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.

Premature newborn with respiratory distress

CXR of symmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome — CXR AP obtained just after birth (above left) shows the lungs bilaterally to be relatively clear and hypoexpanded. CXR obtained 4 hours later after intubation (above right) shows interval development of bilateral symmetrical ground glass opacity in the lungs which remain hypoexpanded. CXR obtained 4 hours after the administration of artificial surfactant (below) shows the lungs now to be normally expanded and to be clear of the previously seen ground glass opacities.

The diagnosis was respiratory distress syndrome before and after the symmetrical administration of artificial surfactant.

Premature newborn with gastrointestinal bleeding after replacement of the nasogastric tube

AXR of nasogastric tube causing gastric perforation — Baseline CXR AP obtained yesterday (left) shows a nasogastric tube coursing through the esophagus and then curving towards the stomach on the left side of the abdomen. AXR AP after nasogastric tube replacement (right) shows a straight course to the newly placed nasogastric tube whose tip projects in the midline at the level of the L3 vertebral body. There is a faint oval lucency in the midline of the upper abdomen at the level of the T10 and T11 vertebral bodies.

The diagnosis was nasogastric tube malfunction in the form of gastric perforation caused by placement of a nasogastric tube resulting in pneumoperitoneum.

Newborn with one perineal opening for the vagina and urethra and rectum

Fluoroscopic exam of cloacal malformation — AP (above left) and lateral (above right) images during injection of water soluble contrast into the vagina shows a dilated vagina and a duplicated uterus. Lateral image during antegrade injection of water soluble contrast into the patient’s distal mucous fistula (below left) shows a connection between the posteriorly located distal rectum and the posterior aspect of the vagina. Lateral image obtained during filling of the anteriorly located bladder with water soluble contrast through a suprapubic catheter (below right) shows the proximal urethra just inferior to the bladder to be dilated.

The diagnosis was cloacal malformation.

Infant with left hip pain

Radiograph of growth arrest lines — AP radiograph of the hip shows multiple transverse densely sclerotic lines in metaphyses of the proximal left femur. There are also multiple curved faintly sclerotic lines in the left iliac bone.

The diagnosis was growth arrest lines.

School ager with Ehler Danlos syndrome being cleared for general anesthesia

Flexion and extension radiographs of atlanto axial instability — Lateral radiograph of the cervical spine in extension (left) shows the atlanto dental interval to measure 0 mm. Lateral radiograph of the cervical spine in flexion (right) shows the atlanto dental interval to measure 7 mm.

The diagnosis was atlanto axial instability in a patient with Ehlers Danlos syndrome.

Immune compromised preschooler with abdominal pain

AXR of pneumatosis intestinalis — AXR AP shows marked curvilinear air throughout the bowel wall of the transverse, descending and sigmoid colon and rectum.

The diagnosis was pneumatosis intestinalis of the colon.

Teenager who fell on their elbow

Radiograph of elbow fracture of the olecranon — AP (left) and lateral (right) radiographs of the elbow show on the lateral radiograph elevation of the anterior fat pad and an irregular lucent line anterior to the ossification center of the olecranon of the ulna.

The diagnosis was elbow fracture of the olecranon.

Term newborn with respiratory distress

CXR of respiratory distress syndrome in a term infant due to congenital absence of surfactant — CXR AP shows low lung volumes and symmetrical ground glass opacity throughout both lungs.

The diagnosis was respiratory distress syndrome in a term infant due to congenital inability to produce surfactant.

School ager who is vomiting when they are being fed through the jejunostomy port of their gastrojejunostomy tube

AXR of jejunostomy catheter tip that has migrated back into the stomach — AXR AP shows that the tip of the jejunostomy tube projects over the body of the stomach.

The diagnosis was gastrojejunostomy malfunction in the form of migration of the gastrojejunostomy tip into the stomach.

Infant with a urinary tract infection who is post repair of an inferior abdominal wall defect at birth

VCUG of grade V vesicoureteral reflux in a patient with bladder exstrophy — AP image from a voiding cystourethrogram shows reflux of contrast into extremely dilated renal collecting systems and ureters bilaterally. There is also diastasis of the symphysis pubis.

The diagnosis was bilateral Grade V vesicoureteral reflux in a patient with bladder exstrophy.

