Preschooler who was suspected of swallowing an object

AXR of a button battery gastrointestinal foreign body — AXR AP (above) shows a round radiopaque foreign body in the stomach which is oriented laterally and has a beveled edge / step off. AXR lateral (below) shows the radiopaque foreign body to have a halo / double rim appearance.

The diagnosis was a gastrointestinal foreign body in the form of a button battery.

School ager with cough and fever

CXR and CT of pulmonary tuberculosis — CXR AP and lateral (above) shows a right paratracheal mass. Axial CT with contrast of the chest (below) shows multiple confluent right paratracheal lymph nodes that extend inferiorly to the level of the carina.

The diagnosis was pulmonary tuberculosis.

Preschooler having difficulty with gastrojejunostomy feedings

AXR of gastrojejunostomy tube that has been pulled back into stomach — AP image obtained immediately after placement of a gastrojejunostomy tube and contrast injection through it (above) shows the tip of the gastrojejunostomy tube to be in good position in the proximal jejunum. AXR AP obtained 1 month later (below) shows the tip of the gastrojejunostomy tube to be in the stomach. A ventriculoperitoneal shunt is also present.

The diagnosis was gastrojejunostomy malfunction with pulling back of the jejunostomy tube tip out of the jejunum and into the stomach.

Teenager who was hit in the right eye by an elbow

CT of subtle orbital blowout fracture — Coronal CT without contrast of the orbits obtained immediately after the injury in soft tissue (above left) and bone (above right) windows show a very small amount of soft tissue herniated into the roof of the right maxillary sinus. No fracture line was identified. Repeat coronal CT without contrast of the orbits obtained two days after the injury in soft tissue (below left) and bone (below right) windows now shows a large amount of soft tissue herniated into the roof of the right maxillary sinus.

The diagnosis was right orbital blowout fracture. In the operating room there was entrapment of the right inferior rectus muscle which was ischemic.

School ager hit by a car while riding their bicycle

CT of non fusion of left synchondrosis of C1 — Axial CT without contrast of the cervical spine shows non-fusion of the left synchondrosis in the C1 vertebral body.

The diagnosis was congenital developmental anomaly of the cervical spine with non fusion of the left C1 synchonrosis.

Teenager who punched his bed frame as he was falling out of bed

Radiograph of boxer's fracture — AP (left) and oblique (right)radiographs of the hand show an angulated and minimally displaced fracture of the metaphysis of the fifth metacarpal.

The diagnosis was boxer fracture of the fifth metacarpal.

Teenager with syncope and vaginal bleeding who has a positive betaHCG test and who denies sexual activity

CT of ruptured ectopic pregnancy — Sagittal CT with contrast of the abdomen (above left) shows in the pelvis from anterior to posterior – a fluid filled bladder, an enhancing uterus, and a solid appearing homogenous mass compressing the rectum behind it. Coronal CT (above right) shows a large amount of free fluid in the pelvis tracking up around the liver. Axial CT (below) again shows the mass anterior to the rectum. The mass was felt to be arising from the left adnexa.

The diagnosis was ruptured ectopic pregnancy.

Toddler with new abdominal pain who also has had a long standing cough

Small bowel follow through of gastrointestinal tuberculosis of the terminal ileum — AP image from late in a small bowel follow through exam shows contrast exiting the small bowel and beginning to fill the cecum and ascending colon. The terminal ileum in the right lower quadrant is narrowed with only a thin string of contrast within it. The cecal pole is also somewhat narrowed in appearance.

The diagnosis was gastrointestinal tuberculosis involving the terminal ileum.

Toddler with a cough after being seen placing a peanut in their mouth

Decubitus CXR of airway foreign body — Right lateral decubitus CXR (left) shows deflation of the right lung when placed in a dependent position. Left lateral decubitus CXR (right) shows lack of deflation of the left lung when placed in a dependent position and note the left lung remains hyperlucent when compared to the right lung.

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

Infant having difficulties with tube feedings

AXR of feeding tube tip in stomach — AXR AP (above) shows a feeding tube that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine with its tip projecting in the left upper quadrant and this is also demonstrated on the pre-tube injection scout image (below left). Injection of contrast through the tube (below right) showed the tip was in the stomach.

The diagnosis was feeding tube malfunction with pulling back of the feeding tube tip out of the duodenum and into the stomach.

Infant with in-utero exposure to a sexually transmitted disease

Radiograph of Wimberger's sign in syphilis — AP radiograph of the lower extremity shows diffuse periostitis of the tibia and some destructive changes on the medial proximal metaphysis of the tibia (Wimberger’s sign).

The diagnosis was syphilis.

School ager with ventriculoperitoneal shunt and new headache

MRI of overshunting of the lateral ventricles — Axial T2 MRI without contrast of the brain from 1 year ago (left) shows normal size of the anterior and posterior horns of the lateral ventricles. The tip of the ventriculoperitoneal shunt (not shown) was in a correct position. Axial T2 MRI without contrast of the brain from today (right) shows interval decrease in size of the anterior and posterior horns of the lateral ventricles which appear slit-like. The tip of the ventriculoperitoneal shunt (not shown) was in a correct position.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of overshunting in a patient with a ventriculoperitoneal shunt.

