Infant with a port-wine stain in the left V1 distribution

MRI of Sturge-Weber syndrome — Axial (above left), coronal (above right) and sagittal (below) T1 MRI with contrast of the brain shows left-sided diffuse, marked leptomeningeal enhancement. There is mild cortical atrophy of the left cerebral hemisphere.

The diagnosis was Sturge-Weber syndrome.

School ager with right hip pain after a motor vehicle accident

Radiograph of posterior hip dislocation — AP radiograph of the pelvis (on a trauma board) shows the right femoral head to be dislocated posteriorly.

The diagnosis was right traumatic posterior hip dislocation. There are no fractures.

School ager with fever and abdominal pain

CT of acute pyelonephritis and chronic pyelonephritis in the same kidney — Axial CT with contrast of the abdomen (above) shows the left kidney to have a striated nephrogram appearance with multiple wedge-shaped areas of low density in the left kidney. Coronal CT (below) shows the low density areas are in the upper pole of the left kidney. The lower pole of the left kidney is shrunken and scarred.

The diagnosis was acute pyelonephritis in the upper pole of the left kidney and evidence of chronic pyelonephritis in the lower pole of the left kidney.

Preschooler with intermittent abdominal distension and abdominal pain who has a past history of necrotizing enterocolitis

CT and enema of colonic stricture after necrotizing enterocolitis — AXR (above left) shows an extremely dilated structure in the mid abdomen filled with air and small radiopaque objects. Axial CT without contrast of the abdomen (above right) shows the dilated structure to be a loop of bowel containing stool and radiopaque foreign bodies. AP image from an enema (below left) shows a dilated ascending colon, an extremely dilated transverse colon, and normal caliber of the descending colon and sigmoid colon. Oblique views of the splenic flexure (not provided) showed a very tight stricture there.

The diagnosis was a very tight stricture at the splenic flexure due to previous necrotizing enterocolitis. The radiopaque objects were a mixture of plant seeds and shells from nuts and various other ingested foreign bodies (below right) that could not make it past the stricture.

Preschooler with sore throat, stridor, and drooling

Radiograph of epiglottitis — Lateral radiograph of the airway at presentation (left) shows a swollen epiglottis (thumb sign) and thickened aryepiglottic folds. Lateral radiograph of the airway taken after 3 days of antibiotic therapy (right) shows an interval decrease in the amount of swelling of the epiglottis and aryepiglottic folds.

The diagnosis was epiglottitis.

Teenager with a bump on the right side of the skull

CT of arachnoid granulation — AP radiograph of the skull (above left) shows a lucent lesion that arises just to the left of the midline at the vertex of the skull. Bone windows from a coronal CT without contrast of the brain (above right) shows thinning of the inner table of the calvarium in that region. Soft tissue windows from sagittal (below left) and coronal CT (below right) show a cerebrospinal fluid density mass at the left parasagittal region adjacent to the superior sagittal sinus associated with the well-defined thinning of the inner table of the calvarium.

The diagnosis was arachnoid granulation.

Teenager with a cough

CXR of Kartagener syndrome — CXR AP (left) shows dextrocardia while the stomach is in the right upper quadrant. There are cystic changes in the lower lobes bilaterally which are best visualized on the CXR lateral (right).

The diagnosis was Kartagener syndrome with bronchiectasis.

Toddler who after a fall was found to have a left non reactive pupil and left leukocoria

CT of retinoblastoma — CT without contrast of the brain shows a round hyperdense lesion almost completely filling the left globe.

The diagnosis was retinoblastoma.

Teenager with severe left hip pain

Radiograph of slipped capital femoral epiphysis — AP radiograph of the pelvis (left) and AP radiograph of the left hip (right) shows left femoral head physeal widening, with the femoral head slipping posteromedially as evidenced by the line of Klein drawn over lateral aspect of femoral neck not intersecting any of the femoral head.

The diagnosis was left slipped capital femoral epiphysis.

School ager with left flank pain who underwent a Deflux injection at the left ureterovesical junction 3 days ago and now has decreased urine output

US of acute ureteral obstruction after Deflux injection — Sagittal US of the right kidney (above left) was normal. Sagittal US of the left kidney (above right) showed new moderate hydronephrosis. Transverse US of the bladder (below left) showed a normal right ureteral jet. Transverse US of the bladder (below right) shows an oval echogenic structure near the left ureterovesical junction at the base of the bladder and a left ureteral jet which is markedly less than its counterpart on the right.

The diagnosis was left acute ureteral obstruction after Deflux injection for left vesicoureteral reflux.

Newborn with failure to pass meconium and bilious vomiting

Enema of meconium plug syndrome — AP image from a contrast enema exam (left) shows a long filling defect in the colon within a normal caliber colon. The cecum was noted to be in the left mid abdomen. The terminal ileum was not refluxed. AP image from an upper GI exam (right) shows that while the duodenal jejunal junction projects over the left pedicle of the spine it is much lower in position than the duodenal bulb.

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

Toddler with stridor who previously had undergone endotracheal intubation for a long period

Radiograph of tracheal granuloma — AP radiograph of the airway shows asymmetric narrowing of the proximal trachea due to a semi-circular mass arising from the right side of the proximal trachea.

The diagnosis was tracheal granuloma.

Teenager with multiple long bone fractures from a motor vehicle accident who now has respiratory distress

CXR of pulmonary fat embolism — CXR AP shows diffuse nodular infiltrates throughout the lungs, right greater than left.

The diagnosis was pulmonary fat embolism.

School ager who fell off their bike

Radiograph of Monteggia fracture dislocation — AP radiograph of the forearm shows a fracture of the proximal ulna, disruption of radioulnar joint, and radial head dislocation as the radial shaft line does not align / intersect with the capitellum.

The diagnosis was Monteggia fracture dislocation.

School ager with right eyelid swelling and redness and right eye pain

CT of orbital cellulitis and subperiosteal abscess — Axial CT with contrast of the orbits (above) shows opacification of the right ethmoid sinus, inflammatory changes within the right orbit, and a low density oval fluid collection with an enhancing wall between the right medial rectus muscle and the right ethmoid sinus. Coronal CT (below) shows how this fluid collection is displacing the right medial rectus muscle laterally.

The diagnosis was right ethmoid sinusitis causing right orbital cellulitis and subperiosteal abscess.

School ager who fell off the monkey bars and now has elbow pain

Radiograph of radial neck elbow fracture — Lateral radiograph of the elbow (left) shows elevation of the anterior and posterior fat pads due to a joint effusion and an abnormal orientation of the radial head. AP radiograph of the elbow (right) shows a complete fracture through the radial neck.

The diagnosis was radial neck elbow fracture.

Teenager with spinal dysraphism

US of bladder stone in neurogenic bladder — Transverse (above) and sagittal (below) US of the bladder shows a round echogenic mass in the base of the bladder that has posterior shadowing. The bladder wall is mildly thickened.

The diagnosis was bladder stone in a patient with neurogenic bladder.

Toddler with 4 days of abdominal pain and feculent vomiting

US and radiograph and air enema of ileocolic intussusception caused by Meckel diverticulum — Transverse US of the right lower quadrant (above) shows a round structure with a hyperechoic center and a hypoechoic rim (target sign). AXR supine (below left) shows multiple dilated loops of air-filled small bowel. Final AP image from an air enema exam (below right) shows an air filled colon with a large oval soft tissue mass in the cecum.

The diagnosis was an ileocolic intussusception resulting in a distal small bowel obstruction. The ileocolic intussusception could not reduced by air enema and at surgery the lead point for the ileocolic intussusception was found to be a Meckel diverticulum.