Preschooler with respiratory distress

CXR and CT of pleuropulmonary blastoma — CXR AP (above) shows complete opacification of the right hemithorax with mediastinal shift to the left. Axial CT with contrast of the chest shows a large mass filling the entire right hemithorax that is solid peripherally and cystic centrally, causing mediastinal shift to the left.

The diagnosis was pleuropulmonary blastoma.

Infant with respiratory distress

CXR and CT of inflammatory myofibroblastic tumor in the chest — CXR AP shows a round opacity laterally in the right lung (above left) which projects in the middle of the chest over the trachea on the lateral (above right). Axial CT without contrast of the chest (below) shows the opacity to be a solid mass without calcification next to the pleura.

The diagnosis was inflammatory myofibroblastic tumor.

Preschooler with cough and fever

CXR of esophageal duplication / esophageal duplication cyst / bronchopulmonary foregut malformation — CXR PA (left) shows a large round opacity located medially in the left hemithorax which is located posteriorly on the lateral (right) over the spine (spine sign).

The diagnosis was esophageal duplication.

Preschooler with cough and fever

CXR of round pneumonia — Initial CXR PA (above left) shows a large round opacity located medially in the right hemithorax which is located posteriorly on the lateral (above right) over the spine (spine sign). CXR PA obtained 5 days later (below) shows interval resolution of the mass.

The diagnosis was round pneumonia.

Preschooler with Wilms tumor

CXR of lung metastasis in Wilms tumor — CXR PA shows a large round opacity just lateral to the left pulmonary artery which is located anteriorly on the lateral view.

The diagnosis was a lung metastasis in a patient with Wilms tumor.

Our DDX For This Week Is

Preschooler with recurrent upper respiratory infections

Pathological image of congenital pulmonary airway malformation / CPAM / CCAM / congenital cystic adenomatoid malformation — Pathological image shows multiple cystic lesions in the right upper lobe.

The diagnosis was congenital pulmonary airway malformation.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Preschooler found face down in a swimming pool

CXR of pulmonary edema in near drowning — CXR AP shows a normal sized heart and bilateral perihilar interstitial infiltrates. There is also a dense opacity in the right upper lobe.

The diagnosis was pulmonary edema due to near drowning and probable aspiration pneumonia of the right upper lobe.

Preschooler with hematuria

CXR of pulmonary edema in acute glomerulonephritis — CXR PA and lateral shows cardiomegaly and bilateral perihilar interstitial infiltrates along with blunting of the costophrenic angles due to small bilateral pleural effusions best seen on the lateral.

The diagnosis was pulmonary edema due to acute glomerulonephritis.

Newborn with respiratory distress and an abnormal cardiac rhythm

CXR of pulmonary edema in paroxysmal atrial tachycardia — CXR AP shows mild cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion.

The diagnosis was pulmonary edema in a patient with paroxysmal atrial tachycardia.

Infant with rheumatic heart disease and bacterial endocarditis

CXR of pulmonary edema due to mitral insufficiency in rheumatic heart disease — CXR AP shows cardiomegaly and bilateral perihilar interstitial infiltrates.

The diagnosis was pulmonary edema due to mitral insufficiency caused by rheumatic heart disease.

School ager with shortness of breath

CXR of cardiogenic pulmonary edema in asthma — CXR AP (left) shows cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion. CXR AP (right) obtained after resolution of symptoms shows the heart and pulmonary vascularity to be normal in appearance while the airways are thickened and the lungs are hyperexpanded.

The diagnosis was pulmonary edema in a patient with underlying asthma.

Our DDX For This Week Is

Teenager with abdominal pain

Pathologic image of acute appendicitis with appendicoliths — Pathological image with the appendix opened longitudinally shows it to be grossly inflamed with two appendicoliths within the lumen of the appendix.

The diagnosis was acute appendicitis.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

School ager with a hacking cough

CXR of mycoplasma pneumonia — CXR PA and lateral shows a faint focal infiltrate in the posterior basilar segment of the right lower lobe, faintly obscuring the right hemidiaphragm on the PA view and causing a faint spine sign over the lowest vertebral body on the lateral view.

The diagnosis was mycoplasma pneumonia.

Newborn now 3 weeks old with respiratory distress

CXR of chlamydia pneumonia — CXR AP and lateral shows bilateral interstitial infiltrates, more prominent in the right lung.

The diagnosis was chlamydia pneumonia.

Our DDX For This Week Is

School ager with chronic inspiratory stridor

Gross pathology image of papillomas — Pathological image shows multiple white subglottic tracheal masses.

The diagnosis was multiple papillomas.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

School ager with a cough after bone marrow transplant

CXR and CT of invasive aspergillosis — CXR AP and lateral (above) shows a round opacity on the lateral view posteriorly projecting over a mid-thoracic vertebral body. Axial CT without contrast of the chest shows a cavitary lesion in the superior segment of the right lower lobe that has a halo sign peripherally with the parenchymal density surrounded by an irregular ground glass density and an air crescent sign with an area of central necrosis detached from the wall of the lesion.

The diagnosis was invasive aspergillosis.

Infant with severe combined immune deficiency and respiratory distress

CXR of Pneumocystis jiroveci pneumonia / PCP / PJP — CXR AP shows bilaterally diffuse, symmetrical, fine reticular infiltrates.

The diagnosis was Pneumocystis jiroveci pneumonia.

Toddler with human immunodeficiency virus infection and respiratory distress

CXR of lymphocytic interstitial pneumonitis / LIP — CXR AP shows bilaterally diffuse, symmetrical, nodular infiltrates.

The diagnosis was lymphocytic interstitial pneumonitis.

Our DDX For This Week Is