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.

Newborn with grunting

CXR of persistent pulmonary hypertension — CXR AP shows cardiomegaly and increased pulmonary blood flow.

The diagnosis was persistent pulmonary hypertension.

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.

Infant with heterotaxy syndrome and complex congenital heart disease and bilious vomiting

Upper GI of malrotation without midgut volvulus in heterotaxy — AP image from an upper GI 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. There is also gastroesophageal reflux.

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

Young adult who has gone from being acyanotic to now being cyanotic

CXR of Eisenmenger syndrome due to ventricular septal defect / VSD — CXR AP at 4 years of age (above) shows mild prominence of the pulmonary arteries bilaterally. CXR AP at 24 years of age (below) shows marked enlargement of the pulmonary arteries bilaterally with peripheral pruning of the pulmonary vasculature.

The diagnosis was Eisenmenger syndrome due to ventricular septal defect.

Cyanotic newborn

Angiogram of truncus arteriosus — AP image from an aortic root injection in an angiogram shows simultaneous opacification of a right aortic arch and the pulmonary artery arising from it.

The diagnosis was truncus arteriosus.

Cyanotic newborn

CXR of transposition of the great arteries / transposition of the great vessels / TGA — CXR AP shows increased pulmonary vascularity and cardiomegaly.

The diagnosis was transposition of the great arteries.

Cyanotic newborn

CXR of totally anomalous pulmonary venous return — CXR AP shows increased pulmonary vascularity and a normal sized heart with an upturned cardiac apex.

The diagnosis was total anomalous pulmonary venous return.

Cyanotic toddler

CXR of tetralogy of Fallot / TOF — CXR AP shows decreased pulmonary vascularity and a normal sized heart with the cardiac apex slightly upturned.

The diagnosis was tetralogy of Fallot.

Cyanotic newborn

CXR of pulmonary atresia with intact ventricular septum — CXR AP shows decreased pulmonary vascularity and mild cardiomegaly.

The diagnosis was pulmonary atresia with intact ventricular septum.

Acyanotic infant

Angiogram of patent ductus arteriosus / PDA — AP image from a ventricular injection in an angiogram shows simultaneous opacification of the aorta and main pulmonary artery.

The diagnosis was patent ductus arteriosus.

Cyanotic newborn

CXR of hypoplastic left heart syndrome / HLHS — CXR AP shows increased pulmonary vascularity and cardiomegaly.

The diagnosis was hypoplastic left heart syndrome.

Acyanotic infant with grunting

CXR of tachyarrythmia cardiomyopathy — CXR AP shows increased pulmonary vascularity and mild cardiomegaly.

The diagnosis was tachyarrythmia cardiomyopathy.

Acyanotic infant

CXR of AV canal / endocardial cushion defect — CXR AP and lateral shows hyperexpanded lungs, increased pulmonary vascularity and marked cardiomegaly.

The diagnosis was AV canal.

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.