Newborn with a cystic lesion in the posterior neck

Clinical image of occipital myelomeningocele — Clinical image shows an overt, non-skin covered spinal dysraphism.

The diagnosis was occipital myelomeningocele.

Preschooler with a cystic lesion in the chest and a positive Casoni skin test

Pathology image of hydatid disease — Gross pathological images show a large cystic structure without internal septations.

The diagnosis was hydatid disease.

Premature newborn with respiratory distress

Pathology image of respiratory distress syndrome — Post-mortem gross pathological image shows bilaterally small hypoplastic lungs.

The diagnosis was respiratory distress syndrome.

Newborn with abnormal facies

Clinical image of holoprosencephaly — Post-mortem clinical image shows hypotelorism, a single nostril, and a cleft lip.

The diagnosis was alobar holoprosencephaly.

Infant with a red lesion near the mouth

Clinical image of soft tissue hemangioma — Clinical image shows a large, raised, red, coarse lesion involving the lower left lip and associated perioral soft tissues.

The diagnosis was soft tissue hemangioma.

Infant with recurrent vomiting with feeds

Endoscopy images of esophagitis due to gastroesophageal reflux — Endoscopic images show the inflammation and ulceration of esophagitis throughout the esophagus.

The diagnosis was esophagitis due to gastroesophageal reflux.

Preschooler with stridor, sore throat, drooling and fever

Clinical image of epiglottitis — Clinical image shows a toxic appearing child who is drooling whose head is tilted forward to keep airway open.

The diagnosis was epiglottitis.

Preschooler with stridor, sore throat, drooling and fever

Endoscopy image of epiglottitis — Endoscopic image shows an endotracheal tube in the center of the image and enlarged cherry-red aryepiglottic folds lateral to it.

The diagnosis was epiglottitis.

Preschooler with stridor, sore throat, drooling and fever

Endoscopy image of epiglottitis — Endoscopic image shows an enlarged, cherry-red epiglottis in the center of the image and enlarged aryepiglottic folds lateral to it.

The diagnosis was epiglottitis.

Preschooler with stridor, sore throat, drooling and fever

Pathology image of epiglottitis — Post-mortem pathological image shows a swollen epiglottis in the center of the specimen and thickened aryepiglottic folds lateral to it.

The diagnosis was epiglottitis.

Newborn with abnormal prenatal cardiac ultrasound

CXR and CT of main pulmonary arterial aneurysm due to absent pulmonary valve syndrome — CXR AP (above) shows an abnormal and prominent contour to the left superior mediastinum. The right superior mediastinum contour represents the thymus. Coronal CT with contrast of the chest (below) shows aneurysmal dilation of the main pulmonary artery. The pulmonary valve was absent.

The diagnosis was main pulmonary arterial aneurysm due to absent pulmonary valve syndrome.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of esophageal pH probe malfunction.

Our DDX For This Week Is

View the illustrated DDX of esophageal pH probe malfunction.

School ager with seizures

MRI and CT of arrested pneumatization of the skull base — Axial T1 MRI without contrast of the brain (above left) shows an isointense signal intensity lesion in the right sphenoid bone that on T2 MRI (above right) shows a high signal intensity and which did not show enhancement post contrast. The remaining paranasal sinuses are clear. Coronal CT without contrast of the maxillofacial bones (below) shows the right sphenoid bone to be filled with a lucent non-expansile and non-destructive lesion.

The diagnosis was arrested pneumatization of the skull base.

Preschooler with short stature

AXR of congenital hypothyroidism — AXR AP shows bilateral absence of the femoral ossification centers.

The diagnosis was delayed skeletal maturation due to congenital hypothyroidism.

Preschooler with a cystic structure in the right kidney

CT of simple renal cyst — Coronal (left) and axial (above right) images from a CT with contrast of the abdomen obtained soon after the injection of contrast (nephrographic phase) show a claw sign in the right kidney encasing a large round low density lesion in the lower pole of the right kidney. The Hounsfield unit of the cystic lesion was that of water. Axial delayed image (excretory phase) from the same exam (below right) shows no contrast in the cystic structure.

The diagnosis was a simple renal cyst and not a calyceal diverticulum.

Teenager with symptoms of gastroesophageal reflux

CXR of correct position of the esophageal pH probe sensor / measurement lead — CXR AP shows an esophageal pH probe. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque stripe in the center of it) is 3-5 cm above the gastroesophageal junction.

School ager with shortness of breath

CXR and CT of lymphangioleiomyomatosis — CXR PA (above left) shows large bilateral pleural effusions. Axial CT with contrast of the chest (above right) shows the pleural effusions to be septated. The lung parenchyma (middle) was normal while the bones (below) had multiple cystic bone lesions in the right scapula, vertebral bodies and bilateral ribs.

The diagnosis was lymphangioleiomyomatosis with bilateral chylous effusions.

Teenager with black and blue subcutaneous nodules and chronic GI bleeding

Tagged red blood cell nuclear medicine scan and angiogram of blue rubber bleb nevus syndrome — Nuclear medicine tagged red blood cell scan for GI bleeding shows AP and lateral images of the abdomen obtained immediately after the beginning of the exam (above top row) and 4 hours later (above bottom row). The images show immediate pooling of radiotracer in multiple discrete areas in the abdomen and pelvis with continued radiotracer accumulation in these areas over time. Arterial phase image from a superior mesenteric artery angiogram (below left) shows normal arterial vessels, while the venous phase (below right) shows contrast puddling in rounded spaces that filled in over time in the small bowel and ascending colon that were consistent with venous malformations.

The diagnosis was blue rubber bleb nevus syndrome.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of cardiac pacemaker lead malfunction.

Our DDX For This Week Is

View the illustrated DDX of cardiac pacemaker lead malfunction.

Preschooler after cardiac arrest

CT and CT angiogram of giant intracranial aneursym — Axial CT without contrast of the head (above) shows a round mixed density lesion just to the right of the third ventricle along with diffuse subarachnoid hemorrhage and cerebral edema. Axial (below left) and sagittal (below right) CT angiogram shows the lesion to arise from the A1 segment of the right anterior cerebral artery.

The diagnosis was giant intracranial aneurysm which had ruptured causing subarachnoid hemorrhage and diffuse cerebral edema.

Young adult with anemia

Radiograph of multiple myeloma of skull — Lateral radiograph of the skull shows multiple well circumscribed lytic lesions throughout the skull.

The diagnosis was multiple myeloma.

School ager male with excessive post-void dribbling

VCUG of prostatic utricle cyst — Lateral image from early in a VCUG exam (left) shows the catheter in a cystic structure that is posterior to the posterior urethra which has a thin line of contrast in it. Lateral image from later in the study during voiding (right) shows the clear communication between the posterior urethra and the cystic structure posterior to it.

The diagnosis was prostatic utricle cyst.

1 month old with gastroesophageal reflux

CXR of correct position of esophageal pH probe sensor / measurement lead — CXR AP shows the tip of the nasogastric tube to be in the stomach. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque stripe in the center of it) is 3-5 cm above the gastroesophageal junction.

The diagnosis was correct position of the esophageal pH probe sensor / measurement lead.