Teenager developing a large body mass index due to steroid use who is having problems with their gastrostomy tube feedings

Fluoroscopy of gastrostomy tube tip inside its tract and outside of the stomach — Lateral image of the abdomen is obtained during injection of the gastrostomy tube shows that the gastrostomy tube balloon is outside of the stomach and contrast is flowing along the gastrostomy tube track into the stomach.

The diagnosis was gastrostomy tube malfunction due to the gastrostomy tube being pulled back along its tract as the patient’s body mass index increased and the gastrostomy tube was too short.

Teenager in a motor vehicle accident with back pain

CT of Chance fracture of L1 vertebral body — Coronal (above left), sagittal (above right) and axial (below) CT without contrast of the lumbar spine shows a flexion distraction fracture of the L1 vertebral body and its posterior elements and a compression fracture of the L4 vertebral body.

The diagnosis was a Chance fracture of the lumbar spine at the L1 vertebral body and a lumbar spine fracture of the L4 vertebral body.

School ager with left upper eyelid swelling

MRI of dacryoadenitis — Coronal T2 MRI without contrast of the orbit (above left) shows hyperintense signal in a superolateral distribution around the left orbit including the left lacrimal gland. Coronal (above right) and axial (below) T1 MRI with contrast shows bright homogenous enhancement in a superolateral distribution around the left orbit including the left lacrimal gland.

The diagnosis was left dacryoadenitis.

Teenager in motor vehicle accident with back pain

CT of lumbar spine fracture of L1 vertebral body — Sagittal CT without contrast of the lumbar spine (left) shows a compression fracture of the L1 vertebral body with fracture fragments off of the anterior and posterior aspects of the L1 vertebral body and a mild compression fracture of the L3 verebral body. Sagittal T2 MRI without contrast of the lumbar spine (right) shows the posterior fracture fragment off of L1 to be effacing the thecal sac anteriorly and causing compression of the spinal cord. There is also bright signal in the L1 vertebral body secondary to the compression fracture.

The diagnosis was a lumbar spine fracture of L1 vertebral body causing cord compression and a lumbar spine compression fracture of L3 vertebral body.

Teenager with tuberous sclerosis and abdominal pain

CT of angiomyolipomas — Axial CT with contrast of the abdomen shows a small round low density lesion in the posterolateral aspect of the left kidney (above) and a larger round low density lesion in the posterior aspect of the right kidney (below). There is also an intermediate density round lesion in the anteromedial aspect of the left kidney (above).

The diagnosis was angiomyolipomas of the kidneys in a patient with tuberous sclerosis with the left anteromedial lesion having microscopic fat and the left posterolateral and right posterior lesions having macroscopic fat.

Newborn with a cystic right adnexal mass on prenatal US

US of ileal duplication — Transverse (above) and sagittal (below) US of the abdomen shows a cystic lesion with septations that has a hyperechoic inner rim (echogenic rim sign).

The diagnosis was ileal duplication.

Infant with respiratory distress

CXR of thymus rebound — CXR AP (left) shows central airway thickening and lung hyperexpansion. The thymus is not visible. Repeat CXR AP obtained 3 months after resolution of respiratory symptoms (right) shows normal central airways and lung expansion. The thymus is now well visualized and is normal in appearance.

The diagnosis was thymus involution during viral pneumonia followed by thymus rebound upon recovery.

Toddler with problems feeding through the jejunostomy port of their gastrojejunostomy tube

Fluoroscopic study of jejunostomy tube tip migration into stomach — AXR (above) shows the tip of the jejunostomy tube projects over the body of the stomach. AP (below left) and lateral (below right) images obtained after injecting water soluble contrast through the jejunostomy port of the gastrojejunostomy tube shows contrast outlining the rugae of the stomach. There is no contrast in the duodenum or jejunum.

The diagnosis was gastrojejunostomy tube malfunction with the tip of the jejunostomy tube having been pulled back into the stomach.

School ager who has arm pain after fall on arm

Radiograph of greenstick fracture of radius — AP (left) and lateral (right) radiographs of the forearm show a faint jagged lucency affecting one cortical surface at the diaphysis of the radius with mild angulation of the fracture fragments.

The diagnosis was greenstick fracture of the radius.

School ager post trauma

CT of colloid cyst — Axial CT without contrast of the brain shows a small, round, high density lesion in the midline in the anterior superior aspect of the third ventricle at the Foramen of Monro. The lesion could not be seen on an MRI performed at the same time.

The diagnosis was colloid cyst of the third ventricle.

Infant exposed to a sexually transmitted disease in utero

Radiograph of syphilis osteomyelitis — AP radiograph of the lower extremities shows diffuse periosteal reaction and cortical thickening and bowing of the bilateral femora and tibae and fibulae.

The diagnosis was chronic osteomyelitis due to syphilis.

Preschooler with Cushing syndrome

CT of adrenocortical carcinoma — Axial (above) and coronal (below) CT without contrast of the abdomen show a large solid nodular mass in the region of the right adrenal gland. The left adrenal gland is normal.

