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.

School ager with acute right lower quadrant pain

CT of acute pyelonephritis — Coronal (above) and axial (below) CT with contrast of the abdomen shows three peripheral wedge shaped areas of low density in the middle and lower right kidney.

The diagnosis was acute pyelonephritis of the right kidney.

School ager who 6 years ago had massive hilar lymphadenopathy which eventually resolved with new cough and fever

CXR and CT of recurrent pulmonary fungal infection in chronic granulomatous disease — CXR AP and lateral (above) shows massive bilateral hilar lymphadenopathy and bilateral multiple small lung nodules. Axial CT with contrast of the chest in soft tissue (below left) and lung (below right) windows shows the lymphadenopathy and lung nodules to contain punctate calcifications.

The diagnosis was recurrent pulmonary fungal infection in a patient with chronic granulomatous disease.

Toddler who was seen to eat something they should not have eaten

CXR of a foreign body in the airway and the esophagus in the form of an earing — CXR AP (left) shows a linear radiopaque object projecting over the trachea. CXR lateral (right) shows the anterior portion of the radiopaque object to project over the trachea and its posterior portion to project over the esophagus.

The diagnosis was an earing whose wire was an airway foreign body and whose ornament was a gastrointestinal foreign body.

Premature newborn after replacement of a nasogastric tube

CXR of a nasogastric tube that has perforated out of the esophagus into the right upper quadrant of the abdomen — Baseline CXR AP (left) shows the tip of the nasogastric tube to project appropriately over the body of the stomach. CXR AP after nasogastric tube replacement (right) shows the tip of the feeding tube to project over the right upper quadrant of the abdomen.

The diagnosis was nasogastric tube malfunction with the tip of the nasogastric tube placed outside the stomach.

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.