Teenager with vomiting and gagging with pills and food

Upper GI of esophageal web — Lateral images from an upper GI exam show a persistent anterior indendation and narrowing of the esophagus at the level of the C4 vertebral body which mildly impedes the flow of contrast through it.

The diagnosis was esophageal web.

Teenager who butted heads with a friend

CT of orbital blowout fracture — Coronal CT without contrast of the orbits in bone windows (above) shows a fracture line through the floor of the left orbit along with some intraorbital air medially. Coronal CT in soft tissue windows (below) shows herniation of fat through the orbital floor fracture and into the roof of the left maxillary sinus. The left inferior rectus muscle is coursing towards the fracture which suggests muscle entrapment.

The diagnosis was left orbital blowout fracture.

School ager with cough and fever

CXR of adenovirus pneumonia with bacterial superinfection — Initial CXR PA (left) shows central airway thickening and bilateral lung hyperinflation resulting in flattening of the diaphragm. CXR PA obtained 3 days later (right) shows new dense opacities obscuring the left and right heart borders (silhouette sign).

The diagnosis was initially adenovirus pneumonia which was later complicated by bacterial superinfection.

School ager with cough and fever for 2 weeks

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the lateral aspect of the left lung that on the lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia / round pneumonia in the lingula.

Female teenager with enuresis

AXR of ovarian teratoma — AXR AP shows an oval calcification in the right pelvis in the region of the right adnexa.

The diagnosis was right ovarian teratoma.

School ager with leg pain after a fall

Radiograph of osteochondromatosis — AP (left) and lateral (right) radiographs of the leg show multiple lesions arising from the distal femoral and proximal tibial metaphyses. Some of the lesions are sessile in appearance while some are pedunculated in appearance. Each lesion has a bony stalk growing away from the metaphysis with a lucent lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.

The diagnosis was multiple osteochondromas in a patient with osteochondromatosis.

Premature newborn undergoing routine screening for intraventricular hemorrhage

US of choroid plexus cyst — Coronal (left) and sagittal (right) US of the brain show a small, round, anechoic lesion within the otherwise echogenic left choroid plexus.

The diagnosis was left choroid plexus cyst.

Teenager with dysphagia

Upper GI of eosinophilic esophagitis — AP image from an upper GI exam (left) shows diffuse tapering of the distal mid-esophagus which resolves in the distal esophagus. Lateral image (right) shows the esophageal narrowing is associated with multiple ring-like narrowings encircling the esophagus.

The diagnosis was eosinophilic esophagitis.

Teenager who fell out of bed and has a swollen nose

CT of comminuted nasal bone fracture — Contiguous axial CT without contrast of the face shows multiple lucent lines through the nasal bones bilaterally. The nasal septum is not thickened.

The diagnosis was bilateral comminuted fractures of the nasal bone.

Infant with respiratory distress

CXR of viral pneumonia — CXR PA (left) and lateral (right) shows thickening of the airways centrally and hyperexpansion of the lungs bilaterally leading to flattening of the diaphragm.

The diagnosis was viral pneumonia.

School ager with fever and worsening cough

CXR of bacterial pneumonia in the lateral aspect of the right middle lobe — CXR PA (left) shows an opacity in the lateral aspect of the right middle lobe which on the CXR lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia in the lateral aspect of the right middle lobe.

Newborn with a multicystic dysplastic kidney on prenatal ultrasound

CXR of patient with oligohydramnios — CXR AP shows a bell-shaped chest with extremely low lung volumes.

The diagnosis was oligohydramnios resulting in pulmonary hypoplasia due to multicystic dysplastic kidney.

School ager with right knee pain

Radiograph of osteochondritis dissecans of the knee — AP radiograph of the knees shows a left-sided osteochondral defect at the articular surface of the lateral aspect of the medial femoral condyle.

The diagnosis was osteochondritis dissecans of the left knee.

Newborn who had a traumatic birth and now has a bump on their head and a decreased hematocrit

CT of cephalohematoma in a newborn — Coronal CT without contrast of the brain shows a high density fluid collection over the top of the left skull that does not cross suture lines. A large amount of high density fluid is seen in the anterior and temporal horns of the right lateral ventricle and there is dilation of the lateral ventricles.