School ager who kicked a tree while playing football and has a puncture wound in his calf.

Radiograph of a tree branch in the soft tissues of the leg — AP radiograph of the tibia and fibula shows a radiopaque fragment of a retained tree branch deep in the soft tissues of the calf with extensive subcutaneous emphysema along the wound tract.

The diagnosis was foreign body in the soft tissues in the form of a tree branch.

Preschooler with an occipital skull fracture after trauma

CT venogram of arachnoid granulations — Axial CT venogram of the brain (left) shows a single smooth round filling defect in each transverse sinus laterally, left larger than right. Coronal CT (right) again shows the filling defect in the left transverse sinus

The diagnosis was arachnoid granulations in the transverse sinuses.

Infant with abdominal pain

AXR of CT of pneumatosis intestinalis of the colon — AXR AP (above left) shows extensive curvilinear air throughout the wall of the colon from the cecum to the rectum. There is contrast in the bladder from the contemporaneously performed CT. Axial (above right) and coronal (below) CT with contrast of the abdomen show a large amount of air in the wall of the colon throughout the entire colon.

The diagnosis was pneumatosis intestinalis of the entire colon of unknown etiology.

Preschooler with elbow pain after a fall

Radiograph of occult elbow fracture — Lateral radiograph of the elbow (right) shows elevation of the anterior and posterior fat pads due to a large elbow joint effusion. No definite fracture line is seen on the lateral radiograph or on the AP radiograph (left).

The diagnosis was ocult elbow fracture.

Premature newborn four hours after administration of artificial surfactant

CXR of asymmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome — CXR AP shows symmetrical ground glass opacity in the hypoexpanded left lung. There is increased lung expansion and no evidence of ground glass opacity in the right lung.

The diagnosis was respiratory distress syndrome showing the appearance of the chest after the asymmetrical administration of artificial surfactant into only the right lung.

School ager whose gastrostomy tube fell out and has just been replaced

Upper GI of gastrostomy tube tip in the stomach — AP (above) and lateral (below) radiographs obtained after the injection of water soluble contrast through the gastrostomy tube show normal appearing gastric rugae. There is no leakage of contrast out of the stomach.

The diagnosis was correct position of the gastrostomy tube tip within the stomach.

Newborn who experienced oligohydramnios in utero

CXR and US of autosomal recessive polycystic kidney disease causing oligohydramnios and pulmonary hypoplasia — CXR AP (above) shows a small bell-shaped thorax with poorly expanded lungs despite being on a ventilator. Transverse US of the left kidney (below left) and right kidney (below right) shows the kidneys bilaterally to be enlarged and to be composed of innumerable microcysts giving the kidneys overall an echogenic appearance.

The diagnosis was autosomal recessive polycystic kidney disease resulting in oligohydramnios resulting in pulmonary hypoplasia.

School ager with arm pain after fall on outstretched hand

Radiograph of polyostotic fibrous dysplasia — AP radiograph of the humerus (left) shows a lengthy ground glass lesion with a sclerotic rim centered in the metaphysis of the humerus. AP radiograph of the hand (right) shows multiple lucent lesions with sclerotic rims in the capitate and hamate and in the proximal fourth and fifth metacarpal bones.

The diagnosis was polyostotic fibrous dysplasia.

Preschooler with developmental delay

MRI of arachnoid cyst of the posterior fossa — Axial (above left), coronal (above right) and sagittal (below) T2 MRI of the brain show a midline to right of midline high signal intensity lesion in the posterior fossa which is inferior to an intact cerebellar vermis and the right cerebellar hemisphere and which is having mass effect on the cerebellum.

The diagnosis was arachnoid cyst of the posterior fossa.

Premature newborn now 9 months old with abdominal distension

AXR of pneumatosis intestinalis of the colon — AXR AP (above) shows curvilinear air throughout the wall of the colon from the cecum to the rectosigmoid colon which is also appreciated on the AXR left lateral decubitus (below). There was no free air or portal venous gas.

The diagnosis was pneumatosis intestinalis of the colon of unknown etiology.

School ager with elbow pain after falling on outstretched hand

Radiology of elbow fracture of the medial epicondyle — AP radiograph of the elbow shows displacement, rotation, and fragmentation of the medial epicondyle.

The diagnosis was elbow fracture of the medial epicondyle of the elbow.