Teenager with a chest wall deformity

CT of pectus excavatum — Axial CT without contrast of the chest shows a marked depression of the sternum towards the spine. The Haller index was 4.

The diagnosis was pectus excavatum.

Infant with stridor and a barky cough

Radiograph of croup — AP radiograph of the airway (left) shows loss of the normal shoulders of the subglottic trachea (steeple sign). Lateral radiograph of the airway (right) shows distension of the hypopharynx, a normal epiglottis and some narrowing of the subglottic trachea.

The diagnosis was croup.

Infant with an echogenic right lung mass on prenatal US

CT of congenital pulmonary airway malformation — Axial (above) and coronal (below) CT with contrast of the chest show a round mass in the right superior hilum that consists primarily of fluid density with a small air bubble in it superiorly.

The diagnosis was congenital pulmonary airway malformation.

Newborn immediately status post repair of left congenital diaphragmatic hernia

CXR of hypoplastic lung bud postoperatively in congenital diaphragmatic hernia — CXR AP (left) shows the hypoplastic lung bud which cannot immediately expand to fill the hemithorax in the apex of the left hemithorax and therefore there is also air in the left pleural space. Note that this is not a pneumothorax and should not be drained via a chest tube. CXR AP obtained 2 days later (right) shows the left pleural space is now filled with fluid rather than air, and again this should not be drained by a chest tube. As the lung bud expands, the pleural effusion will decrease in size.

The diagnosis was development of a left pleural effusion to fill the potential space in the left hemithorax after repair of a left congenital diaphragmatic hernia.

Infant with a whooping cough

CXR of pertussis pneumonia — CXR AP and lateral show bilateral streaky perihilar infiltrates giving the heart contour a shaggy appearance.

The diagnosis was pertussis pneumonia.

Toddler who is post-op from cardiac surgery with respiratory distress

CXR and US of diaphragm paralysis — CXR AP (above) shows elevation of the left hemidiaphragm. Sagittal M-mode US of the right hemidiaphragm (lower left) shows normal sinuous motion of the right hemidiaphragm while sagittal M-mode US of the left hemidiaphragm (lower right) shows no motion of the left hemidiaphragm.

The diagnosis was paralysis of the left hemidiaphragm.

Preschooler with stridor and drooling

Gross pathological image of epiglottitis — Gross pathological image shows a swollen epiglottis in the midline of the specimen with thickened aryepiglottic folds visible lateral to it.

The diagnosis was epiglottitis.

Teenager with chest pain and shortness of breath

CXR and CT of thymoma — CXR PA and lateral (above) shows a mass centered in the anterior mediastinum with a right pleural effusion. Axial images from a CT with contrast of the chest shows a large solid anterior mediastinal mass that has a few areas of calcification (lower left) and fat (lower right) within it.

The diagnosis was thymoma.

School ager with cough and fever

CXR of COVID-19 pneumonia — CXR AP shows bilateral diffuse ground glass opacities in the mid to lower lungs. No lymphadenopathy or pleural effusions were seen.

The diagnosis was COVID-19 pneumonia.

Infant who had undergone emergency thoracotomy for cardiac massage during a cardiac arrest 6 months before and now has a lump under the left arm

CXR of pulmonary herniation — CXR AP in inspiration (above) shows the left 5th intercostal space at the side of the previous thoracotomy to be deformed. CXR AP in expiration (below) shows interval development of a cystic structure in the soft tissues of the left chest wall.

The diagnosis was pulmonary herniation through the left 5th intercostal space secondary to incorrectly repaired thoracotomy incision.

School ager with hypoxia who has Eisenmenger syndrome due to a ventricular septal defect and a brain abscess

CXR and CT of septic emboli in the lungs / septic pulmonary emboli — CXR AP (above) shows prominence of the central pulmonary arteries and multiple round lesions of varying size throughout both lungs which on the axial CT with contrast of the chest (below) are shown to have indistinct margins.

The diagnosis was septic emboli in the lungs in a patient with Eisenmenger syndrome.

Newborn with respiratory distress

CXR of pulmonary lymphangiectasia — CXR AP and lateral shows mild cardiomegaly and diffuse interstitial infiltrates with no evidence of pleural effusions.