The diagnosis was cephalohematoma of the left scalp and intraventricular hemorrhage.

Teenager with abdominal pain and a history of cystic fibrosis

CT of a dilated but normal appendix in a patient with cystic fibrosis — Axial CT with contrast of the abdomen (above left) shows an irregular contour to the liver and fatty replacement in the pancreatic head. Axial (below left) and coronal (right) CT show the appendix is dilated to a diameter of 12 mm but there are no inflammatory changes around it.

The diagnosis was a dilated but normal appendix in a patient with cystic fibrosis along with liver cirrhosis due to cystic fibrosis and pancreatic insufficiency due to cystic fibrosis.

Teenager after motor vehicle accident

CT of mastoid fracture — Axial CT without contrast of the maxillofacial bones shows a linear lucent line extending throughout the left mastoid bone with resultant opacification of the left mastoid air cells.

The diagnosis was left mastoid fracture.

Infant with cough who is hypoxemic

CXR of respiratory syncytial virus pneumonia — CXR AP shows central airway thickening and bilateral lung hyperinflation causing flattening of the diaphragm. There is also a small right apical pneumonthorax.

The diagnosis was respiratory syncytial virus pneumonia.

Toddler with hypoxia

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows a faint opacity in the lingula lateral to the heart while CXR lateral (right) shows the opacity to be located over the heart.

The diagnosis was bacterial pneumonia in the lingula.

Teenager with microscopic hematuria

US of nutcracker syndrome — Transverse US of the abdomen (above) shows focal compression of left renal vein between the superior mesenteric artery anteriorly and the aorta posteriorly resulting in stenosis of the proximal left renal vein (markers #2) with associated dilation of the distal left renal vein (markers #1). Sagittal US of the abdomen (below) shows a reduced aortic-superior mesenteric artery angle of less than 45 degrees.

The diagnosis was nutcracker syndrome.

Teenager with knee pain

Radiograph of Osgood-Schlatter disease — AP radiograph of the knee (left) is unremarkable while lateral radiograph (right) shows infiltration and obscuration of the infrapatellar fat pad and fragmentation of the anterior tibial tubercle.

The diagnosis was Osgood-Schlatter disease.

Newborn with a bump on the back of the head

MRI of occipital cephalocele — Sagittal T2 MRI (above) shows a high signal intensity structure projecting inferiorly off the occiput of the skull. Axial T1 MRI without contrast (below left) clearly shows the interruption of the occipital subcutaneous tissues and the saccular structure posterior to it. Axial T2 MRI (below right) shows the saccular structure to be primarily cystic and to contain a small amount of neural tissue.

The diagnosis was occipital cephalocele.

Teenager with abdominal pain

CT and US of acute cholecystitis — Axial CT with contrast of the abdomen (above) shows a distended gall bladder with gallbladder wall thickening with rim enhancement. Sagittal US of the gallbladder shows diffuse wall thickening of the gallbladder (below left) along with a stone in the neck of the gallbladder causing posterior acoustic shadowing (below right).

The diagnosis was acute cholecystitis.

Teenager with jaw pain after trauma

CT of mandibular fracture — AP 3D CT without contrast of the face (left) shows a fracture line through the mandibular symphysis while lateral 3D CT (right) shows a fracture line through the left mandibular ramus causing a dislocated left condyle.

The diagnosis was mandibular fracture.

Toddler with respiratory distress

CXR of respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia — CXR PA (left) shows central airway thickening and mild lung hyperinflation with a dense opacity in the right upper lobe and a dense opacity in the left lower lobe which is obscuring the left hemidiaphragm (silhouette sign). The lateral radiograph (right) shows dense opacities over the upper spine and over the lower spine (spine sign).

The diagnosis was respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia.

School ager with fever and vomiting

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a dense opacity overlying the heart and obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the lateral radiograph (right) shows dense opacity over the lower aspect of the spine (spine sign).

The diagnosis was bacterial pneumonia in the posterior left lower lobe.