School ager in a motor vehicle accident with respiratory distress

CXR of tracheobronchial injury of left mainstem bronchus — CXR AP shows air in the superior mediastinum and neck, airspace disease in the left upper lobe, and a small amount of air in the left pleural space.

The diagnosis was tracheobronchial injury of the left mainstem bronchus with pneumomediastinum and a small left pneumothorax.

Teenager who rolled over his all terrain vehicle with chest pain

CXR and CT of pneumatoceles — CXR AP shows patchy airspace disease in the right lung. Axial CT with contrast of the chest shows right-sided airspace disease as well as thin-walled cysts with fluid-fluid levels.

The diagnosis was post-traumatic pneumatoceles.

Teenager in a motor vehicle accident with chest pain

CXR and CT of pulmonary contusion — CXR AP shows patchy airspace disease in the right upper lobe which is much better seen on the axial CT with contrast of the chest.

The diagnosis was right-sided pulmonary contusion.

Obtunded toddler who was being carried down stairs by an adult who fell on top of them

CXR and CT of pneumomediastinum — CXR AP shows air outlining the thymus (thymic sail sign) and that the diaphragm can be traced throughout its course (continuous diagphragm sign). Axial CT with contrast of the chest shows air in the posterior mediastinum in front of the spine.

The diagnosis was pneumomediastinum.

Teenager in a motor vehicle accident with chest pain

CXR and CT of pneumothorax and pulmonary contusion and rib fracture — CXR AP shows a widened mediastinum and a small right-sided pneumothorax. Axial CT with contrast of the chest with lung (above) and bone (below) windows shows air in the pleural space anterior to the right lung and fluid in the pleural space posterior to the right lung as well as airspace disease in the right lower lobe and a cortical disruption through one of the right ribs posteriorly.

The diagnosis was a right hydropneumothorax, right pulmonary contusion, and right posterior rib fracture. Angiogram was negative for aortic injury.

School ager hit on right side by truck while riding bike with chest pain

CXR and CT of rib fracture and pulmonary contusion — CXR AP shows cortical irregularities of the right 6th and 7th ribs and no evidence of lung injury. Axial CT of the chest shows a large amount of airspace disease in the right lower lobe and a very small amount of free air anteriorly in the right hemithorax.

The diagnosis was right rib fractures and pulmonary contusion and a small anterior pneumothorax.

Teenager playing football struck in chest with chest pain

CT of sternoclavicular joint dislocation — CXR AP shows a widened superior mediastinum. Axial CT with contrast of the chest shows a mediastinal hematoma and a right sternoclavicular joint disruption that was displaced posteriorly. Angiogram was negative for aortic injury. Venogram was negative for large vessel venous injury.

The diagnosis was sternoclavicular joint dislocation with the mediastinal hemorrhage thought to be due to small vessel venous injury.

Newborn with respiratory distress

CXR of thanatophoric dysplasia — CXR AP shows narrow and short ribs, flattening of the vertebral bodies (platyspondyly) and telephone receiver deformity of the femurs.

The diagnosis was thanatophoric dysplasia.

Newborn with respiratory distress

CXR of asphyxiating thoracic dystrophy (Jeune syndrome) — CXR AP shows shortened ribs resulting in a small thorax and a normal spine.

The diagnosis was asphyxiating thoracic dystrophy.

Premature newborn (35 weeks) with respiratory distress

CXR of hydrops fetalis — CXR AP shows low lung volumes, large bilateral pleural effusions, and extensive body wall edema.

The diagnosis was hydrops fetalis (non-immune). The patient had a thoraco-amniotic shunt placed at 24 weeks gestational age.

Newborn with meconium aspiration syndrome who is paralyzed while undergoing extracorporeal membrane oxygentation (ECMO)

CXR of neuromuscular paralysis — CXR AP shows extensive body wall edema and poorly expanded lungs with the tip of the ECMO venous canula in the right atrium (ra) and the tip of the ECMO arterial canula in the aortic arch (aa).

The diagnosis was neuromuscular paralysis leading to hypotonia.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome — CXR AP shows bilaterally poorly expanded lungs with diffuse ground-glass opacities throughout the lungs.

The diagnosis was respiratory distress syndrome.

Newborn with an amniotic fluid leak in-utero

CXR of pulmonary hypoplasia due to oligohydramnios — CXR AP shows bilateral poorly developed and poorly expanded lungs.

The diagnosis was oligohydramnios causing pulmonary hypoplasia.

Premature newborn on ventilator with respiratory distress

CXR of pneumothorax — Supine CXR shows a large amount of air in the right pleural space with inversion of the right hemidiaphragm and mediastinal shift to the left. There is also evidence of pulmonary interstitial emphysema in the right lung.

The diagnosis was a right tension pneumothorax in a patient with pulmonary interstitial emphysema.

Preschooler status post left central line placement

CXR of pneumothorax — Supine CXR shows the left mediastinal and cardiac border is much more sharp in appearance than the right mediastinal and cardiac border.

The diagnosis was a left-sided pneumothorax which was confirmed on a right lateral decubitus radiograph.

School ager after trauma on an all terrain vehicle

CXR of pneumothorax — Supine CXR shows multiple left-sided rib fractures and the deep sulcus sign which is increased lucency in the left costophrenic angle. No definite pleural edge is seen.

The diagnosis was left-sided pneumothorax.

Newborn with respiratory distress

CXR of pneumothorax — Cross-table lateral CXR shows air collecting anteriorly in the thorax without a clear pleural edge. The thymus is also outlined by air.

The diagnosis was pneumothorax (side undetermined) with pneumomediastinum.

Newborn with respiratory distress

CXR of pneumothorax — Left lateral decubitus CXR shows a distinct left pleural edge with no lung markings superior to it and the left lung collapsing inferiorly.

The diagnosis was a left-sided pneumothorax.

Teenager with cystic fibrosis and chest pain

CXR of pneumothorax — Upright CXR shows a distinct right pleural edge with no lung markings lateral to it and the right lung collapsing inferiorly and medially.

The diagnosis was a right-sided pneumothorax.

Infant with wheezing

Radiograph of airway foreign body — Lateral radiograph of the airway shows a subglottic soft tissue mass. Endoscopy showed a sunflower seed surrounded by granulation tissue.

The diagnosis was a chronic airway foreign body.

Teenager with fever, night sweats, weight loss, and stridor

CXR and CT of Hodgkins lymphoma — CXR shows diffuse narrowing of the trachea due to infiltrative adenopathy shown on the axial CT without contrast of the chest.

The diagnosis was Hodgkin lymphoma.

Former premature newborn with a history of long-standing endotracheal intubation who now has stridor

Radiograph of tracheal granuloma — Lateral radiograph of the airway shows a subglottic soft tissue mass.

The diagnosis was tracheal granuloma.

Teenager with stridor

Radiograph and CXR of tracheobronchial papillomatosis — Lateral radiograph of the airway shows multiple polypoid lesions in the trachea. CXR shows multiple cystic lesions in the chest.

The diagnosis was tracheobronchial papillomatosis.

Preschooler with stridor

Radiograph of aryepilottic fold cyst — AP and lateral radiographs of the airway shows a mass in the left aryepilottic fold.

The diagnosis was aryepilottic fold cyst.

Toddler with stridor

Radiograph of laryngomalacia — Lateral radiograph of the airway obtained in inspiration (left) and expiration (right) shows near-complete collapse of the larynx in expiration.

The diagnosis was laryngomalacia.