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.

Teen with a palpable anterior left chest wall mass

CXR and CT of rib fusion — CXR shows a contour irregularity of the left second rib anteriorly. 3D CT shows a pseudoarthrosis between the left first and second ribs.

The diagnosis was rib fusion / pseudoarthrosis of the left first and second ribs.

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 colli.

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.

Preschooler with a subxiphoid chest wall mass

CT of lipoma of the chest wall and thigh — Axial CT without contrast shows a symmetrical appearing chest wall (top), a fat density center-right sided chest wall mass (middle) and a fat density anterior left thigh mass (bottom).

The diagnosis was lipoma of the chest wall and left thigh.

Newborn with respiratory distress

CXR of esophageal intubation — CXR AP (above) shows the endotracheal tube tip projecting over the left side of the spine and a distended stomach. CXR AP (below) after re-intubation shows the endotracheal tube tip projecting over the right side of the spine and a nasogastric tube projecting over the left side of the spine in the position of the formerly placed endotracheal tube.

The diagnosis was esophageal intubation.

Premature newborn who has just been intubated

CXR of endotracheal tube in the esophagus in a patient with respiratory distress syndrome — CXR AP shows an endotracheal tube with its tip projecting beneath the carina and not over either mainstem bronchus and a distended stomach. There are diffuse ground glass opacities present throughout the lungs. CXR lateral shows the endotracheal tube to be posterior to the trachea and in the esophagus.

The diagnosis was esophageal intubation along with respiratory distress syndrome.

Infant who has just been intubated

CXR of esophageal 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.

Premature newborn with respiratory distress

CXR of endotracheal tube in the right mainstem bronchus 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 partial atelectasis of the right upper lobe with no mediastinal shift. There are diffuse ground glass opacities present throughout the lungs.

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

Preschooler in status epilecticus who is difficult to ventilate during transport

CXR of endotracheal tube in the esophagus — CXR AP shows an endotracheal tube with its tip projecting over the left side of the spine with its tip beneath the carina. There is complete atelectasis of the left lung with mediastinal shift to the left. The stomach is massively distended with air.

The diagnosis was esophageal intubation causing massive gastric distension.

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.

Infant after being re-intubated

CXR of endotracheal tube in right mainstem bronchus — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe but no mediastinal shift.

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

School ager with altered mental status requiring intubation

CXR of an endotracheal tube in the right mainstem bronchus — CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe and mediastinal shift to the left.

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

Newborn with meconium beneath the vocal cords noted during intubation

CXR of a highly positioned endotracheal tube in a patient with meconium aspiration syndrome — CXR AP shows the tip of the endotracheal tube to be above the thoracic inlet. The lungs are hyperinflated and there are coarse interstitial infiltrates bilaterally.

The diagnosis was an endotracheal tube positioned too high along with meconium aspiration syndrome.

Premature newborn with respiratory distress

CXR of correctly positioned endotracheal tube in a patient with respiratory distress syndrome — CXR AP shows the tip of the endotracheal tube to be between the clavicles and carina. The lungs are hypoinflated and there are symmetrical ground glass opacities present bilaterally.

The diagnosis was an endotracheal tube in appropriate position along with respiratory distress syndrome.

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.

Teenager with a complicated bacterial pneumonia

CXR of bronchopleural fistula — CXR AP shows a large right pleural effusion with an air-fluid level within it – a hydropneumothorax – that is being drained by a chest tube.

The diagnosis was right-sided bronchopleural fistula.

Infant whose right chest tube has stopped draining pleural fluid

CXR of chest tube malfunction with chest tube migration out of the pleural space — CXR AP (above) shows left and right chest tubes within their respective pleural spaces. CXR AP (below) shows interval migration of the right chest tube out of the right pleural space into the subcutaneous tissues of the right chest wall.

The diagnosis was persistent right pleural effusion due to the chest tube tip migrating out of the pleural space.

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.

Teenager in motor vehicle accident with continued shortness of breath after chest tube placement

CT of chest tube malposition with chest tube in the lung parenchyma — Axial and coronal and sagittal CT with contrast of the chest shows a large amount of air in the left pleural space. The left chest tube is clearly located within the air space disease in the posterior left lung parenchyma in all three planes.

The diagnosis was persistent pneumothorax in a thoracic trauma patient with pulmonary contusion due to the chest tube tip not being in the pleural space.

Premature newborn after chest tube placement

CXR of chest tube malfunction with chest tube in the subcutaneous tissues of the chest wall — CXR AP shows diffuse ground glass opacity throughout the lungs and a large amount of air in the right pleural space causing mediastinal shift to the left while the right-sided chest tube courses through the subcutaneous tissues of the right chest wall and never enters the right pleural space.

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

Newborn with persistent pulmonary hypertension on ECMO with blood coming out of right chest tube

US of hemothorax in patient on extracorporeal membrane oxygenation (ECMO) — Sagittal and transverse US of the right chest shows a complex fluid collection in the right pleural space.

The diagnosis was hemothorax as a complication of ECMO.

Teenager with abnormal pleural-based nodules on CXR who had sustained blunt abdominal trauma in the remote past

CXR and CT and Tc-99m sulfur colloid scan of diaphragmatic rupture — CXR AP shows a left-sided large pleural nodule just beneath the clavicle. Axial CT with contrast of the chest shows multiple pleural nodules throughout the left hemithorax and absence of the spleen. Tc-99m sulfur-colloid scan shows normal radiotracer uptake in the liver with no uptake in the region of the spleen (lower left), and nodular uptake throughout the left hemithorax (lower middle) and abdomen (lower right).

The diagnosis was diaphragmatic rupture and post-traumatic splenosis.