Acyanotic teenager

CXR of atrial septal defect / ASD — CXR AP shows mildly increased pulmonary vascularity and a normal heart size.

The diagnosis was atrial septal defect.

Preschooler found face down in a swimming pool

CXR of pulmonary edema in near drowning — CXR AP shows a normal sized heart and bilateral perihilar interstitial infiltrates. There is also a dense opacity in the right upper lobe.

The diagnosis was pulmonary edema due to near drowning and probable aspiration pneumonia of the right upper lobe.

Preschooler with hematuria

CXR of pulmonary edema in acute glomerulonephritis — CXR PA and lateral shows cardiomegaly and bilateral perihilar interstitial infiltrates along with blunting of the costophrenic angles due to small bilateral pleural effusions best seen on the lateral.

The diagnosis was pulmonary edema due to acute glomerulonephritis.

Newborn with respiratory distress and an abnormal cardiac rhythm

CXR of pulmonary edema in paroxysmal atrial tachycardia — CXR AP shows mild cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion.

The diagnosis was pulmonary edema in a patient with paroxysmal atrial tachycardia.

Infant with rheumatic heart disease and bacterial endocarditis

CXR of pulmonary edema due to mitral insufficiency in rheumatic heart disease — CXR AP shows cardiomegaly and bilateral perihilar interstitial infiltrates.

The diagnosis was pulmonary edema due to mitral insufficiency caused by rheumatic heart disease.

School ager with shortness of breath

CXR of cardiogenic pulmonary edema in asthma — CXR AP (left) shows cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion. CXR AP (right) obtained after resolution of symptoms shows the heart and pulmonary vascularity to be normal in appearance while the airways are thickened and the lungs are hyperexpanded.

The diagnosis was pulmonary edema in a patient with underlying asthma.

Newborn with an anterior chest wall defect

MRI of Pentalogy of Cantrell — Axial (above), sagittal to the right of midline (below left) and sagittal midline (below right) T2 MRI without contrast of the chest shows a midline defect in the lower anterior chest wall with liver herniating through it.

The diagnosis was Pentalogy of Cantrell.

Premature newborn with respiratory distress on a ventilator

CXR of pneumopericardium — CXR AP (above) shows a large amount of air around the heart. CXR AP obtained after pericardiocentesis (below) shows a decreased amount of air around the heart and the diaphragm can be continuously traced across the image.

The diagnosis was pneumopericardium in a patient with respiratory distress syndrome.

Premature newborn after PICC placement

CXR of a lower extremity peripherally inserted central catheter / PICC in the right atrium — CXR AP shows a lower extremity PICC tip projecting within the right atrium

The diagnosis was high malposition of the PICC.

Premature newborn after PICC placement

AXR of a peripherally inserted central catheter / PICC in a superficial epigastric vein — AXR AP and lateral shows a right lower extremity PICC tip projecting over a superficial epigastric vein in the anterior abdominal wall.

The diagnosis was malposition of the PICC.

Premature newborn after PICC placement

AXR of a peripherally inserted central catheter / PICC in a superficial epigastric vein — AXR AP and lateral shows a right lower extremity PICC tip projecting over a superficial epigastric vein in the anterior abdominal wall.

The diagnosis was malposition of the PICC.

Premature newborn after PICC placement

AXR of lower extremity peripherally inserted central catheter / PICC in a thoracoepigastric vein — AXR AP and lateral shows a left lower extremity PICC coursing along in a thoracoepigastric vein along the left lateral abdominal wall. The umbilical arterial catheter tip projects at T10.

The diagnosis was malposition of the PICC and appropriate position of the umbilical arterial catheter.

Premature newborn after PICC placement

AXR of peripherally inserted central catheter / PICC in the left hepatic vein — AXR AP shows a left lower extremity PICC whose tip projects over the left hepatic vein.

The diagnosis was malposition of the PICC.

