of the membranous urethra.

School ager with a bleeding diathesis with pain and swelling of the lower extremities

MRI of hemophilia with hemorrhage in the calfs — Axial T2 fat sat (above) and axial GRE (below) MRI of the lower extremities shows symmetric bilateral increased T2 signal and gradient echo blooming primarily in the superficial and posterior deep compartments bilaterally.

The diagnosis was hemophilia with hemorrhage in the calfs.

School ager with Trisomy 21 being cleared for general anesthesia

Radiograph of atlanto occipital instability — Lateral flexion view of the cervical spine (left) shows a normal relationship of the occipital condyles to the articular facets of the atlas. The atlanto dental interval is also normal. Lateral extension view of the cervical spine (right) shows posterior displacement of the occipital condyles in relation to the articular facets of the atlas. There is posterior positioning of Wackenheim line and retrolisthesis of the C3 on C4 vertebral body. The atlanto dental interval remains normal.

The diagnosis was atlanto occipital instability in a patient with Trisomy 21.

Toddler with hemophagocytic lymphohistiocytosis with abdominal pain

AXR of pneumatosis intestinalis of the colon — AXR AP shows serpiginous lucencies in the abdomen representing a marked amount of curvilinear appearing air in the wall of the ascending and transverse colon.

The diagnosis was pneumatosis intestinalis of the colon.

Teenager who fell on to their elbow

Radiograph of elbow fracture of the radial head — Lateral radiograph of the elbow (left) shows elevation of the anterior and posterior fat pads of the elbow. Oblique radiograph of the elbow (right) shows a lucent line through the radial head.

The diagnosis was elbow fracture of the radial head.

Premature newborn with respiratory distress

CXR of asymmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome — Initial CXR AP (left) shows the lungs to be bilaterally hypoexpanded and to have symmetrical ground glass opacity present throughout them. CXR AP obtained 4 hours after the administration of artificial surfactant (right) shows interval clearing of ground glass opacity from the right lung which is now normally expanded. The left lung remains hypoexpanded and has ground glass opacity throughout it.

The diagnosis was asymmetrical distribution of artificial surfactant into primarily the right lung in a patient with respiratory distress syndrome.

Infant after nasogastric tube placement

CXR of nasogastric tube in the right mainstem bronchus in a patient with bronchopulmonary dysplasia — CXR AP shows the tip of the nasogastric tube to project over the right lower lobe. The lungs are hyperexpanded bilaterally with emphysematous blebs and interstitial scarring

The diagnosis was nasogastric tube malfunction in the form of the tip of the nasogastric tube going down the right mainstem bronchus into the right lower lobe in a patient with bronchopulmonary dysplasia.

Toddler with a urinary tract infection

US of congenital megaureter — Sagittal US of the left kidney (above) and left ureteropelvic junction (below) show moderate hydroureteronephrosis. There was moderate hydroureter all the way to the ureterovesical junction. A subsequent voiding cystourethrogram showed no evidence of vesicoureteral reflux.

The diagnosis was congenital megaureter.

School ager with an abdominal wall mass after blunt trauma to the anterior abdominal wall

MRI of intramuscular hematoma associated with a lymphatic malformation of the anterior abdominal wall — Axial T1 without contrast (above), T2 (middle) and T2 with fat saturation (below) MRI of the abdomen shows an oval heterogenous fluid collection of layering mixed fluid intensities centered in the right anterior abdominal wall muscle and surrounded by muscle tissue.

The diagnosis was intramuscular hematoma associated with a lymphatic malformation of the anterior abdominal wall.

Teenager after motor vehicle accident

CT of Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation — Midline sagittal CT without contrast of the cervical spine (middle) shows a transverse comminuted fragmented fracture through the C2 vertebral body. There is anterior displacement of the C1 vertebral body resulting in compromise of the spinal canal. There is massive thickening of the retropharyngeal soft tissues due to a retropharyngeal hematoma. The basion-dens interval is abnormally increased. The off midline sagittal CTs (left and right) show distraction between the occipital condyles bilaterally and the C1 articular facets.

The diagnosis was a Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation.

Infant with cystic fibrosis and abdominal pain

Radiograph of pneumatosis intestinalis — AXR AP (above) shows bubbly appearing air in the walls of the ascending colon, transverse colon, descending colon and sigmoid colon. There is also linear appearing air in the walls of the descending colon and sigmoid colon. Left lateral decubitus radiograph of the abdomen (below) shows no evidence of free air.

The diagnosis was pneumatosis intestinalis of the colon.

School ager who fell on an outstretched hand

Radiograph of elbow fracture of the proximal ulna — Lateral radiograph of the elbow shows elevation of the anterior fat pad. There are multiple parallel linear lucent lines through the proximal ulna.

The diagnosis was elbow fracture of the proximal ulna.