Premature newborn baseline screening head ultrasound exam on day of life 7

US of intraventricular hemorrhage — Coronal (above left), left sagittal (above middle) and right sagittal (above right) US of the head shows a round echogenic focus in the left germinal matrix. There was also an echogenic focus in the occipital horn of the left lateral ventricle (not provided). The ventricular system was normal in size. Followup exam from 2 weeks later (below) shows interval decrease in size and cavitation of the echogenic foci in the left germinal matrix and occipital horn of the left lateral ventricle. The ventricular system is minimally increased in size.

The diagnosis was left grade II neonatal intraventricular hemorrhage.

Afebrile preschooler with a painful left limp who “walks like a monster”

Radiograph of transient synovitis of the hip — AP (above) and frog leg (below) radiographs of the pelvis show the left femoral head on both views is slightly more displaced laterally than the right femoral head, suggesting the presence of a left hip effusion.

The diagnosis was transient synovitis of the left hip.

School ager with diffuse abdominal pain

US and CT of ovarian torsion — Sagittal US of the pelvis (above left) shows an enlarged right ovary with multiple peripheral follicles. Axial CT with contrast of the abdomen (above right) shows the right ovary to be enlarged with multiple peripheral follicles and to be malpositioned in the midline of the pelvis while the coronal CT (below) shows the right ovary to be in a position in the midline above the bladder.

The diagnosis was ovarian torsion.

Infant with projectile vomiting, weight loss and severe dehydration

AXR and US of hypertrophic pyloric stenosis — AXR (above) shows an extremely distended stomach with peristaltic waves (caterpillar sign). Sagittal (below left) and transverse (below right) US of the pylorus shows the pylorus muscle to be thickened and elongated in length, measuring 3.9 mm thick and 20 mm in length.

The diagnosis was hypertrophic pyloric stenosis.

Former premature newborn now 1 year old with chronic respiratory distress

CXR and CT of bronchopulmonary dysplasia — CXR (above) shows hyperexpansion and fine interstitial infiltrates. Axial CT without contrast of the chest (below) shows diffuse alveolar and interstitial lung disease bilaterally that is more prominent in the perihilar regions.

The diagnosis was bronchopulmonary dysplasia.

School ager one year after viral pneumonia with progressive respiratory distress

CXR and CT of bronchiolitis obliterans with organizing pneumonia — CXR (above) shows bilateral basilar infiltrates and blunting of the left costophrenic angle. Axial CT without contrast of the lung (below) shows bilateral lower lobe bronchiectasis and mild interstitial prominence, the upper lobes appeared normal.

The diagnosis was bronchiolitis obliterans with organizing pneumonia.

Preschooler with a right abdominal mass and elevated alpha fetal protein

CT and MRI of hepatoblastoma — Axial CT with contrast of the abdomen (above left) shows a large, inhomogenous multifocal mass on the right side of the abdomen that enhances less than the liver and that did not appear to arise from the right adrenal gland or right kidney. Axial T2 (above right) and axial (below left) and coronal (below right) T1 MRI with contrast of the abdomen show the mass arising from and involving nearly the entire liver and encasing the portal veins.

The diagnosis was hepatoblastoma.

Preschooler with right facial swelling

CT and MRI of first branchial cleft cyst — Axial CT with contrast of the face (above) shows a low density, poorly circumscribed lesion with faint rim enhancement expanding the right parotid gland. Inflammatory changes are noted in the adjacent subcutaneous tissues. Axial T2 MRI of the face from 7 months later (below left) shows areas of oval high signal intensity weaving in and out of the plane of the image representing a tract from the posterior aspect of the right parotid gland to the right external auditory canal which on axial DWI MRI (below right) also shows high signal intensity representing diffusion restriction in the tract.

The diagnosis was a parotid abscess due to an infected first branchial cleft cyst.

School ager with a bump on the right side of the face

CT of odontogenic keratocyst in Gorlin syndrome — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the face shows a lytic, expansile lesion in the right maxilla displacing the second right premolar tooth anterolateraly. There was no bone destruction or associated soft tissue mass.

The diagnosis was an odontogenic keratocyst in a patient with Gorlin syndrome.

Preschooler with hydronephrosis

US of hypertrophied column of Bertin — Transverse (above) and sagittal (below) US of the kidney shows an oval mass-like lesion that has been stable over time in the posterior aspect of the upper pole of the kidney that is in continuity with the cortex of the kidney and has the same echogenicity of the cortex of the remainder of the kidney. Mild to moderate hydronephrosis is also present.

