Teenager with flank pain

US of nephrocalcinosis — Sagittal US of the left kidney (above) and right kidney (below) show dense calcification in the medullary pyramids of both kidneys.

The diagnosis was bilateral nephrocalcinosis.

School ager with left hip pain for 2 weeks

MRI of myositis of the hip — Axial (above left and below left) and coronal (above right) T2 with fat saturation MRI of the pelvis shows bright signal in the expanded and edematous left obturator internis and left gluteus medius muscles, which on coronal T1 MRI with contrast (below right) are shown to faintly enhance.

The diagnosis was myositis of the left hip.

Newborn with a brain cyst on prenatal ultrasound

MRI of cavum velum interpositum — Axial (left), coronal (above right) and sagittal (below left) T2 MRI of the brain shows a cerebrospinal fluid space between the atria and trigones of the lateral ventricles, behind the foramen of Monro, beneath the columns of the fornices and above the tela choroidea of the third ventricle.

The diagnosis was cavum velum interpositum.

Newborn with an abdominal mass

US and enema of colonic atresia due to in-utero cecal volvulus — Transverse US of the abdomen (left) shows a large round meconium filled lesion anterior to the right kidney which is at the bottom left of the image. AP image from an enema (right) shows a microcolon with the cecum in the midline of the abdomen. The terminal ileum could not be refluxed.

The diagnosis was a meconium-filled cecum causing in-utero cecal volvulus and subsequent colonic atresia.

School ager who has pain at the distal interphalangeal joint after jamming their finger

Radiograph of mallet finger fracture — Lateral radiograph of the finger shows a faint triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal aspect of the distal phalanx at the distal interphalangeal joint.

The diagnosis was mallet finger fracture.

Teenager with left scrotal pain

US of scrotolith — Transverse (above) and sagittal (below) US of the left scrotum show an oval hyperechoic lesion that is in the scrotum but that is extratesticular in location and which has posterior acoustical shadowing.

The diagnosis was scrotolith.

School ager who had a Nissen fundoplication 4 years ago who now has gagging while eating

UpperGI of para Nissen herniation — AP (left) and lateral (right) images from an UpperGI exam show the Nissen fundoplication wrap is intact. However, a small portion of the stomach has herniated superiorly and posteriorly through the wrap into the chest. This is best seen on the lateral view.

The diagnosis was Nissen fundoplication malfunction due to a para Nissen herniation.

Toddler whose parents both have chronic coughs

CXR of pulmonary tuberculosis — CXR AP shows bilateral hilar adenopathy, right greater than left, and a faint right lower lobe infiltrate.

The diagnosis was tuberculosis pneumonia.

Infant with fever

CT angiogram of polyarteritis nodosa — Axial (above) and coronal (below) CT with contrast of the chest show multiple aneurysms along the course of the bilateral subclavian arteries beginning near their origins.

The diagnosis was polyarteritis nodosa.

Toddler who was on extracorporeal membrane oxygenation as a newborn one year ago

MRI of diffuse cerebral atrophy due to extracorporeal membrane oxygenation — Axial (left) and coronal (right) T2 MRI without contrast of the brain shows diffuse thinning of the grey matter and white matter with subsequent prominence of the cerebral suci, subarachnoid space, and lateral and third ventricles.

The diagnosis was diffuse cerebral atrophy secondary to extracorporeal membrane oxygenation.

Teenager with a productive cough and fever

CXR of right upper lobe bacterial pneumonia — CXR PA (left) shows a dense opacity in the right upper lobe which is located superiorly on the CXR lateral (right).

The diagnosis was right upper lobe bacterial pneumonia.

School ager with cough and fever

CXR of left lower lobe bacterial pneumonia — CXR PA (left) shows a faint opacity in the left lower lung that is obscuring the left hemidiaphragm (silhouette sign) and this opacity is seen just anterior to the lower spine on the lateral radiograph (right).

The diagnosis was bacterial pneumonia in the left lower lobe.

School ager with cough and shortness of breath

CXR of right middle lobe bacterial pneumonia — CXR PA (left) shows dense opacity throughout the right middle lobe which is obscuring the right heart border (silhouette sign). CXR lateral (right) shows the opacity located over the heart.

The diagnosis was right middle lobe bacterial pneumonia.