Teenager with a palpable right upper chest wall mass

CXR of a bifid rib — CXR AP at 1 day of life (above) shows the right third rib to bifurcate starting posteriorly into two separate ribs. CXR AP today at 16 years of age (below) clearly shows the two heads of the right third rib.

The diagnosis was right third bifid rib.

Preschooler with left upper quadrant pain

CT of clear cell sarcoma of the kidney — Axial CT with contrast of the abdomen (above) shows a round, heterogenously enhancing, well-defined lesion arising from the medulla of the left kidney that demonstrates a claw sign. There is also a round focus of high density in the center of the mass anteriorly. Coronal CT (below) shows fluid in the left perirenal and pararenal spaces.

The diagnosis was clear cell sarcoma of the kidney with active hemorrhage into the tumor.

Toddler with abdominal pain who also has a long standing cough

AXR of gastrointestinal tuberculosis — AXR AP shows multiple scattered punctate calcifications just to the right of the L3 and L4 vertebral bodies. A dilated loop of distal small bowel is seen in the left lower quadrant.

The diagnosis was gastrointestinal tuberculosis involving multiple abdominal lymph nodes in the right lower quadrant.

Preschooler with cough and fever

CXR of tuberulosis pneumonia — CXR lateral (right) shows hilar lymphadenopathy which lateralizes to the left on the CXR AP (left) which also shows a dense consolidation in the left upper lobe.

The diagnosis was primary tuberculosis pneumonia in the left upper lobe.

Toddler with heterotaxy syndrome

US and upper GI of malrotation without midgut volvulus in heterotaxy syndrome — Transverse color doppler US of the abdomen (below left) shows an apparent reversal of the normal positions of the superior mesenteric artery and superior mesenteric vein. This is confirmed on the spectral doppler US of the aforementioned mesenteric vessels (above). AP image from an upper GI exam (below right) shows situs inversus with levocardia and the stomach in the right upper quadrant. The duodenum is redundant and the duodenal jejunal junction is over the right pedicle of the T11 vertebral body. The cecum was in the midline.

The diagnosis was malrotation without midgut volvulus in a patient with heterotaxy syndrome.

Preschooler who fell on to their arm

Radiograph of greenstick fracture — AP (above) and lateral (below) radiographs of the forearm show incomplete nondisplaced fractures through the diaphysis of the radius and the ulna.

The diagnosis was greenstick fracture of the radius and ulna.

Newborn with a sacral dimple

US and MRI of tethered cord — Sagittal US of the spine (above) shows an extremely low lying conus which appears to extend as far as S1. Sagittal T2 MRI without contrast of the spine (below) shows the conus to be located around L5-S1.

The diagnosis was tethered cord.

Teenager with a distal thigh mass

Radiograph of osteochondroma — AP (left) and lateral (right) radiographs of the knee show a pedunculated cartilage-capped lesion on a bony stalk in the metaphysis of the femur that is growing away from the physis.

The diagnosis was osteochondroma.

Newborn female with a multicystic dysplastic kidney being investigated for vesicoureteral reflux

VCUG showing a vaginogram — Scout image from a voiding cystourethogram exam (above) shows a urinary catheter looped within the pelvis. AP image (below left) obtained after the introduction of contrast through the catheter shows filling of a structure that does not conform to the expected contour of the bladder and whose inferior aspect lies very low in the pelvis. Lateral image (below right) shows a filling defect on the superior aspect of the structure which represents the cervix projecting into a contrast-filled vagina.

The diagnosis was inadvertent performance of a vaginogram in a patient with possible vesicoureteral reflux.

Newborn with bilious vomiting who has passed meconium

Upper GI of ileal atresia — AP image from an upper GI exam (above) shows the duodenal jejunal junction to be over the left pedicle of the T12 vertebral body in a normal position. AP image obtained 30 minutes later (below) shows progressive passage of contrast into several extremely dilated loops of proximal jejunum.

The diagnosis was ileal atresia.

School ager with shortness of breath

CXR and CT of mediastinal teratoma — CXR AP (above) shows a large mass filling the thorax. Axial CT without contrast of the chest (below) shows a heterogenous mass centered in the anterior mediastinum that has a large round low density component in the right thorax and several focal areas of high density scattered within it.

The diagnosis was mediastinal teratoma.

School ager with hypertension and neurofibromatosis Type 1

CT of midaortic syndrome — Axial CT with contrast of the abdomen shows the aorta to have a normal caliber in the upper abdomen (above left) and a markedly decreased caliber in the mid-abdomen (above right). Sagittal CT (below left) shows a long length of progressive narrowing of the mid-abdominal aorta. 3D CT (below right) shows moderate stenosis of the abdominal aorta from T12 to L2 and severe ostial stenosis of the celiac artery and superior mesenteric artery and the bilateral renal arteries. The inferior mesenteric artery is enlarged with robust collaterals to the celiac and superior mesenteric circulations. There is sparing of the aortic bifurcation and iliac arteries.

The diagnosis was midaortic syndrome in a patient with neurofibromatosis Type 1.

Teenager who fell and twisted their foot and now has pain at the base of the fifth metatarsal

Radiograph of 5th proximal metatarsal fracture (Jone's fracture) — AP radiograph of the foot shows a transverse lucency through the base of the fifth metatarsal.

The diagnosis was a fifth metatarsal fracture.