Newborn with a posterior fossa cyst on prenatal US

MRI of Dandy Walker variant — Sagittal T1 MRI without contrast of the brain (above left) shows a cystic lesion in the inferior posterior fossa which is not causing any mass effect in a normally sized posterior fossa. Coronal T2 MRI (above right) and axial T1 MRI without contrast (below) show a mildly enlarged fourth ventricle which is connecting to the cystic lesion due to mild agenesis of the cerebellar vermis.

The diagnosis was Dandy Walker variant.

Preschooler with elevated liver function tests

US of pediatric acute hepatitis — Sagittal (above left) and transverse (above right) US of the liver show increased echogenicity around the portal veins – a starry sky appearance. Sagittal (below left) and transverse (below right) US of the gallbladder show diffuse gallbladder thickening.

The diagnosis was acute hepatitis.

Newborn who experienced shoulder dystocia during delivery

CXR of humerus fracture due to shoulder dystocia — CXR AP shows a complete fracture through the diaphysis of the left humerus. The fracture fragments are not in anatomic alignment and apposition.

The diagnosis was proximal humerus fracture.

Toddler with respiratory distress

CXR of pediatric atrial septal defect — CXR AP (left) and CXR lateral (right) show the heart to be enlarged and the pulmonary vascularity to be increased. The lungs are clear.

The diagnosis was atrial septal defect.

Newborn with respiratory distress

Pediatric lordotic CXR — CXR AP is angled superiorly at greater than 90 degrees to the patient and therefore shows the apices of the lungs very clearly. The ribs have a different contour than would be expected on a normal CXR AP angled at 90 degrees to the patient. The heart size is normal, the pulmonary vascularity is not congested, and the lungs are clear.

The diagnosis was normal lordotic view of the chest.

Newborn with bilateral unpalpable testicles

US of pediatric intraabdominal testicle — Transverse (above left) and sagittal (below left) US of the pelvis show the right testicle to lie lateral to the superior aspect of bladder. Transverse (above right) and sagittal (below right) US of the left inguinal canal shows the left testicle to lie within the left inguinal canal.

The diagnosis was bilateral undescended testicles with the left testicle in the inguinal canal and the right testicle in the abdomen.

School ager with left preauricular mass

CT of pediatric pilomatricoma — Axial (above) and coronal (below) CT with contrast of the face show a well-circumscribed oval lesion near the left ear that has calcifications within it. There are no inflammatory changes associated with it.

The diagnosis was pilomatricoma.

Newborn with a brain cyst on prenatal ultrasound

MRI of Dandy Walker malformation — Coronal (above right) and axial (below) T1 MRI without contrast of the brain show hypoplasia of the inferior cerebellar vermis. Sagittal T1 MRI (above left) shows dilation of the fourth ventricle, expansion of the posterior fossa and elevation of the tentorium and torcula.

The diagnosis was Dandy Walker malformation.

Toddler with abdominal pain

US of pediatric hepatic steatosis — Sagittal (above) and transverse (below) US of the liver show diffusely increased echogenicity of the liver parenchyma when compared to the right kidney parenchyma.

The diagnosis was hepatic steatosis.

Teenager who hurt his finger playing football

Radiograph of Salter Harris Type II fracture of phalanx — AP radiograph of the hand shows a fracture line through the physis at the base of the second proximal phalanx that extends up into the metaphysis of the phalanx.

The diagnosis was Salter Harris Type II fracture of the second proximal phalanx of the hand.

Toddler with congestive heart failure

CT of pediatric anomalous left coronary artery from the pulmonary artery — Two contiguous images from axial CT with contrast of the chest shows the left coronary artery arising from the left anterior pulmonary sinus in the main pulmonary artery.

The diagnosis was anomalous left coronary artery from the pulmonary artery.

Toddler with gastroesophageal reflux

Upper GI of normal pediatric esophagram — AP (left) and lateral (center and right) images from an upper GI exam show the esophagus to have a smooth contour without fixed narrowing or extrinsic compression.

The diagnosis was normal fluoroscopic appearance of the pediatric esophagus.

