School ager with stridor

Radiograph of bacterial tracheitis — Lateral radiograph of the airway shows loss of definition of the trachea and membranes / plaques within it.

The diagnosis was bacterial tracheitis.

School ager with stridor

Radiographs of croup — AP + lateral radiographs of the airway show narrowing of the subglottic trachea (steeple sign) and overdistension of the hypopharynx.

The diagnosis was croup.

Infant who is status post adenovirus pneumonia 2 months ago

CXR of Swyer James syndrome — CXR shows unilateral hyperexpansion of the left lung with mediastinal shift to the right.

The diagnosis was Swyer James syndrome.

Infant with respiratory distress who continues to have reactive airway disease 15 years later

CXR of respiratory syncytial virus pneumonia — CXR PA and lateral shows airway thickening and lung hyperexpansion with flattening of the hemidiaphragms.

The diagnosis was respiratory syncytial virus pneumonia.

Infant with respiratory distress who is positive for RSV bronchiolitis

CXR of viral pneumonia with a bacterial suprainfection — CXR shows diffuse airway thickening and hyperexpansion along with an infiltrate obscuring the right heart border and the medial hemidiaphragms bilaterally.

The diagnosis was viral pneumonia with a bacterial suprainfection.

Teenager who has had recurrent bacterial pneumonias

CXR of bronchiectasis — CXR shows linear cystic changes in the lingula and left lower lobe posteriorly which were chronic in nature.

The diagnosis was bronchiectasis.

Infant recovering from a Staphylococcal pneumonia

CXR of pneumatocele — CXR shows a large thin walled cystic lesion in the left lower lobe.

The diagnosis was a post-infectious pneumatocele.

Teenager with a bacterial pneumonia not responsive to oral antibiotics

CT of bronchopleural fistula — Axial CT without contrast of the chest shows consolidation of the right lower lobe with multiple air pockets within it giving the appearance of necrotic lung, a large loculated right empyema that contains an air pocket, and one of the air pockets in the right lower lobe appears to be in continuity with the air pocket in the pleural space suggesting the presence of a bronchopleural fistula.

The diagnosis was bacterial pneumonia with a bronchopleural fistula.

Preschooler with chest pain

CXR and CT of lung abscess — CXR and axial and coronal CT without contrast of the chest shows a cavitary mass in the densely consolidated left lower lobe and a moderate left pleural effusion.

The diagnosis was bacterial pneumonia with a lung abscess.

School ager with fever

CXR and CT of necrotizing pneumonia — CXR shows near complete opacification of the left hemithorax. Axial and coronal CT with contrast of the chest shows dense collapsed left upper lobe lobe and less dense collapsed left lower lobe with an even lower density cavity forming within it and a large left pleural effusion without definite pleural enhancement.

The diagnosis was bacterial necrotizing pneumonia.

Preschooler with cough, fever, shortness of breath

CXR and CT of pleural empyema — CXR PA and lateral shows complete opacification of the left hemithorax causing tracheal and mediastinal shift to the right, which is seen on the axial CT with contrast of the chest to be due to a large pleural fluid collection with an enhancing pleura causing near complete left lung atelectasis.

The diagnosis was bacterial pneumonia with a pleural empyema.

Infant with cough and fever

CXR and CT of pleural effusion — CXR PA and left lateral decubitus shows a left lower lobe infiltrate with a free flowing pleural effusion, confirmed on the axial CT with contrast of the chest which showed no enhancement of the pleura to suggest empyema.

The diagnosis was bacterial pneumonia with a reactive pleural effusion.

Teenager with pancreatic insufficiency

AXR of cystic fibrosis with pancreatic insufficiency — AXR shows calcifications throughout the pancreas.

The diagnosis was cystic fibrosis with pancreatic insufficiency.

Young adult with hematemesis

UGI of esophageal varices in cystic fibrosis — Lateral images from an UGI shows multiple rounded filling defects extrinsic to the distal esophageal lumen.

The diagnosis was cystic fibrosis with cirrhosis and portal hypertension causing esophageal varices.

Young adult with hemoptysis

CXR and angiogram of pulmonary hemorrhage in cystic fibrosis — CXR (left) shows chronic changes of cystic fibrosis. Bronchial artery angiogram (right) shows hypertrophy of the right-sided bronchial arteries.

The diagnosis was cystic fibrosis with pulmonary hemorrhage.

Preschooler with a cough

CT of bronchiectasis — Axial CT without contrast of the chest shows extensive bronchiectasis throughout the lungs.

The diagnosis was cystic fibrosis with bronchiectasis.

School ager with fever and cough

CXR of lung abscess — CXR shows a round cavitary lesion with an air-fluid level in the left upper lobe.

The diagnosis was cystic fibrosis with bacterial pneumonia due to Staphylococcus with a lung abscess.

Teenager with cystic fibrosis and abdominal pain

AXR and barium enema of distal intestinal obstruction syndrome — AXR (left) shows a distal small bowel obstruction. Water-soluble contrast enema (right) shows the cecum flipped up into the left upper quadrant with the stool-filled terminal ileum outlined by contrast just beneath it.

The diagnosis was distal intestinal obstruction syndrome.

Newborn with failure to pass meconium

Barium enema of uncomplicated meconium ileus — Early (left) image from a water-soluble contrast enema shows a microcolon and reflux of contrast into a non-dilated terminal ileum. Later (right) image from the same enema shows reflux of contrast into dilated loops of ileum, which are above the level of the obstruction by meconium in the terminal ileum.

The diagnosis was uncomplicated meconium ileus.

Newborn with failure to pass meconium

AXR of complicated meconium ileus — AXR shows an obstructive bowel gas pattern and a thin network of calcifications extending throughout the lower abdomen.

The diagnosis was complicated meconium ileus.

Newborn with failure to pass meconium

Barium enema of meconium plug syndrome — AXR shows a distal bowel obstruction. Water-soluble contrast enema shows normal caliber of the ascending and transverse colon and rectum, but decreased caliber of the descending (left) colon.

The diagnosis was meconium plug syndrome.

Newborn with failure to pass meconium

Clinical image of meconium plug — Clinical image shows a contiguous plug of meconium that was expelled by the patient after a water-soluble contrast enema.

The diagnosis was meconium plug syndrome.

Infant with respiratory distress

CXR and CT of esophageal duplication — CXR shows a subtle double density over the left side of the heart in the paraspinal region. Axial CT with contrast of the chest shows a soft tissue mass in the posterior mediastinum on the left.

The diagnosis was esophageal duplication.

Infant with recurrent pneumonias

CXR and CT of neuroblastoma — CXR shows a posterior mediastinal mass to the left of the spine that is clearly calcified on the coronal and axial CT with contrast of the chest.

The diagnosis was neuroblastoma.

School ager with back pain

Radiograph of tuberculous osteomyelitis — AP and lateral radiographs of the spine shows a calcified paraspinal posterior mediastinal soft tissue mass to the left of the spine from T10-T12 with relative sparing of the disc spaces. A subsequent PPD was positive.

The diagnosis was tuberculous osteomyelitis / diskitis.