School ager with abdominal pain

Small bowel followthrough of normal appearance of the pediatric jejunum and ileum — Early image from a small bowel follow through exam (left) shows the opacified jejunum to have a feathery appearance. Later image (right) shows that compared to the ileum (on the bottom of the image) the jejunum has a greater caliber and has thicker and more numerous folds.

The diagnosis was normal fluoroscopic appearance of the jejunum and ileum.

Newborn with gross hematuria

US of renal vein thrombosis — Sagittal US of the left kidney (above) and right kidney (below) shows an asymmetry in renal length, with the right kidney being more than 1.5 cm longer than the left kidney. Color doppler ultrasound (not provided) showed a non occlusive thrombus in the right renal vein.

The diagnosis was right renal vein thrombosis.

Teenager with knee pain

Radiograph of parosteal osteosarcoma — AP and lateral radiographs of the knee show in the posterior distal femur a lobulated, exophytic mass which appears attached to the underlying cortex with minimal periosteal reaction.

The diagnosis was parosteal osteosarcoma.

Premature newborn with apnea and bradycardia

Head US of connatal cysts — Coronal US of the brain (above) shows bilateral cysts at the superolateral angles of the frontal horns of the lateral ventricles while on left sagittal (below left) and right sagittal (below right) images the cysts look like a string of pearls.

The diagnosis was bilateral connatal cysts.

Toddler with a gastrostomy tube who when fed by mouth has her feeds come out of the gastrostomy tube, which has been replaced by a wound vacuum

Upper GI of pediatric gastroparesis — AP image from an upper GI exam taken 15 minutes after injection of water soluble contrast into the stomach through a nasogastric tube shows some of the contrast to have emptied out of the stomach into the small bowel. Contrast was also emptying out of the stomach through the wound vac on the lower left side of the abdomen. The stomach remains distended with contrast.

The diagnosis was gastroparesis.

Toddler hit by a car while running across the street to an ice cream truck

Radiograph of complex pediatric pelvic fracture — AP radiograph of the pelvis shows a fracture of the left inferior and left superior pubic rami, a fracture of the left iliac wing, diastasis of the symphysis pubis and diastasis of the right sacroiliac joint.

The diagnosis was a complex pelvis fracture.

School ager with respiratory distress

CXR of pediatric bronchogenic cyst — CXR PA (left) shows a round soft tissue mass projecting just to the left of the spine that on CXR lateral (right) localizes to the middle mediastinum.

The diagnosis was bronchogenic cyst.

Teenager with chronic abdominal pain

Upper GI of normal fluoroscopic appearance of the stomach and small bowel — AP image from a small bowel follow through exam shows the gastric rugae in the contrast filled stomach. The jejunum (on the left side of the abdomen) has a feathery appearance and compared to the ileum (on the right side of the abdomen) the jejunum has a greater caliber and has thicker and more numerous folds.

The diagnosis was normal fluoroscopic appearance of the stomach and small bowel.

Teenager with right flank pain

CT and US of pediatric cystic nephroma — Axial (above left) and sagittal (above right) CT with contrast of the abdomen show two multiseptated low density lesions in the superior and middle poles of the right kidney. Sagittal US of the right kidney (below) show the two lesions are anechoic and filled with multiple thin septations without any nodularity.

The diagnosis was pediatric cystic nephroma.

Preschooler with foot pain

Radiograph and MRI of Brodie abscess — Oblique radiograph of the foot (left) shows a lesion in the base of the first metatarsal which has an oval radiolucent center with surrounding reactive sclerosis. Sagittal T2 MRI of the foot (above right) shows an oval hyperintense lesion surrounded by a very low signal intensity rim and hyperintense marrow edema throughout the first metatarsal. Sagittal T1 MRI with contrast (below right) shows rim enhancement (penumbra) around the lesion.

The diagnosis was subacute osteomyelitis with Brodie abscess.

Preschooler with neck pain after motor vehicle accident

3D CT of non-fusion of the anterior and posterior arches of the C1 vertebral body and hypoplasia of the dens — Anterior (left) and posterior (right) views of a 3D CT without contrast of the cervical spine show non-fusion of the anterior and posterior arches of the C1 vertebral body and hypoplasia of the C2 vertebral body.

The diagnosis was congenital developmental anomaly of the cervical spine in the form of non-fusion of the anterior and posterior arches of the C1 vertebral body and hypoplasia of the dens.

Infant with vomiting

Upper GI of pediatric mesenteroaxial gastric volvulus — Lateral image from an upper GI exam (left) shows a fixed indentation on the posterior aspect of the mid-esophagus. AP images from the upper GI exam (right) show the stomach appears to be upside-down with the antrum and pylorus superior to the fundus and proximal body of the stomach. Note how the pylorus of the stomach is located superiorly to the gastroesophageal junction.

The diagnosis was mesenteroaxial gastric volvulus in a patient with a left aortic arch and aberrant right subclavian artery.

School ager with hip pain after a fall

Radiograph of pediatric pathologic fracture through unicameral bone cyst — AP (above) and lateral (below) radiographs of the left hip show a completely displaced fracture through the femoral metaphysis. The fracture appears to go through the center of a lucent lesion in the bone.

