Teenager with noisy breathing at night

CXR and CT of tracheobronchial papillomatosis — CXR AP (above left) shows multiple thin walled cystic and solid lesions in both lungs. Axial CT without contrast of the chest (right) shows multiple cystic and solid lesions in the lungs bilaterally. AP image of the airway (below left) shows a mural tracheal mass arising from the left side of the trachea which nearly completely occludes the airway.

The diagnosis was tracheobronchial papillomatosis.

Newborn with respiratory distress

CXR and CT of pulmonary agenesis — CXR AP (above) shows complete opacification of the left hemithorax with mediastinal shift to the left. Axial CT without contrast of the chest (below) show hyperexpansion of the right lung with herniation across the midline, mediastinal shift to the left, and non-visualization of the left mainstem bronchus.

The diagnosis was left pulmonary agenesis.

School ager with cough and fever and chest pain

CXR and CT of lung abscess — CXR AP (above) shows two air filled cavities in the right upper lobe in an otherwise completely opacified right hemithorax. Axial CT with contrast of the chest (below) shows a large right pleural effusion, right lung consolidation and a cavitary lesion in the right upper lobe.

The diagnosis was a developing lung abscess due to Streptococcal pneumonia.

Infant with cough and wheezing

CXR and CT of extrapulmonary sequestration — CXR AP (above) shows a round density projecting to the left of the 8th and 9th thoracic vertebral bodies. Axial CT without contrast of the chest (below) better shows a solid left paraspinal mass. In the operating room it was seen to lay outside the lung and to have its arterial supply coming from the aorta.

The diagnosis was extralobar pulmonary sequestration.

Toddler with respiratory distress

CXR and CT of post-infectious pneumatocele — CXR AP (above) shows the arterial catheter tip projecting over the aortic arch and the venous catheter tip projecting over the right atrium. There is bilateral diffuse airspace disease and bilateral pleural effusions. A cystic lesion is seen in the right lower lobe. Axial CT without contrast of the chest (below left) shows the cystic lesion is thin walled and communicates with the bronchial tree and has multiple septations (below right).

The diagnosis was pneumatocele due to pneumococcal pneumonia in a patient on ECMO.

Teenager with cough, fever and halitosis

CXR and CT of lung abscess — CXR PA and lateral (above) show a large round cavitary lesion with an air fluid level in the right lower lobe. Axial CT with contrast of the chest (below) shows a large round intraparenchymal fluid collection in the right lower lobe with thick nodular walls and an air fluid level.

The diagnosis was lung abscess in a patient with bacterial pneumonia.

Toddler with respiratory distress

CXR and CT of bronchopleural fistula — CXR AP (above) shows diffuse bilateral airspace disease and a right sided pneumothorax that is almost completely drained by a right chest tube. Axial CT with contrast of the chest (below left) shows air and fluid and a chest tube in the right pleural space and an enhancing rim sign of the pleura. There is also a bronchopleural fistula from the superior segment of the right lower lobe to the necrotic lung and pleural space (below right).

The diagnosis was bronchopleural fistula and pleural empyema in a patient with streptococcus pneumonia.

Teenager with past history of Wilms tumor

CXR and CT of lung metastasis in Wilms tumor — CXR AP (above) shows a soft tissue density projecting in the right cardiophrenic angle. Axial CT with contrast of the chest (below) shows a soft tissue mass in the right posterior costophrenic sulcus.

The diagnosis was lung metastasis in a patient with Wilms tumor.

Toddler with respiratory distress

CXR and CT of post-infectious pneumatocele — CXR AP (above left) initially shows an infiltrate in the left lower lobe that on a CXR AP one week later (above right) has developed a cystic cavity in the middle of it. A left pleural effusion is also now present. Axial CT with contrast of the chest (below) shows the cystic cavity is thin walled and septated. Left lower lobe consolidation and left pleural effusion remain present.

The diagnosis was post-infectious pneumatocele due to pneumococcal pneumonia.

School ager with cough and fever

CXR and CT of lipoblastoma — CXR PA and lateral (above) shows a right sided chest mass in the posterior mediastinum. Axial CT with contrast of the chest (below) shows a homogeneous mass, of fat density, with a few septations, in the right posterior mediastinum causing some anterior displacement of the right mainstem bronchus.

The diagnosis was lipoblastoma in the posterior mediastinum.

School ager with fever and cough

CXR and CT of pleural empyema — CXR AP (above) shows consolidation in the right upper lobe and a large right pleural effusion. Axial CT with contrast of the chest (below) shows a large right pleural effusion with an enhancing rim causing atelectasis of the adjacent lung.

The diagnosis was pleural empyema.

Premature newborn now 2 months old with respiratory distress

CXR and CT of pneumatocele — CXR (above) and axial CT without contrast of the chest (below) shows diffuse interstitial thickening and a large, round, unilocular thin-walled cyst in the posterobasal aspect of the right lower lobe. The bronchus of the posterobasal segment of the right lower lobe was seen to extend into it.

The diagnosis was pneumatocele due to positive pressure ventilation in a patient with chronic lung disease.

Teenager with hypertension

CT of histoplasmosis — Coronal CT with contrast of the chest (left) shows a large round soft tissue nodule with a calcified center in the lateral aspect of the left hemithorax. Axial CT (above right) shows calcified mediastinal lymph nodes near the descending aorta and better demonstrates the calcification in the lung nodule (below right).

