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.

Premature newborn with worsening respiratory distress after intubation

CXR of endotracheal tube in the right mainstem bronchus and pneumothorax in a patient with respiratory distress syndrome
CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. There is diffuse lucency in the right hemithorax which is also surrounding the right upper lobe.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus causing a right pneumothorax along with respiratory distress syndrome.

Infant with respiratory distress after begin re-intubated

CXR of endotracheal tube in the right mainstem bronchus and after it is pulled back
CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position just above the carina with subsequent near-complete re-expansion of the left lung.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

Newborn with respiratory distress

CXR of endotracheal tube in the right mainstem bronchus and after it is pulled back
CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with mediastinal shift to the left. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position between the clavicles and the carina with subsequent complete re-expansion of the left lung.

The diagnosis was an endotracheal tube positioned too deep in the right mainstem bronchus.

Newborn after repair of a left-sided congenital diaphragmatic hernia

CXR after congenital diaphragmatic hernia repair showing no need for a chest tube
CXR AP (above) taken immediately postop shows that the hypoplastic left lung cannot expand to completely fill the pleural space particularly in the basilar region and subsequently there is a moderate amount of air in the pleural space. This should not be called a pneumothorax. CXR AP taken 1 day later (below) shows the left pleural space now filling with fluid.

The diagnosis was normal post-operative appearance after congenital diaphragmatic hernia repair.

Young adult with cystic fibrosis with continued shortness of breath after chest tube placement

CXR of chest tube malposition with chest tube in the lung parenchyma
CXR AP (left) shows chronic interstitial fibrosis and scarring in the lungs, a left-sided chest tube, and a moderately-sized basilar left pleural air collection manifesting as a deep sulcus sign. Gross pathological specimen (right) shows the left chest tube entering the upper lobe of the left lung.

The diagnosis was persistent pneumothorax in a patient with cystic fibrosis due to the chest tube tip not being in the pleural space.