Infant who has just had a right lower extremity PICC line removed which upon measuring was seen to be shorter than it should have been

Lower extremity radiograph of retained PICC line fragment — AP radiograph of the right lower extremity shows a retained fragment of a PICC line in the posterior soft tissues of the right calf.

The diagnosis was peripherally inserted catheter malfunction with a retained fragment of the removed PICC line in the right calf.

School ager who just had an old left central venous catheter removed and a new right central venous catheter placed

CXR of retained central venous catheter fragment — CXR AP shows the tip of the new right central venous catheter to be in the superior vena cava. Also seen is a short piece of catheter in the left brachiocephalic vein.

The diagnosis was central venous catheter malfunction with a retained fragment of the removed left central venous catheter in the left brachiocephalic vein.

Newborn with complex congenital heart disease

CT of umbilical venous catheter in normal position — Sagittal CT with contrast of the chest shows the umbilical venous catheter to course through the umbilical vein into the liver to the left portal vein to the ductus venosus to the left hepatic vein to the inferior vena cava with its tip near the junction of inferior vena cava and the right atrium.

The diagnosis was normal position of the umbilical venous catheter with the tip near the junction of the inferior vena cava and the right atrium.

Newborn after PICC placement

AXR of PICC line tip in spinal canal — AXR lateral (left) shows the tip of a right lower extremity PICC line looping back upon itself and projecting over the spinal canal. AXR AP (right) after reposition of the line shows the tip projecting over the inferior vena cava. The patient also has a large anterior abdominal wall defect containing loops of bowel which is covered by a membranous sac.

The diagnosis was peripherally inserted central venous catheter malfunction with the tip within the spinal canal in a patient with an ompahlocele.

Infant who is choking with feedings

UGI of double aortic arch — Lateral (right) image from an UGI exam shows a persistent posterior indentation on the mid-esophagus. There is associated narrowing of the trachea at the same level.

The diagnosis was double aortic arch causing a complete vascular ring.

Premature newborn after umbilical venous catheter placement

AXR of umbilical venous catheter tip in the superior vena cava — CXR AP shows the tip of the umbilical venous catheter to be in the superior vena cava. The tip of the umbilical arterial catheter projects at the level of the T6 vertebral body.

The diagnosis was umbilical venous catheter malfunction with the tip of the catheter in the superior vena cava.

Newborn status post left upper extremity PICC placement

CXR of PICC line in the aorta — CXR AP shows an umbilical arterial catheter in the aorta whose tip is at the level of the T8 vertebral body and a left upper extremity PICC which courses parallel to the umbilical arterial catheter and whose tip projects at the level of T8 as well.

The diagnosis was peripherally inserted central catheter malfunction with the tip of the catheter in the descending aorta.

School ager with asymmetric pulses in the upper and lower extremities

CT of post-ductal coarctation of the aorta — Sagittal CT (above left) and 3D CT (above right) with contrast of the chest show significant narrowing of the proximal descending aorta distal to the origin of the left subclavian artery. Anterior 3D CT (below left) shows dilated bilateral collateral internal mammary arteries and posterior 3D CT (below right) shows dilated bilateral collateral 3rd-8th intercostal arteries.

The diagnosis was post-ductal coarctation of the aorta.

Premature newborn after umbilical arterial catheter placement

Radiograph of low-lying umbilical arterial catheter — CXR shows the tip of the umbilical arterial catheter to be at the level of the L2 vertebral body.

The diagnosis was umbilical arterial catheter malfunction with the tip of the catheter being low in position.

Teenager in a motor vehicle accident

CXR and CT of thoracic aortic injury — CXR AP (above left) shows a widened superior mediastinum. Axial CT with contrast of the chest shows an aortic laceration beginning at the level of aortic isthmus (above right) with a large amount of hemorrhage in the mediastinum which continues downward (below left) until the aorta is almost completely occluded by thrombus (below right).

The diagnosis was thoracic aortic injury.

Infant after left lower extremity PICC removal which after measuring was found to be too short in length

Radiograph of broken PICC line — AXR AP (left) and lateral (right) show a discontinuous catheter fragment in the left femoral and iliac veins.

The diagnosis was peripherally inserted central venous catheter malfunction with the catheter having broken during removal with a retained catheter fragment in the left femoral and iliac veins.

