School ager with a cough after bone marrow transplant

CXR and CT of invasive aspergillosis
CXR AP and lateral (above) shows a round opacity on the lateral view posteriorly projecting over a mid-thoracic vertebral body. Axial CT without contrast of the chest shows a cavitary lesion in the superior segment of the right lower lobe that has a halo sign peripherally with the parenchymal density surrounded by an irregular ground glass density and an air crescent sign with an area of central necrosis detached from the wall of the lesion.

The diagnosis was invasive aspergillosis.

Teenager with a small deformed right chest wall and a small right hand

CXR and CT of Poland syndrome
CXR PA and lateral shows thinning of the soft tissues over the right chest. The upper right ribs are deformed and there is mild scoliosis. Axial CT without contrast of the chest shows the asymmetry of the thoracic cavity and the concavity of the right chest wall. The right breast is absent, the right pectoralis major and right pectoralis minor muscles are absent, and the right serratus anterior and latissimus dorsi muscles are decreased in size.

The diagnosis was Poland syndrome.

Teenager without symptoms after a large left congenital diaphragmatic hernia repair over 10 years ago

CXR and upper GI of recurrent congenital diaphragmatic hernia / Bochdalek hernia
CXR PA and lateral (above) shows loops of bowel in the left lower chest posteriorly. This finding had been present and unchanged post-operatively for over 10 years. AP and lateral images from a small bowel follow through (below) shows colon in lower left chest.

The diagnosis in the operating room was recurrent congenital diaphragmatic hernia with colon and spleen in the lower left hemithorax.

School ager with right lower quadrant pain, fever, and elevated white blood cell count

Upper GI exam of congenital diaphragmatic hernia / Bochdalek hernia
AXR AP (above) is remarkable for a paucity of bowel gas in the abdomen. CXR PA (below left) obtained at the same time to rule out right lower lobe pneumonia as a cause of referred right lower quadrant pain shows dense opacity throughout the left hemithorax. CXR PA (below right) obtained during an upper GI and small bowel follow through exam shows a large amount of small bowel in the left hemithorax.

The diagnosis was delayed presentation of a left congenital diaphragmatic hernia. In the operating room the patient was also found to have acute appendicitis.

Infant with a fever

CXR and CT of diaphragm eventration
CXR PA and lateral (above) shows a right sided anteromedial opacity that obscures the right heart border on the PA image and the anterior portion of the right hemidiaphragm on the lateral image. Fluoroscopy showed the opacity to move synchronously with the diaphragm during normal respiration. Axial CT with contrast of the chest (below) shows the source of the opacity to be the liver positioned within the anteromedial lower right hemithorax.

The diagnosis was diaphragm eventration containing liver.