Premature newborn with respiratory distress

CXR of respiratory distress syndrome / surfactant deficiency disorder — CXR AP shows the lungs to be hypoexpanded with symmetrical ground glass opacity present throughout the lungs from their apex to their base.

The diagnosis was respiratory distress syndrome.

Teenager with a chest wall deformity

Clinical image of pectus excavatum — Clinical image shows a marked concavity of the chest wall.

The diagnosis was pectus excavatum.

Toddler who was seen ingesting gasoline

CXR of lipoid pneumonia — CXR AP obtained 1 week after the ingestion of gasoline shows bilateral perihilar confluent infiltrates. No pneumatocele is seen.

The diagnosis was lipoid pneumonia.

Toddler who was seen ingesting kerosene

CXR of lipoid pneumonia — CXR obtained at 1 hour (upper left), at 10 hours (upper right), and 72 hours (bottom) after the ingestion of kerosene shows initially an unremarkable CXR that at 10 hours has developed bilateral fine interstitial infiltrates which have become more confluent at 72 hours.

The diagnosis was lipoid pneumonia.

Toddler with respiratory distress after a surgical procedure that utilized general anesthesia

CXR of aspiration pneumonia — CXR AP shows a dense infiltrate in the apical aspect of the right upper lobe. The stomach is air-filled and distended.

The diagnosis was aspiration pneumonia.

Infant who is often noted to gag and choke with feedings

CXR of aspiration pneumonia — CXR AP shows a dense infiltrate in the lateral aspect of the right upper lobe.

The diagnosis was aspiration pneumonia.

Newborn with meconium stained amniotic fluid and meconium noted beneath the vocal cords during intubation

CXR of meconium aspiration syndrome — CXR AP shows a hyperinflated chest with coarse interstitial infiltrates.

The diagnosis was meconium aspiration syndrome.

Preschooler with stridor, dysphagia, fever and drooling

Endoscopic image of epiglottitis — Endoscopic image shows an enlarged epiglottis and thickened areyepiglottic folds with an endotracheal tube in the trachea.

The diagnosis was epiglottitis.

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 who fell on to her right shoulder

CXR and CT of teratoma of thymus — CXR AP+lateral shows a large anterior mediastinal mass. Axial CT with contrast of the chest shows a heterogenous mass containing low density fat and high density calcium.

The diagnosis was teratoma of the thymus.

School ager with respiratory distress

CXR and CT of thymic cyst — CXR AP shows an abnormal contour to the left superior mediastinum in the region of the aortic arch which is too prominent for the patient’s age. Axial CT with contrast of the chest shows a low density lesion within the thymus compressing the brachiocephalic vein.

The diagnosis was thymic cyst.

School ager with respiratory distress

CXR and CT of Hodgkins lymphoma with infiltration of the thymus — CXR AP+lateral shows a large mass filling the anterior mediastinum which is seen to be homogeneous in appearance on the axial CT with contrast of the chest.

The diagnosis was Hodgkin lymphoma with infiltration of the thymus.

School ager with malaise

CXR of acute lymphocytic leukemia with infiltration of the thymus — CXR AP+lateral shows a large anterior mediastinal mass centered in the region of the thymus.

The diagnosis was acute lymphocytic leukemia with infiltration of the thymus.

Infant who was ill one month ago and now has recovered and presents for followup

CXR of thymic rebound — CXR AP from one month ago (left) shows evidence of a right lower lobe infiltrate and right pleural effusion due to bacterial pneumonia. The superior mediastinum is narrow. CXR AP taken today (right) shows resolution of the pneumonia and interval reappearance of the thymus.

The diagnosis was thymic rebound.

Newborn with abnormal facies and respiratory distress

CXR of absent thymus in DiGeorge Syndrome — CXR AP shows a very narrow superior mediastinum while on the lateral view the anterior mediastinum appears empty.

The diagnosis was an absent thymus due to DiGeorge syndrome

Preschooler with left neck mass

US and CT of cervical thymus — Transverse+sagittal US of the neck (above) shows the mass to have a starry sky appearance. Axial+coronal CT with contrast of the neck shows the mass to be inferior to the thyroid and contiguous with the thymus.

The diagnosis was cervical thymus.

Newborn with respiratory distress

CXR of a prominent thymus — CXR AP+lateral shows an anterior mediastinal mass without a thymic wave or thymic sail sign that was confirmed on US to be normal thymic tissue.

The diagnosis was prominent thymus.

Premature newborn with respiratory distress

CXR of normal thymus on rotated CXR — CXR AP rotated to the right shows complete opacification of the right lung apex. Repeat CXR without rotation was unremarkable.

The diagnosis was a rotated CXR accentuating the appearance of a normal thymus.

Newborn with respiratory distress

CXR of normal thymus with wave sign — CXR AP shows an anterior mediastinal mass with a wave-like appearance to the left mediastinal contour.

The diagnosis was normal thymus with a wave sign.

Infant with respiratory distress

CXR of normal thymus with sail sign — CXR AP and lateral shows a prominent anterior mediastinal mass whose right inferior margin appears triangular and sail-like in appearance.

The diagnosis was normal thymus with a sail sign.

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 Hodgkin Lymphoma.

Newborn with a large left chest wall deformity

CXR and CT of mesenchymal hamartoma of chest wall — CXR AP shows a large mass arising from the left 4th-6th ribs. Axial CT without contrast of the chest with soft tissue windows (right upper and middle) show the mass to have a fluid-fluid level within it superiorly while bone windows (right lower) show the mass to be calcified.

The diagnosis was mesenchymal hamartoma of the chest wall.

Teenager with right posterior chest wall pain and swelling for 2 years

CT of Ewing sarcoma of the rib — Axial CT with contrast of the chest shows a large heterogenous non-enhancing soft tissue mass centered around the posterior aspect of the right 11th rib. 3D CT reconstruction better demonstrates the lesion’s origin from the right 11th rib.

The diagnosis was Ewing sarcoma.

School ager with cystic fibrosis and a right chest wall mass

CXR of osteomyelitis of the rib — CXR PA and magnified view of the ribs (below) shows dense opacity in the right upper lobe and marked periosteal reaction of the right 4th rib posteriorly.

The diagnosis was botryomycosis (recurrent staphylococcus infection) resulting in osteomyelitis of the rib in a patient with cystic fibrosis.

School ager with a protuberant left chest wall

CXR and CT of pectus excavatum — CXR PA and lateral and axial CT without contrast of the chest shows marked depression of the sternum posteriorly leading to deformation of the chest wall.

The diagnosis was pectus excavatum.