School ager with crampy abdominal pain and a non-transient small bowel-small bowel intussusception

Surgical image of small bowel - small bowel intussusception due to Non-Hodgkin lymphoma
Laparoscopic surgical image (above) shows the small bowel-small bowel intussusception. Surgical image of the small bowel after reduction of the intussusception (below) shows the serosa is pink-tan and intact with a 1.5 x 0.6 cm puckered, red, firm area that when opened in pathology revealed a 2.6 x 2.0 cm red-pink mass.

The diagnosis was diffuse B-cell lymphoma (Non-Hodgkin lymphoma) causing small bowel-small bowel intussusception.

School ager with abdominal pain and a non-transient small bowel-small bowel intussusception

Gross pathological image of small bowel - small bowel intussusception due to Burkitt lymphoma
Gross pathological images of the resected segment of intussuscepted small bowel shows on its serosal surface (above) a 2.0 x 1.2 cm irregular, tan-white centrally ulcerated and umbilicated firm area. The opened image of small bowel (below) reveals a 3.4 x 2.9 x 1.2 cm irregular, tan-white, smooth, firm mass which was sectioned to reveal smooth, tan-white, glistening, homogenous cut surfaces.

The diagnosis was Burkitt lymphoma causing small bowel-small bowel intussusception.

Newborn with a myelomeningocele

MRI of Chiari II malformation and myelomeningocele
Sagittal T1 MRI without contrast of the brain (left) shows a small posterior fossa with downward cerebellar tonsil herniation and a small fourth ventricle. There is kinking of the spinal cord at the cervico-medullary junction. Sagittal (above right) and axial (below right) T2 MRI without contrast of the spine shows a low-lying conus medullaris with the spinal cord nerve roots terminating in a posteriorly located cerebrospinal fluid filled sac which is not covered by skin at the level of the L5-S1 vertebral bodies.

The diagnosis was Chiari II malformation with a myelomeningocele.

Infant with heart failure

MRI and MRA and US of intracranial arteriovenous malformation
Axial T2 MRI of the brain (above left) shows large vascular flow voids representing the nidus of the lesion along the right hemisphere of the brain and a dilated sagittal sinus. Sagittal US of the midline of the brain (above right) shows a large vascular structure with mixed arterial and venous flow within it that is compressing and displacing the sagittal sinus beneath it. MR angiogram with contrast of the brain (below left) shows a large nidus of arterial vessels along the right cerebral hemisphere fed primarily by the right middle cerebral artery that rapidly drain into a dilated sagittal sinus on the MR venogram (below right).

The diagnosis was intracranial arteriovenous malformation with arteriovenous fistula.

Toddler who fell out of the top of his bunk bed 3 days ago and is now seizing

CT and MRI of cavernous malformation
Axial (above left) and coronal (above right) CT without contrast of the brain shows a large round high density lesion in the left middle cranial fossa. Axial T1 MRI without contrast of the brain (below left) shows the lesion to have mixed signal intensity while the axial gradient echo MRI (below right) shows a low signal intensity ring around the lesion representing hemosiderin deposition.

The diagnosis was cavernous malformation with subacute and chronic hemorrhage in the left temporal lobe.

Newborn with failure to pass meconium and bilious vomiting

Surgical image of Hirschsprung disease
Surgical image shows a transition zone in the terminal ileum with the proximal portion of the small bowel above the transition zone dilated (on the right) and the non dilated distal small bowel (on the left). The frozen biopsies showed no ganglion cells from the rectum all the way up to the terminal ileum.

The diagnosis was total colonic Hirschsprung disease.

School ager with headaches and behavior changes

MRI of medulloblastoma in the posterior fossa
Axial (above left), sagittal (above middle) and coronal (above right) T1 MRI with contrast of the brain shows a heterogeneously enhancing mass centered in the fourth ventricle which extends into the right cerebellar hemisphere. Axial T2 MRI (below left) shows the mass to be solid and on diffusion weighted imaging (below right) the mass demonstrates diffusion restriction.

The diagnosis was medullobastoma.