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.

Teenager with flank pain

CT and VCUG of bilateral orthotopic ureteroceles — Coronal (above left) and axial (below left) CT without contrast of the abdomen show single renal collecting systems bilaterally along with bilateral oval fluid-filled structures superior and posterior to the bladder near the ureterovesical junctions. AP image from a voiding cystourethrogram exam (right) shows two large round filling defects in the bladder.

The diagnosis was bilateral orthotopic ureteroceles.

School ager with abdominal pain

CT of enlarged but normal appendix in cystic fibrosis — Axial CT with contrast of the abdomen (above left) shows a low density liver due to fatty infiltration and a low density pancreas with calcifications that has a round low density fluid collection near the pancreatic head. The appendix in the right lower quadrant posterior to the cecum is dilated in diameter up to 10 mm but has no periappendiceal inflammation (above right and below). There is stool mixed with air in the terminal ileum medial to the cecum (above right and below).

The diagnosis was fatty infiltration of the liver, acute pancreatitis with pseudocyst and chronic pancreatitis, distal intestinal obstruction syndrome, and normal appearance of the appendix in a patient with cystic fibrosis.

Preschooler with cough and fever

CXR of military tuberculosis — CXR AP shows right hilar lymphadenopathy and innumerable small pulmonary nodules that are uniformly distributed throughout the lungs.

The diagnosis was miliary tuberculosis pneumonia.

Teenager with left lower quadrant pain

CT of gastrostomy tube tip in subcutaneous tissues — Axial (above left) and sagittal (above right) CT with contrast of the abdomen shows the anchoring balloon and tip of the gastrostomy tube are in the subcutaneous tissues of the anterior abdominal wall rather than in the stomach. Lateral image from an injection of the gastrostomy tube (below) shows contrast flowing through the gastrostomy tube track and entering the stomach. Again, the gastrostomy tube anchoring balloon and tip of the gastrostomy tube are not in the stomach.

The diagnosis was gastrostomy tube malfunction with migration of the gastrostomy tube tip out of the stomach.

School ager with forearm pain after fall

Radiograph of Monteggia fracture dislocation — AP (left) and lateral (right) radiographs of the forearm show a fracture of proximal ulna, disruption of radioulnar joint, and dislocation of the radial head.

The diagnosis was Monteggia fracture dislocation.

Teenager after motor vehicle accident

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line oriented perpendicular to the long axis of the petrous temporal bone that goes through both walls of the carotid canal. There was a small amount of intracranial air. The right interal carotid artery was normal in appearance on a subsequent CT angiogram.

The diagnosis was right transverse temporal bone fracture.

School ager with left groin pain

Radiograph of ischiopubic synchondrosis asymmetry — AP radiograph of the pelvis shows a normally fused right ischiopubic synchrondrosis while the left ischiopubic synchondrosis is asymmetrically enlarged in appearance.

The diagnosis was ischiopubic synchondrois asymmetry on the left side.

Toddler with right testicular swelling

US of testicular microlithiasis — Sagittal US of the left testicle (above) shows multiple punctate calcifications throughout the testicle. Sagittal US of the right testicle (below) again shows multiple punctate calcifications throughout the testicle. There is also an anechoic structure superior and inferior to the right testicle.

The diagnosis was bilateral testicular microlithiasis and a right hydrocele.

Preschooler after an alkaline (lye) ingestion

UpperGI of corrosive esophagitis due to lye ingestion — Lateral image from an upper GI exam obtained 2 weeks after the ingestion (left) shows mild esophageal ulceration and atony of the esophagus. Lateral image from an upper GI exam obtained 4 weeks after the ingestion (right) shows multiple stricture in the mid and distal esophagus.

The diagnosis was corrosive esophagitis due to an alkaline (lye) ingestion.

School ager with a cough

Airway radiograph of airway foreign body in the pyriform sinus — Lateral radiograph of the airway shows a linear radiopaque foreign body in the airway anterior to the C2 and C3 vertebral bodies.

The diagnosis was airway foreign body in the pyriform sinus.

