Preschooler who is HIV positive with respiratory distress

CXR of lymphoid interstitial pneumonia — CXR AP and lateral (above) show a diffuse, symmetrical, nodular infiltrate in the lungs bilaterally without hilar or mediastinal adenopathy. CXR AP obtained a year later (below) shows the nodular infiltrate has decreased slightly in the interval.

The diagnosis was lymphoid interstitial pneumonia.

Young adult who is coughing after feeding tube placement

AXR of feeding tube tip in the left mainstem bronchus — Initial AXR (left) shows the tip of the feeding tube in the left mainstem bronchus. Subsequent AXR after feeding tube repositioning (right) shows the feeding tube tip to be in the fundus of the stomach.

The diagnosis was feeding tube malfunction with the feeding tube tip in the left mainstem bronchus.

Teenager after a motor vehicle accident

Radiograph of a pelvis apophyseal avulsion fracture of the right anterior superior iliac spine and a pelvis fracture of the right iliac crest — AP radiograph of the pelvis shows an apophyseal avulsion fracture of the right anterior superior iliac spine and a laterally displaced fracture of the right iliac crest.

The diagnosis was a pelvis apophyseal avulsion fracture of the right anterior superior iliac spine and a pelvis fracture of the right iliac crest.

Teenager with papilledema

MRI of empty sella in idiopathic intracranial hypertension — Sagittal T1 MRI with contrast of the brain shows the pituitary gland to be thinned and flattened in appearance. Most of the sella is filled with cerebrospinal fluid.

The diagnosis was empty sella due to idiopathic increased intracranial hypertension.

Preschooler with unusual appearing feet

Radiograph of amniotic band syndrome of the feet — AP radiograph of the feet shows in the left foot there is amputation of most of the phalanges while in the right foot there is amputation of most of the first distal phalanx and the second middle and distal phalanges.

The diagnosis was amniotic band syndrome causing amputation of the phalanges of the feet.

Infant with renal failure

US of autosomal recessive polycystic kidney disease — Sagittal US of the right kidney shows the kidney to be enlarged, diffusely echogenic, and to be composed almost entirely of microcysts. The left kidney (not provided) was identical in appearance. The liver is echogenic in appearance as well.

The diagnosis was autosomal recessive polycystic kidney disease.

Toddler who had a Nissen fundoplication for gastroesophageal reflux a year ago who is now retching with feeding

Upper GI of para-Nissen herniation — AP (left) and lateral (right) images from an upper GI exam show the Nissen fundoplication wrap to be intact around the fundus of the stomach. However, part of the stomach has herniated above the level of the wrap.

The diagnosis was Nissen fundoplication malfunction in the form of a para-Nissen herniation.

Preschooler with a new cough

CXR of foreign body in the left mainstem bronchus — CXR AP shows hyperaeration and increased lucency of the left lung compared to the right lung. There is also mediastinal shift to the right.

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

Newborn with abdominal distension after nasogastric tube placement

CXR of nasogastric tube curled back upon itself in the esophagus — CXR AP shows a nasogastric tube curling back upon itself within the esophagus with the tip of the nasogastric tube located above the thoracic inlet.

The diagnosis was nasogastric tube malfunction with the nasogastric tube curled in the esophagus.

Teenager punched in the left eye

CT of left orbital blowout fracture — Coronal CT without contrast of the orbits in soft tissue (above) and bone (below) windows shows a fracture defect in the floor of the left orbit with fat herniating through it into the left maxillary sinus.

The diagnosis was left orbital blowout fracture.

Preschooler with left leg weakness and back pain

MRI of diffuse leptomeningeal glioneuronal tumor — Sagittal T1 MRI without contrast of the spine (above left) shows a focal protruberant intramedullary mass in the spinal cord at C7 and T1 that is hyperintense on sagittal T2 MRI (above center) and that on the sagittal T1 MRI with contrast (above right) enhances minimally. There is also thick leptomeningeal enhancement anterior and posterior to the cervical spine. The sagittal T1 MRI with contrast of the brain (below) shows thick leptomeningeal enhancement of the brain, particularly around the basal cisterns.

The diagnosis was diffuse leptomeningeal glioneuronal tumor.

Teenager with a painful, red, axillary mass.

US of subcutaneous abscess — Transverse US of the axilla centered on the palpable mass shows an oval hypoechoic lesion in the subcutaneous tissue.

The diagnosis was subcutaneous abscess.

School ager who fell and was stepped on by a horse

CT of autosomal dominant polycystic kidney disease — Axial CT with contrast of the abdomen (above left) shows a large laceration in the middle of the right lobe of the liver that is associated with a large amount of hemoperitoneum inferior to the liver (below left). Coronal CT (right) shows multiple large cysts scattered throughout the cortex and medulla in both kidneys.

The diagnosis was autosomal dominant polycystic kidney disease in a patient with a liver laceration.

School ager with abdominal pain and emesis

US of Meckel diverticulum — Transverse US of the abdomen (below) shows a non-peristalsing cystic lesion in the center of the image superiorly. Transverse US (above) shows a dilated loop of small bowel with an air-fluid level within it.

The diagnosis was Meckel diverticulum with a band of tissue coming off of it causing a small bowel volvulus and closed loop bowel obstruction resulting in small bowel ischemia.

Preschooler who was seen to swallow a foreign body and then start coughing

CXR of airway foreign body in left mainstem bronchus — CXR AP (above) shows hyperlucency of the left lung when compared to the right lung. Right lateral decubitus CXR (below left) shows appropriate collapse of the right lung when placed in a dependent position. Left lateral decubitus CXR (below right) shows inappropriate non-collapse of the left lung when placed in a dependent position.

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

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.