School ager with growth hormone deficiency

MRI of pituitary interrupted stalk syndrome
Sagittal (above) and coronal (below) T1 MRI without contrast of the sella shows absence of the pituitary stalk between the sella and the hypothlamus. In addition, the high signal intensity posterior pituitary bright spot, which should be located posteriorly in the sella turcica, is instead located in the inferior aspect of the hypothalamus.

The diagnosis was pituitary interrupted stalk syndrome and ectopic posterior pituitary.

School ager with hypopituitarism

MRI of craniopharyngioma
Lateral radiograph of the skull (top image) shows an enlarged sella turcica. Sagittal TI MRI without and with contrast of the sella (middle two images) shows a large heterogenous mass arising in the sella and extending superiorly into the suprasellar region that shows primarily rim enhancement with contrast. Coronal T2 MRI of the sella (bottom image) shows the sellar and suprasellar mass to have a high signal intensity implying it has cystic and or proteinaceous components.

The diagnosis was craniopharyngioma.

School ager with long standing headaches who just had a VP shunt placed

Radiograph and CT of copper beaten skull
AP and lateral radiographs of the skull (above) show throughout skull vault prominence of convolutional markings from gyral impressions on the inner table of the skull, which is also well demonstrated on the axial CT without contrast of the brain (below).

The diagnosis was copper beaten skull caused by long-standing hydrocephalus in a patient with aqueductal stenosis.

A patriotic toddler with increasing stridor over time

Pathological image of an esophageal foreign body
Lateral radiograph of the airway (left) shows a radiopaque foreign body in the cervical esophagus which is associated with a large amount of retropharyngeal soft tissue swelling. Gross pathological image (right) shows a metal flag-shaped pin that was endoscopically retrieved from the patient’s esophagus.

The diagnosis was gastrointestinal foreign body which had been present for a long period of time.

Preschooler with epigastric discomfort, especially when laying down to go to bed at night, who had a loop of bowel behind the sternum incidentally noted on a CXR

Surgical image of Morgagni hernia
Surgical image shows an anterior midline defect in the diaphragm, measuring 7 cm in width by 3 cm in depth. The transverse colon was herniated through this defect into the retrosternal space and had been reduced before this image was obtained.

The diagnosis was Morgagni hernia.

Preschooler who stools out of her vagina and rectum and is known to have a duplicated colon

Surgical image of colonic duplication
Surgical image shows the duplicated colon at the level of the sigmoid colon with the two colonic lumens running side by side. The mucosa was removed from the duplicated colon from the level of its sigmoid colon to the vaginal orifice. The duplicated colon was then anastomosed to the normal colon at the level of the normal colon’s sigmoid colon.

The diagnosis was colonic duplication.