The diagnosis was hypertrophied column of Bertin.

Infant with projectile vomiting

US of hypertrophic pyloric stenosis — Sagittal US of the pylorus (middle) shows the calipers on the hypoechoic pyloric muscle which is thickened and elongated, measuring 3.7 mm thick and 20 mm in length. Transverse US of the pylorus (right) shows the circumferentially thickened and hypoechoic pyloric muscle whose boundaries are marked by the calipers surrounding the echogenic mucosa in the center of it.

The diagnosis was hypertrophic pyloric stenosis.

Infant with reactive airway disease

CXR and CT of bronchiolitis obliterans — CXR AP and lateral (above) shows hyperinflation. Axial CT without contrast of the chest shows focal areas of decreased lung density in a lobular patter most prominent in the bilateral upper lobes (below left) and several nodular opacities in the lingula (below right).

The diagnosis was bronchiolitis obliterans.

Teenager on chemotherapy with fever

CXR and CT of invasive aspergillosis — CXR on day 8 of the fever (above left) shows opacities in the left upper lobe and right middle lobe. Axial CT without contrast of the chest on day 13 of the fever (above right) shows parenchymal opacities surrounded by irregular ground glass density (halo sign). CXR on day 20 of the fever (below left) shows interval cavitation of the bilateral lung lesions which on axial CT with contrast of the chest on day 34 of the fever (below right) shows central necrosis in the lesions which is detached from the wall (air crescent sign).

The diagnosis was invasive aspergillosis.

Toddler with an unusual appearing eye

Clinical image of aniridia in a patient with Wilms tumor — Clinical image shows absence of the iris.

The diagnosis was aniridia in a patient with Wilms tumor.

Preschooler with abdominal pain

Gross pathology image of cystic Wilms tumor — Gross pathological image shows a large left renal mass along with the left ureter with the upper part of the mass being ballotable, demonstrating its primarily cystic nature.

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Gross pathology image of cystic Wilms tumor — Sectioned gross pathological image after drainage of fluid shows the preserved lower pole of the left kidney (above), the replacement of the upper and middle poles by a cystic tumor containing multiple septations which is now decompressed, and a mural nodule (center of image).

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Surgical image of cystic Wilms tumor — Surgical image shows a large mass arising from the left kidney which is being effectively transilluminated by the overhead lights, demonstrating its primarily cystic nature.

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Surgical image of cystic Wilms tumor — Surgical image shows a large fluid-filled mass arising from the left kidney just after it has been resected along with the left ureter.

The diagnosis was cystic Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Gross pathological image (left) shows a large, heterogenous mass arising from the inferior pole of the right kidney. Note the claw sign of the renal parenchyma draped along the medial and lateral margins of the mass on the sectioned gross pathological image (right).

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Sectioned gross pathological image shows a large, heterogenous, round mass arising from the inferior pole of the right kidney. Note the claw sign of the renal parenchyma draped along the lateral margin of the mass.

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Surgical image of Wilms tumor — Surgical image shows a large heterogenous mass in the right kidney (to the right of the surgical field) which was intimately adherent to the ileum and cecum (to the left of the surgical field).

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Gross pathological image after right nephroureterectomy and en bloc ileocolectomy shows a large heterogenous mass in the right kidney which was intimately adherent to the cecum (held by the forceps on the right) and the ileum (held by the forceps on the left).

The diagnosis was Wilms tumor.

Infant with a mass protruding from the vagina

Clinical image of sarcoma botryoides — Clinical image shows a tan mass with frond-like excrescences protruding from the vagina.

The diagnosis was genitourinary rhabdomyosarcoma (sarcoma botryoides).

Infant with a mass protruding from the vagina

Clinical image of hydrometrocolpos — Clinical image shows a large tan mass protruding from the vagina. Ultrasound of the mass showed it to be distended with fluid and in continuity with the uterus and vagina.

The diagnosis was hydrometrocolpos.

Infant with a mass protruding from the vagina

Clinical image of prolapsed ectopic ureterocele — Clinical image shows a purple mass protruding from the vagina. Ultrasound of the mass showed it to be cystic. Renal ultrasound showed the left kidney to be duplicated with hydronephrosis of the upper pole.

The diagnosis was a prolapsed ectopic ureterocele in a patient with a duplicated kidney.