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.

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.