Teenager with right lower quadrant pain

MRI of Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx — Contiguous axial (above) and coronal (below) T2 MRI of the pelvis show a bicornuate unicollis uterus with the left horn intact and with the right horn atretic and dilated and associated with a right hydrohematosalpinx.

The diagnosis was Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx.

School ager with a left mandibular mass

CT of myofibroma — Coronal CT without contrast of the face (above left) shows a soft tissue mass adjacent to or arising from the left mandible which on coronal CT with contrast (above right) is seen to be enhancing and well circumscribed. Coronal CT with bone windows (below) better shows the mandibular disruption and destruction caused by the mass.

The diagnosis was myofibroma.

Teenager with headache and tremors

CT and MR of cavernous malformation — Coronal (above left) and axial (below right) CT without contrast of the brain shows a slightly hyperdense, round, poorly circumscribed lesion in the right frontal lobe. Coronal T1 MRI without contrast of the brain (above right) shows the lesion to have a popcorn appearance with small round lesions of various signal intensities. Axial gradient echo MRI (below right) shows the lesion to be surrounded by a very low signal intensity ring.

The diagnosis was cavernous malformation containing mixed blood products with a hemosiderin ring.

Infant with sepsis after being taken off of ECMO

CT of abdominal abscess in an infected hematoma — Axial (above) and coronal (below) CT with contrast of the abdomen shows an isodense oval fluid collection inferior to the liver and superior and lateral to the right kidney.

The diagnosis was abdominal abscess in an infected hematoma which was a complication of extracorporeal membrane oxygenation.

School ager in a motor vehicle accident with back pain

CT of Chance fracture in lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior wedging of the L1 and L2 vertebral bodies and a horizontal fracture through the spinous process of the L1 vertebral body. 3D CT from the left (middle) and right (right) show bilateral L1-L2 facet distraction resulting in a focal kyphosis at L1-L2.

The diagnosis was Chance fracture of the lumbar spine.

School ager with fever and cough for 1 week

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the lingula that is obscuring the left heart border (silhouette sign) which on the CXR lateral (right) is seen to be projecting over the heart.

The diagnosis was lingular bacterial pneumonia.

Infant with suspected vascular ring on an upper GI exam

CT of intrathoracic kidney — Coronal CT with contrast of the chest (above left) shows the left kidney in the lower left thorax with its vascular pedicle coursing away from it inferiorly. Sagittal CT (above right) shows the kidney had ascended into the chest through the foramen of Bochdalek. Axial CT (below) again shows the kidney in the left hemithorax.

The diagnosis was intrathoracic kidney.

Infant with seizures and kinky appearing hair

MRA of tortuous intracranial vessels in Menkes disease — Coronal MIP MRA with contrast of the brain (above) shows tortuosity of the bilateral middle and anterior cerebral arteries and vertebrobasilar system which is also appreciated on the axial MIP MRA (below).

The diagnosis was Menkes disease.

Preschooler with constipation and anal stenosis on physical exam

CT and MRI of Currarino syndrome — 3D CT of the pelvis (left) shows near complete absence of the lower sacrum with the sacrum having a sickel shape on the right. Midline sagittal T2 MRI of the lumbar spine (middle) shows the conus medullaris to be low in position terminating at L5. Off center sagittal T2 MRI (right) shows a small round low signal intensity lesion anterior to the S2 vertebral body.

The diagnosis was caudal regression syndrome in the form of Currarino syndrome with anal stenosis, a sickle shaped and hypoplastic sacrum, and a presacral mass in the form of an anterior myelomeningocele.

Toddler with intermittent abdominal distension

Small bowel follow through of protein losing enteropathy — AP image from a small bowel follow through exam shows diffuse fold thickening throughout the small bowel which is more prominent in the jejunum than in the ileum.

The diagnosis was protein losing enteropathy.

Teenager with back pain after motor vehicle accident

CT of multiple compression fractures in the lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior compression fractures of the T12 thru L3 vertebral bodies with corresponding loss of height in each which is more subtly appreciated on the 3D CT (right).

The diagnosis was multiple anterior compression fractures of the lumbar spine.

School ager with fever and left chest pain

CXR of bacterial pneumonia in left lower lobe — CXR PA (left) shows a dense opacity over the heart obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the CXR lateral (right) shows the opacity is located posteriorly over the lower thoracic spine (spine sign).

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