Teenager in a motor vehicle accident with chest pain

CXR and CT and angiogram of thoracic aortic injury — CXR AP shows widened mediastinum. Axial CT with contrast of the chest shows dilated caliber of the thoracic aorta at the level of the diaphragm with surrounding mediastinal fluid (above) and normal caliber of the abdominal aorta with evidence of retrocrual hemorrhage tracking into the abdomen (below). Angiogram shows a pseudoaneurysm of the aorta at the level of the diaphragm.

The diagnosis was thoracic aortic injury.

Teenager shot by sibling with pellet gun one day ago with progressive dyspnea and chest pain

CXR and CT of pericardial effusion — CXR AP shows an enlarged cardiac silhouette, bilateral pleural effusions and radioopaque pellets in the right thorax near the hilum and left axilla. Axial and coronal CT with contrast of the chest shows a large amount of fluid in the pericardial space.

The diagnosis was traumatic pericardial effusion.

School ager with diminished femoral pulses

CXR of coarctation of aorta — CXR AP shows a 3 sign in the region of the aortic arch and bilateral rib notching.

The diagnosis was coarctation of the aorta.

School ager with dyspnea

CXR of pericardial effusion — CXR AP shows normal pulmonary vasculature and an enlarged water bottle-shaped heart.

The diagnosis was pericardial effusion. 375cc of chylous fluid were drained out of the pericardium.

Newborn with cyanosis

CXR of Ebstein anomaly — CXR AP shows decreased pulmonary vascularity and a huge box-shaped heart.

The diagnosis was Ebstein anomaly.

Preschooler with cyanosis

CXR of tetralogy of Fallot — CXR AP shows decreased pulmonary blood flow and an upturned cardiac apex resulting in a boot-shaped heart.

The diagnosis was tetralogy of Fallot.

School ager with dyspnea

CXR and angiogram of partial anomalous pulmonary venous return — CXR AP (above) shows a hypoplastic right lung, AP arterial (left) and venous (right) phases of a pulmonary artery angiogram show a right pulmonary (scimitar) vein draining into the inferior vena cava.

The diagnosis was partial anomalous pulmonary venous return.

Infant with cyanosis

CXR and angiogram of total anomalous pulmonary venous return — CXR AP (above) shows increased pulmonary blood flow and a snowman-shaped heart, AP angiogram venous phase (below) shows dilated superior vena cava on right and left vertical vein on left.

The diagnosis was total anomalous pulmonary venous return – supradiaphragmatic.

Infant with cyanosis

CXR of transposition of the great arteries — CXR AP shows increased pulmonary blood flow and an egg on a string-shaped heart.

The diagnosis was transposition of the great arteries.

Infant with tracheomalacia and concern for vascular ring

CT of calcified ligamentum arteriosum — Axial CT with contrast of the chest shows a linear crescent-shaped calcification just to the left of the trachea which appears to join the main pulmonary artery to the descending aorta. An outside institution misinterpreted this calcification as a fish bone perforating out of the esophagus and transferred the patient emergently to our institution.

Infant with a murmur

CXR of patent ductus arteriosus ductus diverticulum — CXR AP shows mild cardiomegaly and pulmonary vascular congestion along with an extra soft tissue mass just to the left of the spine near the presumed position of the ductus arteriosus.

The diagnosis was a ductus diverticulum in a patient with patent ductus arteriosus.

Infant with murmur

Angiogram of patent ductus arteriosus — AP angiogram while injecting the pulmonary artery shows simultaneous filling of the descending aorta.

The diagnosis was patent ductus arteriosus.

Newborn with a murmur

CXR AP at 1 day of life (above) and 1 year of life (below) shows interval development of cardiomegaly and pulmonary vascular congestion.

The diagnosis was patent ductus arteriosus.

Premature newborn (35 weeks) with respiratory distress

CXR of hydrops fetalis — CXR AP shows low lung volumes, large bilateral pleural effusions, and extensive body wall edema.

The diagnosis was hydrops fetalis (non-immune). The patient had a thoraco-amniotic shunt placed at 24 weeks gestational age.

Infant with respiratory distress

CXR and MRI and angiogram of left atrial aneurysm — CXR PA and lateral, coronal MRI T1WI without contrast, and a left atrial injection from an angiogram shows an extremely dilated left atrium.

The diagnosis was left atrial aneurysm.

Infant with dysphagia

UGI of left aortic arch with aberrant right subclavian artery — AP (left) and lateral (right) images from an upper GI exam shows a left sided aortic arch and a posterior indentation on the esophagus.

The diagnosis was left aortic arch with aberrant right subclavian artery.

Toddler with stridor

CXR of right aortic arch with aberrant left subclavian artery — CXR shows a right side aortic arch. Echocardiogram showed an aberrant left subclavian artery.

The diagnosis was right aortic arch with aberrant left subclavian artery.

Infant with stridor

Angiogram of double aortic arch — The upper GI (not provided) showed a focal posterior indentation of the esophagus. AP and lateral images from an angiogram shows the aortic arch to have left and right components.

The diagnosis was double aortic arch.

Toddler with stridor

CXR of innominate artery compression — Lateral image of the airway shows anterior compression of the mid-trachea by a soft tissue mass.

The diagnosis was innominate artery compression.

Infant with stridor

Angiogram of pulmonary sling — AP image from a pulmonary angiogram shows the left pulmonary artery arising from the right pulmonary artery.

The diagnosis was pulmonary sling.

Infant with stridor

UGI of pulmonary sling — AP (above) and lateral (below) images from an upper GI exam shows right sided and anterior indentations on the esophagus.

The diagnosis was pulmonary sling.