Newborn with complex congenital heart disease

US of Tamm Horsfall proteins — Sagittal US of the right kidney (above) and left kidney (below) show multiple round echogenic foci in the renal pyramids bilaterally.

The diagnosis was Tamm Horsfall proteins.

Infant being worked up for suspected child abuse

Radiograph of physiologic periosteal reaction — AP radiographs of the bilateral tibiae and fibulae show bilateral symmetrical periosteal reaction along the medial diaphyses of the tibiae.

The diagnosis was physiologic periosteal reaction.

School ager with excessive right-sided tearing after a right facial fracture

CT of dacrocystocele — Axial (above) and coronal (below) CT with contrast of the orbits show an oval low density lesion with a thin enhancing wall located along the course of the right nasolacrimal duct.

The diagnosis was right dacrocystocele.

School ager with abdominal pain

US of pediatric hepatic cyst — Transverse (above) and sagittal (below) US of the liver show in the anterior aspect of the right lobe of the liver an oval anechoic lesion with smooth margins with no internal septations or nodules.

The diagnosis was simple hepatic cyst.

Teenager with left hip pain

Radiograph of avulsion fracture of the left anterior superior iliac spine. — AP radiograph of the pelvis shows an avulsion fracture of the left anterior superior iliac spine.

The diagnosis was pelvis fracture and hip apophyseal avulsion of the anterior superior iliac spine.

Teenager with respiratory distress who has a history of vaping

CXR and CT of pediatric vaping associated lung disease — CXR PA (left) shows bilateral ground glass opacities that are more basilar than apical in nature, and which are more prominent on the left than on the right. Coronal (above right) and axial (below right) CT with contrast of the chest show diffuse bilateral ground glass opacities with a basilar predominance and some subpleural sparing.

The diagnosis was vaping associated lung disease.

Newborn with vomiting

Upper GI of normal appearance of the pediatric esophagus — Serial lateral images from an upper GI exam show normal caliber of the esophagus with no extrinsic compressions on it. The esophageal mucosa is normal in appearance.

The diagnosis was normal fluoroscopic appearance of the esophagus.

School ager with a urinary tract infection

VCUG of pediatric spinning top urethra — AP image from a voiding cystourethrogram exam during voiding shows a non-obstructive ellipsoid-shaped dilation of the posterior urethra just distal to internal urethral sphincter.

The diagnosis was spinning top urethra.

School ager who is being followed up for a supracondylar fracture that occured 6 months ago

Radiograph of pediatric Panner disease — AP (left) and lateral (right) radiographs of the elbow show demineralization, fragmentation and sclerosis of the capitellum which also has an irregular border.

The diagnosis was Panner disease.

School ager with headache and vision problems

CT of craniopharyngioma — Sagittal CT without contrast of the brain (above left) shows a large, oval, suprasellar, low density, thin-walled lesion. Coronal (below left) and axial CT (right) show the lesion to be above the optic chiasm and causing obstructive hydrocephalus evidenced by dilation of the lateral ventricles and transependymal flow of cerebrospinal fluid.

The diagnosis was craniopharyngioma.

Teenager with a storage disease

MRI of femur in Gaucher disease — Coronal T1 MRI without contrast (left) and coronal T2 MRI (right) of the femurs shows a heterogeneous appearance to the bone marrow of the femurs due to diffuse marrow infiltration. The femurs have a mildly reduced constriction of diaphysis and flaring of metaphysis due to undertubulation, giving them the appearance of an Erhlemeyer flask.

The diagnosis was Gaucher disease.

Teenager who hurt his big toe playing football

Radiograph of Salter Harris Type III fracture of the phalanx in the foot — AP radiograph of the foot shows a lucent line in the medial aspect of the physis of the first proximal phalanx that then extends down into the epiphysis.

The diagnosis was Salter Harris Type III fracture of the phalanx in the foot.

Infant with chronic cough

CXR of pediatric mycoplasma pneumonia — CXR AP shows bilateral mild central airway thickening, interstitial infiltrates and lung hyperexpansion.

The diagnosis was mycoplasma pneumonia.