Teenager who stepped on a pencil in their bare feet

Radiograph of pencil tip in the subcutaneous soft tissues of the foot — Lateral radiograph of the ankle shows a faintly radiopaque pointed object in the heel of the foot as indicated by the arrow.

The diagnosis was a foreign body in the soft tissues of the heel in the form of a pencil tip.

Infant who had suffered non-accidental trauma

MRI of spinal subdural hematoma — Sagittal T1 MRI without contrast of the spine (left) shows a small linear high signal intensity fluid collection posterior to the C7 vertebral body that is low signal intensity on sagittal T2 MRI (middle) and dark on sagittal GRE MRI (right).

The diagnosis was spinal subdural hematoma.

Newborn who experienced shoulder dystocia during delivery and now has pain when the left arm is moved

Radiograph of humerus fracture — AP radiograph of the upper extremity shows a fracture line through the diaphysis of the humerus. The fracture fragments are not in anatomic alignment and apposition.

The diagnosis was fracture of the proximal humerus.

Teenager with Factor 8 deficiency who took a knee to the left groin and now has back pain

CT of retroperitoneal hematoma of psoas muscle and iliacus muscle — Axial CT with contrast of the abdomen shows asymmetrical enlargement of the left psoas muscle and left iliacus muscle.

The diagnosis was retroperitoneal hematoma in the left psoas and left iliacus muscles.

School ager with abdominal pain

Small bowel followthrough of Crohn disease — Spot image from an upper GI small bowel followthrough exam (left) shows a long segment of ileum on the right of the image that has lost its normal folds, is narrowed in caliber, and has a cobblestone appearance. Spot image of the terminal ileum (right) shows it also lacks its normal folds and is narrowed in caliber. Inflammatory changes are also noted in the cecum.

The diagnosis was Crohn disease affecting the distal ileum and terminal ileum.

Toddler with cough and fever

CXR of pulmonary tuberculosis — CXR AP shows an extensive amount of right hilar lymphadenopathy.

The diagnosis was tuberculosis pneumonia.

Toddler after a gastrostomy tube change

Fluoroscopy of gastrostomy tube tip in peritoneal cavity — AP radiograph of the abdomen after injection of water soluble contrast through the gastrostomy tube shows contrast outlining the spleen and several loops of small bowel. There is no contrast in the stomach.

The diagnosis was gastrostomy tube malfunction with the tip of the gastrostomy tube in the peritoneal cavity.

School ager who fell off a motorcycle

CT of longitudinal temporal bone fracture — Axial CT without contrast of the temporal bones shows a fracture line running parallel to the long axis of the right petrous temporal bone. Disruption of the ossicles is also present.

The diagnosis was a right longitudinal temporal bone fracture.

School ager with new headaches

MRI of acute cerebellitis — There is loss of differentiation of the cerebellar folia due to cerebellar edema seen as the cerebellar folia having low signal intensity on axial T1 MRI without contrast (below left), high signal intensity on axial T2 MRI (above right) and mild enhancement on axial T1 MRI with contrast (below right). The ventricular system is also dilated on axial T2 MRI (above left).

The diagnosis was acute cerebellitis.

Teenager who hurt their knee playing football

Radiograph of tibial plateau fracture — AP radiograph of the knee (left) shows a linear lucency associated with the medial aspect of the proximal metaphysis. Lateral radiograph (right) shows a linear lucency associated with the posterior aspect of the metaphysis.

The diagnosis was tibial plateau fracture.

Teenager with fever and abdominal pain

CT of retroperitoneal fasciitis — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the abdomen shows a large of amount of air in the right posterior pararenal space with associated fat stranding. The appendix was normal in size and there was an appendicolith that was outside of the appendix (not provided).

The diagnosis was right retroperitoneal fasciitis due to perforated appendicitis.

School ager with fevers who is 1 week postop from surgery for perforated appendicitis

CT of abdominal abscesses — Axial CT with contrast of the abdomen and pelvis shows low density fluid collections with enhancing rims anterior to the spleen (above), in the right pelvis (middle) and posterior to the bladder and anterior to the rectum (below).

The diagnosis was perisplenic, pelvic, and perirectal abdominal abscesses due to perforated appendicitis.

Infant with chronic cough and wheezing

CT of neuroendocrine cell hyperplasia — Coronal (above) and axial (below) CT without contrast of the chest shows focal increased lucency in the right middle lobe and lingula indicating hyperinflation of the right middle lobe and lingula.