The diagnosis was pathologic fracture through a unicameral bone cyst.

Female teenager who 2 weeks ago developed a fever and erythema around the nipple of the breast and now has drainage of fluid from the nipple

US of pediatric breast abscess — Transverse (above) and sagittal (below) color doppler US of the breast show a poorly defined retroareolar mass that has a hyperemic thick wall with a multiloculated hypoechoic center. The surrounding subcutaneous fat is hyperechoic.

The diagnosis was mastitis evolving into a breast abscess.

Infant with persistent cough

CXR of pediatric bacterial pneumonia in the lingula — CXR AP (left) shows an opacity in the lingula that is obscuring the left heart border (silhouette sign) which on the CXR lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia in the lingula.

School ager with fever and left flank pain

CT of pediatric acute pyelonephritis followed by development of a renal abscess — Coronal CT without contrast of the abdomen (above) shows an enlarged left kidney with associated perinephric fat around its inferior pole. Sagittal (below left) and transverse (below left) ultrasound of the left kidney obtained 1 month later after antibiotic treatment shows a well-circumscribed, round, isoechoic lesion in the inferior pole of the left kidney.

The diagnosis was initially acute pyelonephritis of the inferior pole of the left kidney followed by development of a renal abscess in the inferior pole of the left kidney.

Newborn who is not moving their legs very much

Radiographs of neonatal osteomyelitis due to Pseudomonas aeruginosa — AP radiograph of the pelvis at day of life 14 (above left) is unremarkable. AP radiograph of the pelvis at day of life 28 (below left) shows boney destruction and fragmentation at the bilateral proximal femoral metaphyses. AP radiograph of the forearm at day of life 28 (right) shows boney destruction at the distal radial metaphysis.

The diagnosis was neonatal osteomyelitis due to Pseudomonas aeruginosa.

Infant with seizures

MRI of pediatric coloboma — Axial T2 (above) and T1 (below) MRI without contrast of the brain shows in the left orbit a small pouch-like fluid-filled discontinuity of the posterior left orbit.

The diagnosis was left coloboma.

Newborn who had a cyst in their left upper quadrant on prenatal ultrasound

US of pediatric gastric duplication — Transverse (above) and sagittal (below) US of the left upper quadrant of the abdomen shows a large round anechoic lesion anterior to the stomach. The inner layer of the lesion is hyperechoic (echogenic rim sign).

The diagnosis was gastric duplication.

School ager with knee pain after a sledding injury

Radiograph of pediatric patellar fracture — Lateral radiograph of the knee shows an avulsion fracture of the superior pole of the patella. There is a large suprapatellar joint effusion.

The diagnosis was patella fracture.

Toddler with fever and cough

CXR of pediatric viral pneumonia with subsegmental atelectasis — CXR AP (left) and lateral (right) shows thickened central airways and bilateral lung hyperexpansion causing flattening of the diaphragm. There is an opacity in the medial aspect of the right middle lobe causing the right heart border to be obscured (silhouette sign).

The diagnosis was viral pneumonia with subsegmental atelectasis in the medial aspect of the right middle lobe.

Preschooler with cough and fever

CXR of bacterial pneumonia of the right middle lobe — CXR PA (left) shows an opacity in the lower right lung that is obscuring the right heart border (silhouette sign) which on the lateral radiograph (right) projects over the heart.

The diagnosis was bacterial pneumonia of the right middle lobe.

Male teenager with abdominal pain

CT of prostatic utricle cyst — Axial (above) and sagittal (below) CT with contrast of the abdomen show a round, thin-walled, low density structure posterior to the bladder and anterior to the rectum. On a subsequent voiding cytourethrogram exam (not provided) the structure did not fill with contrast.

The diagnosis was prostatic utricle cyst.

Teenager with long standing leg pain

Whole body STIR MRI of chronic recurrent multifocal osteomyelitis — Coronal STIR MRI of the chest (above) shows increased bone marrow signal in the bilateral clavicular heads. Coronal STIR MRI of the knees (below left) and ankles (below right) shows increased bone marrow signal intensity in the bilateral distal femoral metaphyses, left distal femoral epiphysis, bilateral proximal tibial metaphyses and bilateral distal tibial metaphyses.

The diagnosis was chronic recurrent multifocal osteomyelitis.

Teenager who had horrible headaches for 2 days and then collapsed

CT of colloid cyst of third ventricle — Axial CT without contrast of the brain (above left) shows a small, round, faintly dense lesion in the midline near the Foramen of Monro in the third ventricle while the axial CT more superiorly (above right) shows dilation of the lateral ventricles with transependymal flow of cerebrospinal fluid with the right lateral ventricle herniated to the left. There are additional signs of increased intracranial pressure, evidenced by the effacement of the basilar cisterns and sulci. Coronal CT (below left) shows the faintly dense round lesion in the third ventricle which is much better seen on the coronal CT obtained after placement of a ventriculoperitoneal shunt (below right).

The diagnosis was colloid cyst of third ventricle causing diffuse cerebral edema.