Young adult with complex congenital heart disease and fever, fatigue and left upper quadrant pain

CXR and V/Q scan and CT of pulmonary embolism — CXR AP (above left) shows dextrocardia and an infiltrate in the left lower lobe. Anterior ventilation image from a V/Q scan (above middle) shows near-normal ventilation to the lungs. Posterior perfusion image from a V/Q scan (above left) shows markedly decreased perfusion to the left lung, with 95% of the perfusion going to the right lung. Coronal CT with contrast of the chest (below left) shows a massively enlarged left pulmonary artery with thrombus in its left lower lobe branches. Axial images (below middle and below right) show multiple peripheral infarcts in the left lower lobe.

The diagnosis was massive pulmonary embolism in the left pulmonary artery.

Preschooler with wheezing

Upper GI of double aortic arch — CXR (left) shows a right paratracheal mass. AP image from an UGI exam (middle) shows kinking of the upper esophagus while lateral (right) image shows a posterior indentation on the esophagus.

The diagnosis was double aortic arch.

Infant with dysphagia

Upper GI of right aortic arch with aberrant left subclavian artery — AP image (left) from an UGI exam shows a right sided aortic arch and an indentation running across the upper esophagus which on the lateral image (right) shows the indentation to be posterior to the esophagus.

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

School ager with chest wall ecchymosis post motor vehicle accident

CT of false positive thoracic aortic injury / aortic dissection — Non-gated axial (above left) and coronal (above right) CT with contrast of the chest show a line in the lumen of the aorta from the sinotubular junction to the origin of the brachiocephalic artery. Repeat gated axial (below left) and coronal (below right) CT with contrast of the chest show absence of the previously seen line in the lumen of the aorta from the sinotubular junction to the origin of the brachiocephalic artery.

The diagnosis was false positive thoracic aortic injury due to the non-gated nature of the original CT scan.

Infant with choking with feedings

CT angiogram of right aortic arch with aberrant left subclavian artery — Lateral image from an esophagram (above left) shows a posterior indentation on the esophagus which was persistent. Coronal CT with contrast of the chest (above right) with 3D reconstructions (below) show a right-sided aortic arch with an aberrant left subclavian artery that originated from a Kommerell diverticulum and that courses behind the esophagus. The ductus arteriosus was noted to extend from the Kommerell diverticulum and completed the vascular ring.

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

Preschooler with a murmur

Angiogram of patent ductus arteriosus — AP (left) and lateral (right) images from an angiogram with the catheter in the aortic arch shows simultaneous opacification of the aorta and the main pulmonary artery.

The diagnosis was patent ductus arteriosus.

Newborn with tachypnea

CXR of viral myocarditis — CXR AP shows cardiomegaly and pulmonary vascular congestion.

The diagnosis was viral myocarditis.

Infant with cyanosis and increased pulmonary blood flow on CXR

CT of double outlet right ventricle — Coronal CT with contrast of the chest show a large monoatrium (above) and a large right ventricle (below) with the aorta (to the right of midline) and pulmonary artery (in the midline) arising from it. The left ventricle was small.

The diagnosis was double outlet right ventricle.

Toddler with a connective tissue disease

CXR of Marfan syndrome — CXR AP shows a prominent aortic arch and left lateral border of the aorta due to aortic ectasia.

The diagnosis was Marfan Syndrome.

Preschooler with right upper quadrant pain and jaundice

US of gallbladder hydrops in Kawasaki's disease

The diagnosis was Kawasaki disease causing hydrops of the gallbladder.

Teenager with left arm tingling

CT angiogram of Takayasu arteritis of the subclavian artery — CT angiogram of the chest with 3D reconstruction shows diffuse narrowing of the left subclavian artery beginning at its origin along with diffuse narrowing of the left vertebral artery beginning at its origin.

The diagnosis was Takayasu arteritis.

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.

Former premature newborn with past history of umbilical venous catheter

CXR and CT of portal vein thrombosis due to umbilical venous catheter — CXR AP (above) shows a calcification in the liver just to the right of the L1 vertebral body. Axial CT with contrast of the abdomen (below) shows the dense calcification to be in the left portal vein.

The diagnosis was portal vein thrombosis due to prior umbilical vein catheter.

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.