The diagnosis was neuroendocrine cell hyperplasia.

Teenager whose gastrostomy jejunostomy tube was replaced with difficulty 1 day before and now has abdominal pain and pneumoperitoneum on AXR

Jejunostomy tube injection showing jejunostomy tube tip is in peritoneum. — AP image obtained after injection of contrast through the jejunostomy port shows that contrast is not in the jejunum and instead is in the peritoneum.

The diagnosis was gastrostomy jejunostomy tube malposition in the form of the jejunostomy tube tip being in the peritoneal cavity.

School ager with leg pain

Radiograph of stress fracture of proximal tibia — AP (left) and lateral (right) radiographs of the tibia and fibula show a double density in the tibial metaphysis which has periosteal reaction associated with it medially and posteriorly.

The diagnosis was stress fracture of the proximal tibia.

Teenager with midline back pain

CT of Schmorl nodes — Sagittal CT without contrast of the thoracic spine shows nodular lucent lesions along the superior and inferior aspects of multiple vertebral bodies with some of these lesions having sclerotic margins.

The diagnosis was Schmorl nodes.

Teenager with leukemia and pancytopenia and knee pain

MRI of avascular necrosis of knee — Sagittal T1 (left) and STIR (right) MRI without contrast of the knee show a large knee joint effusion along with well demarcated serpiginous lesions in the distal femur and proximal tibia that on STIR images demonstrate the double line sign.

The diagnosis was avascular necrosis of the knee.

Teenager with an incidental renal cyst containing calcium on US

CT of renal milk of calcium cyst — Coronal (above left), sagittal (above right) and axial (below left) CT without contrast of the abdomen show a round low density lesion in the inferior pole of the right kidney that has a cresenteric calcification next to the wall of its inferior-posterior aspect. Axial CT with contrast of the abdomen (below right) more clearly shows the calcification next to the wall of the inferior-posterior aspect of the low density lesion in the kidney.

The diagnosis was renal milk of calcium cyst.

Infant with vomiting after feeding

UGI of gastroesophageal reflux — AP sequential images from an upper GI exam show contrast flowing in a retrograde manner from the stomach back up into the esophagus, reaching ultimately the level of the thoracic inlet (not shown).

The diagnosis was a moderate to marked amount of gastroesophageal reflux.

Infant with cough and fever

CXR of pulmonary tuberculosis — CXR AP (above) shows a large amount of right hilar adenopathy. Axial CT without contrast of the chest (below left) shows right hilar and subcarinal adenopathy while the CT (below right) shows the right lower lobe atelectasis caused by the adenopathy.

The diagnosis was tuberculosis pneumonia.

Infant whose feeding tube cannot be flushed and fed through

CXR of aneurysmal dilation of feeding tube — CXR AP shows a feeding tube with its tip projecting over the proximal jejunum. Incidentally noted is an aneurysmal dilation of the feeding tube just beneath the level of the thoracic inlet.

The diagnosis was feeding tube malfunction due to aneurysmal dilation of its proximal portion.

Infant who fell 4 feet

CT of ping pong fracture of skull — Axial (above left) and coronal (above right) CT without contrast of the brain show a depression in the left side of the skull. There was no intracranial hemorrhage. The depression is better seen on the 3D CT (below).

The diagnosis was a depressed ping pong fracture of the skull.

Teenager with pharyngitis and trismus

CT of peritonsillar abscess — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the neck show an enlarged left palatine tonsil with a low density round lesion lateral to it and associated inflammatory change in the left parapharyngeal space.

The diagnosis was peritonsillar abscess.

Infant with hepatosplenomegaly, jaundice, and a maculopapular rash

Radiograph of syphilis of long bones — AP radiograph of the knee at presentation (left) shows faint periostitis of the distal femur and proximal tibia and fibula. There is a metaphyseal lucency present along the proximal portion of the medial aspect of the tibial metaphysis (Wimberger corner sign). Repeat radiograph obtained 2 months later while on therapy (right) shows dense periostitis of the bones with resolution of the lesion previously seen on the proximal medial tibial metaphysis.

The diagnosis was syphilis.

Female teenager with acute onset of right lower quadrant pain and nausea and vomiting

CT of ovarian cystadenoma — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the abdomen show a large, well circumscribed, homogenous, non-enhancing, fluid density mass that fills the width of the lower abdomen and pelvis and lies superior and separate from the bladder and uterus. Neither ovary was clearly identified.

The diagnosis was ovarian cystadenoma.