Teenager with abdominal pain

CT of azygos continuation of the inferior vena cava
Coronal CT with contrast of the abdomen (below) shows interruption of the infrahepatic inferior vena cava which then communicates with the hemiazygos vein to the left of the spine which then via dilated azygos and hemiazygos venous collaterals alongside the vertebral body on the axial CT (above) ultimately drain into the superior vena cava.

The diagnosis was azygos continuation of the inferior vena cava.

Newborn with an abnormal fetal echo

CT of interrupted aortic arch
Axial CT with contrast of the heart (above), obtained in a venous phase, shows discontinuity of the ascending and descending aorta while the sagittal image (below right) shows a dilated patent ductus arteriosus reconstituting the descending aorta and the coronal image (below left) shows dextrocardia.

The diagnosis was interrupted aortic arch supplied by a patent ductus arteriosus in a patient with dextrocardia.

School ager with hypercoagulable state with respiratory distress

CXR, VQ scan, angiogram of pulmonary embolism / pulmonary embolus / PE
CXR AP (above) shows a large wedge shaped infiltrate in the right lower lobe and a right pleural effusion. Ventilation image from a V/Q scan (middle left) shows normal ventilation to both lungs. Perfusion image from a V/Q scan (middle right) shows essentially no perfusion to the right lung. PA image from a pulmonary angiogram shows a near complete lack of blood flow to the right lung.

The diagnosis was right pulmonary embolism.

Infant with cough and decreased left ventricular ejection fraction

CXR and CT of anomalous left coronary artery from the pulmonary artery / ALCAPA
CXR AP (above) shows the left hemithorax is completely opacified with no mediastinal shift to the left and the pulmonary vascularity is congested. Axial CT with contrast of the chest (below) shows an extremely dilated left ventricle causing compression of the left mainstem bronchus and complete collapse of the left lung.

The diagnosis was anomalous left coronary artery from the pulmonary artery causing ischemic cardiomyopathy.

School ager with dyspnea

Angiogram of pulmonary ateriovenous malformation
CXR AP (upper left) shows an ill-defined mass in the right hilum. AP image from a selective injection of the right pulmonary artery from a pulmonary angiogram (upper right) shows a tangle of dilated arterial vessels comprising the mass. Arterial phase (lower left) and venous phase (lower right) AP images from a pulmonary angiogram demonstrate the early arterial appearance of the lesion and then its venous drainage back into the left atrium.

The diagnosis was pulmonary arteriovenous malformation.

School ager with heterotaxy syndrome and asplenia and bilious vomiting

CXR of heterotaxy syndrome and upper GI of malrotation without midgut volvulus
CXR AP (above) shows the cardiac apex to be in the right hemithorax and the gastric bubble to be in the left upper quadrant. AP image from an upper GI (below) shows the ligament of Treitz to be in the right upper quadrant. There is no evidence of duodenal obstruction. The proximal jejunum is also in the right upper quadrant.

The diagnosis was malrotation without midgut volvulus in a patient with heterotaxy syndrome.