The diagnosis was pulmonary lymphangiectasia.

Infant with respiratory distress

CXR and bronchogram and pulmonary angiogram of pulmonary agenesis — CXR AP and lateral (above) shows complete opacification of the left hemithorax and tracheal and mediastinal shift to the left and hyperexpansion of the right lung. CXR AP taken during a bronchogram (below left) shows absence of the left mainstem bronchus. AP image from a pulmonary angiogram (below right) shows a normal appearing right main pulmonary artery and absence of the left pulmonary artery.

The diagnosis was pulmonary agenesis.

School ager with cough and fever

CXR of bronchial atresia — Inspiratory CXR AP (upper left) shows increased lucency in the left upper lobe when compared to the right upper lobe while expiratory CXR AP (upper right) shows air trapping in the left upper lobe. Magnified view of the upper lobes (below) better shows a round lesion in the lower portion of the left upper lobe which represents mucous trapped distally to an area of atresia in a bronchus.

The diagnosis was bronchial atresia.

School ager with a cough

CXR of Kartagener syndrome — CXR AP shows situs inversus with the cardiac apex in the right hemithorax, the stomach bubble in the right abdomen and mild thickening of the airways centrally.

The diagnosis was Kartagener syndrome.

School ager with sickle cell disease and chest pain

CXR of acute chest syndrome in sickle cell disease — CXR AP shows bibasilar infiltrates, right greater than left, and a small right pleural effusion.

The diagnosis was acute chest syndrome.

Toddler with hemoptysis and anemia

CXR of pulmonary hemosiderosis — Initial CXR AP (left) shows diffuse alveolar infiltrates primarily in the upper lobes. CXR AP obtained a week later (right) shows resolution of the findings.

The diagnosis was pulmonary hemosiderosis.

Preschooler with malaise

CXR and CT of acute lymphocytic leukemia / ALL — CXR AP and lateral (above) shows left hilar and superior mediastinal lymphadenopathy which is better demonstrated on the axial CT with contrast of the chest (below).

The diagnosis was acute lymphocytic leukemia.

School ager with a cough

CXR of tuberculosis — CXR PA and lateral shows massive bilateral hilar lymphadenopathy with the lungs being clear.

The diagnosis was tuberculosis.

Teenager with malaise

CXR of sarcoidosis — CXR PA and lateral shows bilateral hilar lymphadenopathy, left greater than right, with the lungs being clear.

The diagnosis was sarcoidosis.

School ager with chronic cough

CXR of histoplasmosis — CXR PA and lateral shows bilateral hilar lymphadenopathy, right greater than left, and small miliary nodules throughout the lungs.

The diagnosis was histoplasmosis.

Toddler with refractory wheezing

CXR and CT of Castleman disease — CXR AP (above) shows massive bilateral hilar and mediastinal lymphadenopathy. Axial CT with oral contrast and without IV contrast of the chest and abdomen (below) better demonstrates the bilateral hilar and mediastinal lymphadenopathy (lower left) and shows bilateral retroperitoneal adenopathy anterior to the psoas muscles (lower right).

The diagnosis was Castleman disease.

Preschooler with respiratory distress

CXR and CT of pleuropulmonary blastoma — CXR AP (above) shows complete opacification of the right hemithorax with mediastinal shift to the left. Axial CT with contrast of the chest shows a large mass filling the entire right hemithorax that is solid peripherally and cystic centrally, causing mediastinal shift to the left.

The diagnosis was pleuropulmonary blastoma.

Infant with respiratory distress

CXR and CT of inflammatory myofibroblastic tumor in the chest — CXR AP shows a round opacity laterally in the right lung (above left) which projects in the middle of the chest over the trachea on the lateral (above right). Axial CT without contrast of the chest (below) shows the opacity to be a solid mass without calcification next to the pleura.

The diagnosis was inflammatory myofibroblastic tumor.

Preschooler with cough and fever

CXR of esophageal duplication / esophageal duplication cyst / bronchopulmonary foregut malformation — CXR PA (left) shows a large round opacity located medially in the left hemithorax which is located posteriorly on the lateral (right) over the spine (spine sign).

The diagnosis was esophageal duplication.