The diagnosis was histoplasmosis.

School ager with right scapular and right chest pain

CXR and CT of Ewing Sarcoma of the rib / Askin Tumor — CXR AP and lateral (above) show a large right sided chest mass whose obtuse angles with the chest wall suggest it is extrapleural in origin. Axial CT without contrast of the chest (below) shows the mass to be arising from a rib and to be causing periosteal reaction.

The diagnosis was Ewing sarcoma of the rib (Askin tumor).

School ager with an upper respiratory infection

CXR and CT of congenital pulmonary airway malformation type I — CXR AP and lateral (above) shows a large cystic lesion in the right upper lobe. Axial CT with contrast of the chest (below) shows the lesion consisted of a single cyst.

The diagnosis was congenital pulmonary airway malformation type I.

School ager being evaluated for lung transplantation

CXR and CT of cystic fibrosis — CXR AP and lateral (above) show bilaterally hyperexpanded lungs with a coarse interstitial pattern, bronchial wall thickening and bronchiectasis. Axial CT without contrast of the chest show thickened interlobular septa and bronchiectasis in the bilateral upper (below left) and lower (below right) lobes.

The diagnosis was cystic fibrosis.

Newborn with respiratory distress

CXR and CT of congenital lobar emphysema — CXR AP (above) and axial CT without contrast of the chest (below) show hyperinflation of the right middle lobe causing mediastinal shift to the left and partial collapse of the right upper and lower lobes.

The diagnosis was congenital lobar emphysema of the right middle lobe.

Newborn with an echogenic right chest mass on prenatal ultrasound

CXR and CT of congenital pulmonary airway malformation type I — CXR AP and lateral (above) show a round heterogenous mass in the right upper lobe. Axial CT without contrast of the chest (below) shows a dominant central cyst in the lung surrounded by many smaller cysts.

The diagnosis was congenital pulmonary airway malformation type I.

School ager with substernal distress associated with exercise

CXR and US and CT of Morgani hernia — CXR AP and lateral (above) shows an anteromedial soft tissue density in the right cardiophrenic angle obscuring the right heart border. Sagittal US of the chest performed anteriorly and just to the right of the midline (below left) shows liver extending above the level of the diaphragm. Axial CT with contrast of the chest (below right) shows liver in the right cardiophrenic angle just to the right of the heart in the right hemithorax.

The diagnosis was a right-sided Morgagni hernia containing liver.

Newborn with an echogenic left lower lung mass on prenatal ultrasound

CT of congenital pulmonary airway malformation Type I — CXR at birth (above left) shows an ill-defined large mass in the lower left chest obscuring the heart border and causing mediastinal shift to the right. Axial CT without contrast of the chest at birth (above right) shows the left chest mass to contain multiple cysts that are filled with air and fluid. CXR at 10 months (below left) shows the large lower left chest mass to now be hyperlucent. Axial CT without contrast of the chest at 10 months (below right) shows the left chest mass to contain multiple large air-filled cysts.

The diagnosis was congenital pulmonary airway malformation Type I.

Newborn with respiratory distress and new abdominal distension

CT of congenital diaphragmatic hernia — CXR (left) shows massive pneumoperitoneum and right pneumothorax which outlines a mass in the lower right chest which is causing mediastinal shift to the left. Coronal CT with contrast of the chest (above right) shows liver herniating through a lateral defect in the diaphragm into the lower right chest and lying above the right diaphragm (below right).

The diagnosis was congenital diaphragmatic hernia containing liver as outlined by pneumothorax and pneumoperitoneum.

Former premature newborn now 1 year old with chronic respiratory distress

CXR and CT of bronchopulmonary dysplasia — CXR (above) shows hyperexpansion and fine interstitial infiltrates. Axial CT without contrast of the chest (below) shows diffuse alveolar and interstitial lung disease bilaterally that is more prominent in the perihilar regions.

The diagnosis was bronchopulmonary dysplasia.

School ager one year after viral pneumonia with progressive respiratory distress

CXR and CT of bronchiolitis obliterans with organizing pneumonia — CXR (above) shows bilateral basilar infiltrates and blunting of the left costophrenic angle. Axial CT without contrast of the lung (below) shows bilateral lower lobe bronchiectasis and mild interstitial prominence, the upper lobes appeared normal.

The diagnosis was bronchiolitis obliterans with organizing pneumonia.

Infant with reactive airway disease

CXR and CT of bronchiolitis obliterans — CXR AP and lateral (above) shows hyperinflation. Axial CT without contrast of the chest shows focal areas of decreased lung density in a lobular patter most prominent in the bilateral upper lobes (below left) and several nodular opacities in the lingula (below right).

The diagnosis was bronchiolitis obliterans.

Teenager on chemotherapy with fever

CXR and CT of invasive aspergillosis — CXR on day 8 of the fever (above left) shows opacities in the left upper lobe and right middle lobe. Axial CT without contrast of the chest on day 13 of the fever (above right) shows parenchymal opacities surrounded by irregular ground glass density (halo sign). CXR on day 20 of the fever (below left) shows interval cavitation of the bilateral lung lesions which on axial CT with contrast of the chest on day 34 of the fever (below right) shows central necrosis in the lesions which is detached from the wall (air crescent sign).

The diagnosis was invasive aspergillosis.