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.

School ager with gastroesophageal reflux

UGI of malrotation without midgut volvulus — AP image from an UGI exam shows the duodenal-jejunal junction is just to the right of the spine at the level of the L2 vertebral body and is low in position, being beneath the level of the duodenal bulb.

The diagnosis was malrotation without midgut volvulus.

Toddler with wheezing

CXR of pulmonary tuberculosis — CXR AP taken in expiration shows hyperinflation of the right lung with mediastinal shift to the left due to asymmetrical air trapping in the right lung on expiration.

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

Premature newborn after placement of a nasogastric tube

Upper GI of esophageal perforation caused by nasogastric tube — AXR AP (above left) shows the nasogastric tube to follow a rather straight course into the abdomen. There is increased lucency in the upper abdomen. Subsequent AXR decubitus (above right) shows free air between the abdominal wall and liver. AP view obtained 9 days later immediately after the injection of water soluble contrast through the nasogastric tube (below left) shows some contrast extravasating out of the esophagus into the mediastinum and some contrast entering the stomach. Lateral view obtained 15 minutes later (below right) shows contrast outlining the left pleural space.

The diagnosis was nasogastric tube malposition with the nasogastric tube causing esophageal perforation.

Teenager with right wrist pain after trauma

Radiograph of scaphoid fracture — AP radiograph of the wrist (left) shows a double density over the scaphoid bone. Scaphoid view (right) shows a lucency through the waist of the scaphoid bone with displacement of the fracture fragments.

The diagnosis was scaphoid fracture.

School ager with severe combined immune deficiency and right facial swelling and tenderness

CT of pediatric parotitis — Axial (above) CT with contrast of the face shows lymphoepithelial cysts in the parotid glands bilaterally. Coronal CT (below) shows the right parotid gland is enlarged and hyperemic and surrounded by inflammation. A right intraparotid lymph node is present.

The diagnosis was right parotitis.

Preschooler with left hip pain

Radiograph of Meyer dysplasia — AP radiograph of the hips shows a normal appearing left hip. There is flattening and sclerosis of the right femoral epiphysis which may have multiple ossification centers and there is also right metaphyseal subcortical cystic change.

The diagnosis was Meyer dysplasia.

Female teenager with abdominal pain

CT of uterus didelphys or bicornuate uterus — Sequential axial CT with contrast of the abdomen shows a fluid-filled bladder in the anterior aspect of the pelvis that has a soft tissue structure posterior to it, believed to be the uterus, that is composed of what appear to be left and right horns.

The diagnosis was Mullerian duct anomaly in the form of a uterus didelphys or a bicornuate uterus.

Newborn who is having difficulty handling their secretions

CXR of esophageal atresia without tracheo-esophageal fistula — CXR AP (above left) shows the chest to be unremarkable aside from a right sided aortic arch. However, there is no air seen within the gastrointestinal tract. CXR lateral (above right) shows the proximal esophagus behind the trachea to be very dilated. CXR obtained after placement of a nasogastric tube (below) shows the nasogastric tube to be looped within the proximal esophagus.

The diagnosis was esophageal atresia without tracheo-esophageal fistula.

Preschooler with cough and fever

CXR of tuberculosis pneumonia — CXR AP and lateral show bilateral hilar lymphadenopathy and dense consolidation in the right middle lobe.

The diagnosis was tuberculosis pneumonia.

Toddler whose gastrostomy tube was just replaced with difficulty

Gastrostomy tube injection showing tube in retroperitoneum — AP (left) and lateral (right) images after the injection of water soluble contrast through the gastrostomy tube show the injected contrast is not in the stomach but is outlining the haustra of the colon.

The diagnosis was gastrostomy tube malposition with the tip of the gastrostomy tube in the retoperitoneum.

Teenager who jammed their finger in a door

Radiograph of Salter Harris Type III phalanx fracture — Lateral radiograph of the hand shows a fracture line through the physis and extending into the epiphysis of the fourth middle phalanx. There is a fracture fragment displaced dorsally.

The diagnosis was Salter Harris Type III fracture of the fourth middle phalanx.

Teenager in a motor vehicle accident

CT of mastoid fracture — Axial CT without contrast of the maxillofacial bones shows a linear lucent line through the lateral aspect of the right mastoid bone with resultant opacification of the mastoid air cells. There was associated diastasis of the right lambdoid suture.

The diagnosis was right mastoid fracture.

Infant with a maculopapular rash on the buttocks

Radiograph of syphilis — AP radiographs of the bilateral lower extremities show diffuse, thick, symmetric periosteal reaction bilaterally. There is a suggestion of a metaphyseal notch on the proximal medial right tibial metaphysis (Wimberger corner sign).

The diagnosis was syphilis.

Female teenager with right lower quadrant pain

MRI of unicornuate uterus — Sequential coronal T2 MRI without contrast images of the pelvis show the uterus to consist of a single fluid filled dilated right horn (above) which empties into the vagina (below).

The diagnosis was Mullerian duct anomaly in the form of right unicornuate uterus.

Infant with bilious vomiting

Upper GI of malrotation with midgut volvulus — AP image from an upper GI exam shows the contrast filled stomach in the upper right of the image emptying into the duodenal bulb which is just to the right of the spine. The position of the duodenal-jejunal junction is not well defined and it may be in the right upper quadrant or in the left upper quadrant. In either case, it is well below the level of the duodenal bulb and therefore is malpositioned.

The diagnosis was malrotation with midgut volvulus.

Toddler with new coughing and wheezing

CXR of airway foreign body in right mainstem bronchus — Inspiratory CXR (above) shows normal symmetrical aeration of the lungs bilaterally. Expiratory CXR (below) shows asymmetrical increased aeration (seen as increased lucency) of the right middle and lower lobes compared to the remainder of the lungs due to air trapping in the right middle and lower lobes.

The diagnosis was airway foreign body due to a peanut in the distal right mainstem bronchus.

Young adult with a gastrojejunostomy tube and chronic abdominal pain

CT of gastrojejunostomy tube causing duodenal-jejunal intussusception — Axial (above) CT with contrast of the abdomen shows a round soft tissue mass to the right of the vertebral body that has a target sign appearance and that has a jejunostomy tube coursing in the center of it. Coronal CT (below) shows the soft tissue mass to be long in length and to comprise the second and third parts of the duodenum and the proximal jejunum and to have the jejunostomy tube coursing throughout its length.

The diagnosis was gastrojejunostomy tube malfunction due to the formation of a duodenal-jejunal intussuception forming around the tip of the jejunostomy tube.