School ager whose pacemaker is not firing correctly

CXR of broken cardiac pacemaker lead. — CXR AP shows the cardiac pacemaker lead in the middle of the heart is not intact radiographically while the other two pacemaker leads are intact radiographically.

The diagnosis was cardiac pacemaker lead malfunction in the form of a pacemaker lead fracture.

Teenager who fell

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line perpendicular to the right petrous temporal bone long axis (left) and a small amount of intracranial air (right). The mastoid air cells are opacified.

The diagnosis was transverse fracture of the right temporal bone.

Toddler with developmental delay who had a seizure and fell on the floor

Head CT of hypoparathyroidism and cavum septum pellucidum and cavum vergae — Axial (above) and coronal (below) CT without contrast of the brain shows multiple bilateral calcifications in the subcortical white matter. There are additional CSF spaces present between the leaflets of the septum pellucidum and anterior to the splenium of the corpus callosum.

The diagnosis was hypoparathyroidism in a patient with cavum septum pellucidum and cavum vergae.

Teenager with neurofibromatosis type I and knee pain

Radiograph of multiple non ossifying fibromas in Jaffe Campanacci Syndrome — AP and lateral radiographs of the knee show multiple lucent lesions with thin sclerotic margins in the metaphysis of the femur, tibia and fibula.

The diagnosis was multiple non ossifying fibromas in Jaffe Campanacci Syndrome in a patient with neurofibromatosis type I.

School ager with incontinence

CT of spinning top urethra — Coronal MIP simulating an intravenous pyelogram (above left), coronal (above right) and axial (below) CT urogram with contrast shows the right kidney to be duplicated. There were normal ureteral insertions bilaterally into the bladder (not pictured). There was an oval structure inferior to the bladder that appeared to be the posterior urethra.

The diagnosis was spinning top urethra in a patient with a right duplicated kidney.

School ager with long standing dysphagia and no other significant history

Upper GI of congenital esophageal stenosis — AP (left) and lateral (right) images from an upper GI exam show a fixed, smoothly tapered, concentric, long narrowing of the esophageal lumen of the mid to distal esophagus.

The diagnosis was congenital esophageal stenosis.

Newborn with hydrops fetalis after bilateral chest tube placement

CXR of chest tube in the subcutaneous tissues. — CXR AP shows body wall thickening. The tip of the left chest tube is in the left pleural space and there is a small left pleural effusion. The tip of the right chest tube is in the right subcutaneous tissues. There is a small right pleural effusion

The diagnosis was chest tube malfunction with the tip of the right chest tube in the subcutaneous tissues of the right chest wall in a patient with hydrops fetalis.

Toddler after feeding tube placement

CXR of feeding tube tip malposition in the cervical esophagus — CXR AP shows a feeding tube which courses into the stomach and then loops back upon itself and reenters the esophagus and whose tip lies at the level of C6.

The diagnosis was feeding tube malfunction with malposition of the feeding tube tip in the cervical esophagus.

School ager with ankle pain after a fall

Radiograph of triplane fracture of the ankle — AP (left), lateral (center) and oblique (right) radiographs of the ankle show a fracture line that is in the sagittal plane on AP view and in the axial and coronal planes on the lateral view.

The diagnosis was triplane fracture.

Preschooler with vomiting and headaches

MRI of tectal glioma — Sagittal T1 MRI without contrast of the brain (above left) shows an isointense lesion in the tectum and in the pineal gland which on sagittal FLAIR (above right) appears to shows low signal intensity representing perhaps calcification in its pineal component. The lesion is causing dilation of the third ventricle. Axial T2 MRI (below left) shows dilation of the lateral ventricles and transependymal flow of cerebral spinal fluid. Axial T1 MRI with contrast (below right) shows enhancement in the mass.

The diagnosis was tectal glioma that may also involve the pineal gland.

Preschooler with a limp

Radiograph of growth arrest lines in the long bones — AP radiograph of the lower extremity shows two dense fine lines in the proximal metaphysis of the femur, and in the proximal and distal metaphyses of the tibia and fibula.

The diagnosis was growth arrest lines.