Toddler with respiratory distress

CXR and CT of lymphatic malformation of the thymus
CXR AP obtained intially (left) shows a normal appearing exam with a normal appearing thymus. CXR AP obtained 10 days later for continued respiratory distress (right) showed interval development of an anterior mediastinal mass. Axial+coronal CT with contrast of the chest shows a large low density anterior mediastinal mass with multiple thin septations.

The diagnosis was lymphatic malformation of the thymus which had bled in the interval between the two exams.

School ager with an enlarging and tender chest mass who has also had fatigue and weight loss over the last 3 months

CXR and CT of Hodgkins lymphoma with chest wall invasion
CXR PA and lateral shows a large lobulated mediastinal mass compressing and displacing the trachea to the right. Axial CT without contrast of the chest shows the mass to be in the anterior and middle mediastinum, compressing the left mainstem bronchus and eroding into the sternum and chest wall soft tissues.

The diagnosis was Hodgkins Lymphoma.

Infant with torticollis and a right superior chest wall mass

CT and US of fibromatosis coli / torticollis tumor
Axial CT with contrast of the chest (above) shows asymmetry of the sternocleidomastoid muscles, right larger than left. Transverse US of the chest (middle) at the same level of the CT better shows the enlarged right sternocleidomastoid muscle. Sagittal US of the sternocleidomastoid muscles (bottom) shows the normal smooth contour of the left sternocleidomastoid muscle and the spindle shaped appearance of the right sternocleidomastoid muscle.

The diagnosis was fibromatosis coli.

Infant with severe eczema and an enlarging left chest wall mass over the last week and elevated white count

CT and MRI of osteomyelitis of the rib
Axial CT without contrast of the chest (above) shows bilateral axillary adenopathy and soft tissue swelling over the left lateral chest wall and associated rib destruction. Coronal T2 MRI of the chest (below left) shows a high signal intensity fluid collection between the skin and the ribs with surrounding edema. Axial T1 MRI with contrast of the chest (below right) shows extensive enhancement of the left ribs and surrounding muscle.

The diagnosis was cellulitis and a subcutaneous abscess resulting in osteomyelitis of the rib via direct extension. The abscess was drained operatively and grew staphlococcus.

Infant who has just been intubated

CXR of endotracheal intubation
CXR AP (above) shows nasogastric tube with its tip within a distended stomach. An endotracheal tube is present to the right of the nasogastric tube and is projecting over an air-distended esophagus. There is near-complete atelectasis of the right lung. CXR AP (below) after reintubation now shows the endotracheal tube to the left of the nasogastric tube and interval resolution of the esophageal and gastric distension.

The diagnosis was esophageal intubation causing massive distension of the esophagus and stomach.