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.

Toddler with stridor

Radiograph of croup — AP radiographs of the airway in inspiration (left) and expiration (right) show symmetric subglottic narrowing of the proximal trachea (left) leading to the loss of the normal shoulders of the subglottic trachea due to subglottic edema (church steeple sign).

The diagnosis was croup.

Toddler with a murmur

CXR of pulmonary hypertension — CXR AP shows cardiomegaly with a prominent pulmonary outflow tract, enlarged pulmonary arteries, and pruning of peripheral pulmonary vessels.

The diagnosis was pulmonary hypertension.

Teenager with left midfoot pain after a diving board accident

Radiograph of LisFranc fracture dislocation — AP radiograph of the feet shows widening at the base between the left first and second metatarsals.

The diagnosis was left LisFranc fracture dislocation.

Newborn with a posterior skull mass

CT and MR of occiptal menigoencephalocele — Axial CT without contrast of the skull (above left and below left) shows a large primarily low density soft tissue mass in the midline of the posterior skull extruding through a large defect in the posterior skull (above right). Axial T2 MRI of the brain (below right) shows the mass contains a thin amount of neural tissue.

The diagnosis was occipital meningoencephalocele.

Preschooler with short stature

MRI of spinal stenosis in achondroplasia — Sagittal T2 MRI of the spine shows a very narrow spinal canal with only a small amount of cerebrospinal fluid present anteriorly and posteriorly to the spinal cord, especially at the skull base. There is mild scalloping of the posterior aspect of the vertebral bodies.

The diagnosis was achondroplasia causing spinal stenosis.

Infant with a urinary tract infection

US and VCUG of ectopic ureterocele — Sagittal US of the right kidney (above left) was unremarkable. Sagittal US of the left kidney (above right) shows a duplicated kidney with hydronephrosis of the upper pole. Sagittal US of the bladder (below left) shows a round thick walled lesion at the base of the bladder. AP image from a voiding cystourethrogram exam (below right) shows a round filling defect on the left side of the bladder.

The diagnosis was left duplicated kidney with a left ectopic ureterocele causing hydronephrosis of the upper pole.

School ager with abdominal pain

CT and US of target sign and pseudokidney sign in ileocolic intussusception — Axial CT with contrast of the abdomen (above left) shows a mass involving the ascending colon which has a target sign appearance which on sagittal CT (above right) has a pseudokidney appearance. Transverse US of the ascending colon mass (below left) again demonstrates a target sign while the sagittal US of the mass (below right) again demonstrates a pseudokidney sign.

The diagnosis was ileocolic intussusception due to lymphoid hyperplasia with the lead point of the intussusception being mesenteric lymph nodes.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR AP shows air in the pulmonary interstitium bilaterally, in a branching pattern radiating outwards from the hila.

The diagnosis was pulmonary intestitial emphysema.

Premature newborn with respiratory distress

CXR of congenital hypertrophic cardiomyopathy — CXR AP shows cardiomegaly with pulmonary vascular congestion. There is underlying mild ground glass opacity in the lungs as well.

The diagnosis was congenital hypertrophic cardiomyopathy and underlying respiratory distress syndrome.

Teenager who fell off his bike

Radiograph of clavicle fracture — AP (left) and oblique (right) radiographs of the clavicle show multiple lucent lines through the distal clavicle.

The diagnosis was a comminuted distal clavicle fracture.

Newborn with a skin covered bump on his lower back

MR of lipomyelomeningocele — Sagittal T1 MRI without contrast of the spine (above) shows the conus medullaris to be low in position at L5 and to be contiguous with a lipomatous mass in the posterior spinal canal with neural elements extending from the low-lying cord through a defect in the bone posteriorly and being contiguous with subcutaneous fat. Axial T1 MRI at the level of the conus (below left) shows fat adherent to the conus posteriorly and the conus / neural tissue extending into the subcutaneous fat. Axial T2 MRI at the level of the conus (below right) also shows that there is some cerebrospinal fluid extending into the subcutaneous fat as well.