The diagnosis was adrenocortical carcinoma.

Infant with bilious vomiting

Upper GI of malrotation with midgut volvulus — AP images from an upper GI exam with the duodenum collapsed (above) and distended (below) show the duodenal jejunal junction to lie over the left pedicle of the spine but to be below the level of the duodenal bulb. The proximal jejunum is in the right upper quadrant.

The diagnosis was malrotation with midgut volvulus.

Toddler who is HIV positive and has months of respiratory distress

CXR of lymphoid interstitial pneumonia — Initial CXR AP and lateral (above) show diffuse reticular interstitial infiltrates throughout the lungs bilaterally. CXR AP several months later (below) shows some interval clearing of the reticular infiltrates.

The diagnosis was lymphoid interstitial pneumonia.

Infant who is having difficulty being fed through their feeding tube

AXR of kink in feeding tube — AXR AP shows the tip of the nasogastric tube to be in the body of the stomach. The tip of the feeding tube is transpyloric in position at the duodenal jeujunal junction. However, the feeding tube lumen is kinked in the body of the stomach.

The diagnosis was feeding tube malfunction due to a kink in the feeding tube.

Teenager who hit the side of his foot on a door and now has pain in the proximal fifth metatarsal

Radiograph of fifth metatarsal fracture — AP (left) and oblique (right) radiographs of the foot show a transverse linear lucency through the base of the fifth metatarsal.

The diagnosis was fracture of the fifth metatarsal.

Preschooler who sustained penetrating trauma to the skull base with a rake

MR myelogram of cerebrospinal fluid leak due to dural tear — Sagittal MR myelogram (above left) shows leakage of hyperintense cerebrospinal fluid into the soft tissues inferior to the cerebellum, which lateralizes to the left side on the coronal MR myelogram (above right). Sagittal T2 MRI without contrast of the brain (below) shows the tear in the linear hypointense dura with the hyperintense cerebrospinal fluid leaking through it just inferior to the tip of the cerebellar tonsil.

The diagnosis was cerebrospinal fluid leak due to a dural tear.

Newborn with respiratory distress

CXR of short rib polydactaly syndrome — CXR AP (left) and lateral (center) show extremely short ribs resulting in a very small thorax and thus low lung volumes. AP radiograph of the upper extremity (right) shows a short humerus and an extra digit attached to the fifth digit.

The diagnosis was short rib polydactyly syndrome with post axial polydactyly.

Newborn with hydronephrosis on prenatal US

US of uterus under maternal stimulation of estrogen — Transverse (above) and sagittal (below) US of the uterus show the uterus to be enlarged in size and to have a prominent endometrial stripe.

The diagnosis was a normal post natal uterus under maternal stimulation of estrogen.

Newborn vomiting up their feeds

AXR of jejunal atresia — AXR AP shows extreme dilation of the stomach to the left of the spine, the duodenum to the right of the spine and a loop of proximal jejunum inferior to the stomach and to the left of the spine – a triple bubble sign.

The diagnosis was jejunal atresia.

Toddler with a cough

CXR and CT of foreign body in left mainstem bronchus — CXR AP at presentation (above left) shows mediastinal shift to the left and complete opacification of the left hemithorax due to complete atlectasis of the left lung. A subsequent CXR AP obtained the next day (not provided) showed reexpansion of the left lung which was symmetrically expanded when compared to the right lung. CXR AP obtained 3 months later (above right) showed the left hemithorax to be hyperlucent when compared to the right hemithorax. Axial CT without contrast of the lungs (below) again shows the relative hyperlunceny of the left hemithorax and a foreign body is seen just beneath the carina filling the proximal left mainstem bronchus (below center).

The diagnosis was airway foreign body in the proximal left mainstem bronchus.

Toddler after nasogastric tube placement

AXR of transpyloric nasogastric tube — CXR AP shows the tip of the nasogastric tube to project near the ligament of Treitz.

The diagnosis was nasogastric tube malfunction with the tip of the nasogastric tube being transpyloric in position.

Toddler with elbow pain after fall on outstretched hand

Radiograph of supracondylar elbow fracture — AP radiograph of the elbow (left) shows a supracondylar fracture line in the humerus. Lateral radiograph (right) shows the anterior humeral line does not intersect the capitellum.

The diagnosis was supracondylar elbow fracture.

Teenager with back pain after jumping off a truck

CT of thoracic spine fracture dislocation with epidural hematoma and cord compression — Coronal (left) and sagittal (middle) CT without contrast of the spine shows fracture of the T6 and T8 vertebral bodies with displacement at T7-T8. Sagittal T2 MRI without contrast of the spine (right) shows spinal stenosis and cord compression and abnormal cord signal and ligament disruption and an epidural hematoma at T7-T8.

The diagnosis was fracture dislocation of the thoracic spine with a spinal epidural hematoma.

School ager with hand pain after trauma

Radiograph of melorheostosis — AP and oblique radiographs of the hand show a flame-shaped sclerotic lesion in the proximal aspect of the third metacarpal.

The diagnosis was melorheostosis.