Newborn with abnormal prenatal echocardiogram after PICC placement

AXR of lower extremity peripherally inserted central catheter / PICC in a left-sided inferior vena cava in a patient with situs inversus — AXR AP shows a left lower extremity PICC and a right femoral venous catheter both of whose tips project over a left-sided inferior vena cava. An umbilical venous catheter tip projects over the ductus venosus. An umbilical arterial catheter tip projects at the level of T9. Nasogastric tube tip projects over the stomach in the right upper quadrant. Feeding tube tip projects transpylorically over the duodenal bulb. The cardiac apex is in the right chest.

The diagnosis was appropriate position of the PICC and low malposition of the umbilical venous catheter in a patient with situs inversus.

Premature newborn with hypoplastic abdominal wall musculature after PICC placement

AXR of peripherally inserted central catheter / PICC in the renal vein in a patient with gastroschisis — AXR AP and lateral shows a right lower extremity PICC coursing across the midline with its tip projecting over the left renal vein. The abdomen appears to be bulging and protruberant in both medial-lateral and anterior-posterior dimensions. The tip of the bladder catheter projects high within the pelvis within a dilated bladder

The diagnosis was low malposition of the PICC in a patient with Prune Belly Syndrome.

Premature newborn after PICC placement

AXR of lower extremity peripherally inserted central catheter / PICC in the iliac vein — AXR AP shows a left lower extremity PICC which courses across the midline and down the right common iliac vein. The tip of the umbilical venous catheter projects over the umbilical vein. The tip of the umbilical arterial catheter projects at T6.

The diagnosis was low malposition of the PICC and low malposition of the umbilical venous catheter and appropriate position of the umbilical arterial catheter.

Premature newborn after PICC placement

AXR of lower extremity peripherally inserted central catheter / PICC in the femoral vein — AXR AP shows a right lower extremity PICC which is curled back upon itself and whose tip projects over the right femoral vein. The tip of the umbilical venous catheter projects within the umbilical vein.

The diagnosis was low malposition of the PICC and low malposition of the umbilical venous catheter.

Premature newborn after PICC placement

AXR of normal position of lower extremity peripherally inserted central catheter / PICC in the inferior vena cava — AXR AP and lateral shows a right lower extremity PICC with its tip within the inferior vena cava anterior to the spine at the level of T11. The tip of the umbilical venous catheter is within the ductus venosus.

The diagnosis was appropriate position of the PICC and low malposition of the umbilical venous catheter.

Premature newborn after PICC placement

CXR of peripherally inserted central catheter / PICC in the right atrium — CXR AP shows a left upper extremity PICC coiled within the right atrium.

The diagnosis was low malposition of the PICC.

Premature newborn after PICC placement

CXR of peripherally inserted central catheter / PICC projecting over the inferior vena cava — CXR AP shows a right upper extremity PICC tip projecting over the inferior vena cava.

The diagnosis was low malposition of the PICC.

Premature newborn after PICC placement

CXR of peripherally inserted central catheter in the middle hepatic vein — CXR AP shows a left upper extremity PICC whose tip projects within the liver in the middle hepatic vein.

The diagnosis was low malposition of the PICC.

Preschooler after PICC placement

CXR of peripherally inserted central catheter / PICC in the internal mammary vein — CXR AP and lateral shows a left upper extremity PICC whose tip projects over the left internal mammary vein.

The diagnosis was malposition of the PICC.

Premature newborn after right upper extremity PICC placement

CXR of upper extremity peripherally inserted central catheter / PICC in the jugular vein — CXR AP shows the left upper extremity PICC tip to project over the left brachiocephalic vein. The new right upper extremity PICC tip projects over the right internal jugular vein.

The diagnosis was high malposition of both PICCs.

Teenager with PICC placement after recent spinal fusion

CXR of upper extremity peripherally inserted central catheter / PICC in an axillary vein — CXR AP shows a left upper extremity PICC looped back upon itself with its tip in a vein in the left axilla.

The diagnosis was high malposition of the PICC.

Premature newborn after PICC placement

CXR of peripherally inserted central catheter / PICC deep in the right atrium — CXR AP (left) shows the tip of the left upper extremity PICC to project deep within the right atrium. CXR AP (right) obtained later the same day shows the tip of the PICC to have pulled back into the superior vena cava. There is ground glass opacity throughout the lungs.

The diagnosis was deep position of the upper extremity PICC tip in a patient with respiratory distress syndrome.