The diagnosis was lipomyelomeningocele.

School ager with progressive back pain

CT and MR of vertebra plan in Langerhans cell histiocytosis — Sagittal CT without contrast of the spine (far left) shows a marked compression deformity of the T7 vertebral body which is almost flat in appearance. Sagittal T2 MRI of the spine (near left) shows again loss of height in the T7 vertebral body with the T6-T7 and T7-T8 intervertebral disks in close approximation to each other. There is evidence of a high signal intensity soft tissue mass anterior and posterior to the T7 vertebral body. Sagital T1 MRI of the spine without (near right) and with contrast (far right) show enhancement of this soft tissue mass anterior and posterior to T7 which has an extradural component which is compressing the spinal cord at this level.

The diagnosis was vertebra plana of the T7 vertebral body due to Langerhans cell histiocytosis.

Newborn with hydronephrosis on prenatal US

VCUG of bilateral vesicoureteral reflux — AP image from a voiding cystourethrogram exam shows bilateral vesicoureteral reflux up to the level of the single bilateral renal collecting systems, which are moderately dilated. There were normal ureteral insertions present bilaterally.

The diagnosis was bilateral vesicoureteral reflux grade III.

School ager with abdominal pain who just had a cardiac arrest

CT of Meckel diverticulum causing distal small obstruction due to small bowel volvulus around the Meckel diverticulum resulting in a closed loop obstruction and small bowel ischemia of the ileum and pneumatosis intestinalis from necrosis in the ileum — AXR AP (above left) shows multiple dilated loops of small bowel and a decomopressed colon. Coronal CT with contrast of the abdomen (above right) shows normal caliber and normal enhancement of the proximal jejunum loops in the left upper quadrant. The distal ileum loops in the right lower quadrant are dilated and do not enhance. There is pneumatosis intestinalis in the walls of the most lateral loop of ileum. Axial CT (below) again shows the pneumatosis in the walls of the most lateral loop of ileum on the right and again shows the difference in bowel wall enhancement between the normal jejunum on the left and the abnormal ileum on the right.

The diagnosis was Meckel diverticulum causing distal small obstruction due to small bowel volvulus around the Meckel diverticulum resulting in a closed loop obstruction and small bowel ischemia of the ileum and pneumatosis intestinalis from necrosis in the ileum.

Preschooler with fever, drooling and sore throat

Radiograph of epiglottitis — Lateral radiograph of the airway shows a swollen epiglottis (thumb sign) and thickened aryepiglottic folds.

The diagnosis was epiglottitis.

Newborn with a sacral dimple

Clinical image of a dermal sinus tract — Clinical image shows a sacral dermal sinus tract in the midline just above the gluteal cleft.

The diagnosis was normal position of the conus in a patient without a tethered cord.

Newborn with a sacral dimple

Clinical image of a sacral dimple — Clinical image shows a round sacral dimple in the midline just above the gluteal cleft.

The diagnosis was a tethered cord.

Newborn with a hard swollen right scrotum

Surgical image of testicular torsion — Surgical image shows a purple and necrotic appearing right testicle and a normal appearing and well-perfused left testicle.

The diagnosis was right testicle torsion.

Newborn with a hard swollen right scrotum

Clinical image of testicular torsion — Clinical image shows an enlarged right scrotum.

The diagnosis was right testicle torsion.

Newborn with a hard swollen right scrotum

Surgical image of testicular torsion — Surgical image shows a purple and necrotic appearing right testicle and a normal appearing and well-perfused left testicle.

The diagnosis was right testicle torsion.

Newborn with a palpable right-sided abdominal mass

Surgical image of retroperitoneal teratoma — Gross pathological image shows a large heterogenous mass that was cystic to palpation.

The diagnosis was retroperitoneal teratoma.

Newborn with a palpable right-sided abdominal mass

Gross pathology image of retroperitoneal teratoma — Gross pathological image shows a large heterogenous mass that was cystic to palpation.

The diagnosis was retroperitoneal teratoma.