School ager with respiratory distress which has not responded to medical therapy

CXR of carcinoid tumor of the chest — CXR AP and lateral show a dense consolidation in the right middle lobe.

The diagnosis was carcinoid tumor of the lung.

Teenager with chest pain

CT of spontaneous pneumothorax due to apical bleb — Axial CT with contrast of the chest at presentation (above) shows a large amount of air in the right pleural space which was subsequently treated with a chest tube. Coronal CT without contrast of the chest performed 1 week after presentation and after chest tube removal (below) shows a small bleb in the apex of the right lung.

The diagnosis was spontaneous pneumothorax due to an apical bleb.

Toddler with a cough

CXR of mycoplasma pneumonia — CXR AP and lateral show bilateral diffuse bronchial wall thickening and subsequent interstitial infiltrates.

The diagnosis was mycoplasma pneumonia.

Toddler with a whooping-sounding cough

CXR of pertussis pneumonia — CXR AP shows bilateral lung hyperexpansion with bilateral perihilar infiltrates that blur the border of the heart, resulting in the heart border having a shaggy appearance.

The diagnosis was pertussis pneumonia.

7 week old infant with respiratory distress without fever

CXR of chlamydia pneumonia — CXR AP and lateral show bilateral diffuse infiltrates with hyperexpanded lungs.

The diagnosis was chlamydia pneumonia.

School ager with nausea, vomiting, and jaundice who is Hepatitis A positive

US of acute hepatitis — Transverse (above) and sagittal (below) US of the liver show a starry sky appearance to the liver with hypoechoic liver parenchyma and echogenic portal tracts.

The diagnosis was acute hepatitis.

Teenager with shortness of breath for 1 month

CXR and CT of granulomatosis with polyangiitis — CXR (above left) shows bilateral peripheral airspace disease that is more prevalent in the lower lobes than the upper lobes. Coronal (above right) and axial (below) CT with contrast of the chest better demonstrates the disease distribution and the presence of a few small non-cavitary nodules bilaterally.

The diagnosis was granulomatosis with polyangiitis.

Newborn after chest tube placement for a right pneumothorax

CXR of chest tube tip in the subcutaneous tissues of the chest wall — CXR AP shows a right sided chest tube whose tip is in the right subcutaneous tissues and not in the right hemithorax. There is a small right pneumothorax. The remainder of the tubes and lines are in appropriate position.

The diagnosis was chest tube malfunction due to the chest tube tip being in the subcutaneous tissues.

School ager with fever, stridor and a sore throat

Airway radiograph of bacterial tracheitis — Lateral radiograph of the airway shows subglottic asymmetric narrowing of trachea with an irregular tracheal border and loss of the normal definition of the tracheal walls with membranes and plaques noted within the subglottic trachea.

The diagnosis was bacterial tracheitis.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome — CXR AP shows symmetrical low lung volumes bilaterally with ground glass opacities that are symmetrical from apex to base as well as from medial to lateral in each hemithorax. The endotracheal tube tip is just beneath the thoracic inlet.

The diagnosis was respiratory distress syndrome.

Infant after chest tube removal

CXR of chest tube fracture during chest tube removal — CXR AP (left) shows a chest tube in the left hemithorax. CXR AP after chest tube removal (right) shows a long fragment of the chest tube remaining in the left hemithorax.

The diagnosis was chest tube malfunction due to fracture of the chest tube during chest tube removal.

Newborn with respiratory distress

CXR of normal inspiratory chest — CXR AP shows the lungs to be well expanded and clear. The heart and mediastinal contour are normal. There is no pneumothorax or pleural effusion.

The diagnosis was normal inspiratory chest.

Toddler on a farm with fevers and night sweats

CXR and CT of mycobacterium avium pneumonia — CXR AP (left) shows widening of the mediastinal contour bilaterally which on axial CT with contrast (above right) is seen to be due to confluent bilateral hilar and parahilar and subcarinal lymphadenopathy. Axial CT with contrast of the abdomen (below right) shows confluent mesenteric lymphadenopathy.

The diagnosis was mycobacterium avium pneumonia.

Newborn with echogenic appearing kidneys on prenatal US

The diagnosis was pulmonary hypoplasia due to oligohydramnios and a right pneumonthorax.

Preschooler with a skin rash

CXR of varicella pneumonia — CXR AP shows small round lung nodules scattered throughout the lungs.

The diagnosis was varicella pneumonia.

Toddler who is HIV positive with respiratory distress

CXR of lymphoid interstitial pneumonia — CXR AP and lateral (above) shows a diffuse, symmetrical, reticulonodular infiltrate which is better appreciated on the magnified view (below). There is no hilar lymphadenopathy.

The diagnosis was lymphoid interstitial pneumonia.

Toddler with stridor and dysphagia

Radiograph of epiglottitis — Lateral radiograph of the airway shows a swollen and thickened and rounded epiglottis (thumb sign) and thickened aryepiglottic folds.

The diagnosis was epiglottitis.

Teenager with worsening right arm and right shoulder pain when doing things overhand or overhead

CXR of cervical rib — CXR AP shows a large right cervical rib at C7.

The diagnosis was thoracic outlet syndrome due to a right cervical rib.

Teenager with cough and fever

CXR of spine sign in bacterial pneumonia — CXR AP (above left) shows a hazy opacity projecting over the apex of the heart while the CXR lateral (above right) places the hazy opacity over the last vertebral body that is completely above the diaphragm. Note on the lateral that over the spine, the lung is not getting more lucent going from lung apex to lung base because of this hazy opacity (spine sign). Sagittal CT without contrast of the left hemithorax of the chest (below) shows a dense opacity in the posterior aspect of the left lower lobe.

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

Preschooler who is HIV positive with respiratory distress

CXR of lymphoid interstitial pneumonia — CXR AP and lateral (above) show a diffuse, symmetrical, nodular infiltrate in the lungs bilaterally without hilar or mediastinal adenopathy. CXR AP obtained a year later (below) shows the nodular infiltrate has decreased slightly in the interval.

The diagnosis was lymphoid interstitial pneumonia.

Preschooler with a new cough

CXR of foreign body in the left mainstem bronchus — CXR AP shows hyperaeration and increased lucency of the left lung compared to the right lung. There is also mediastinal shift to the right.

The diagnosis was airway foreign body in the left mainstem bronchus.

Preschooler who was seen to swallow a foreign body and then start coughing

CXR of airway foreign body in left mainstem bronchus — CXR AP (above) shows hyperlucency of the left lung when compared to the right lung. Right lateral decubitus CXR (below left) shows appropriate collapse of the right lung when placed in a dependent position. Left lateral decubitus CXR (below right) shows inappropriate non-collapse of the left lung when placed in a dependent position.

The diagnosis was airway foreign body in the left mainstem bronchus.

Infant with respiratory distress

CXR of thymus rebound — CXR AP (left) shows central airway thickening and lung hyperexpansion. The thymus is not visible. Repeat CXR AP obtained 3 months after resolution of respiratory symptoms (right) shows normal central airways and lung expansion. The thymus is now well visualized and is normal in appearance.

The diagnosis was thymus involution during viral pneumonia followed by thymus rebound upon recovery.

Toddler who is HIV positive and has months of respiratory distress

CXR of lymphoid interstitial pneumonia — Initial CXR AP and lateral (above) show diffuse reticular interstitial infiltrates throughout the lungs bilaterally. CXR AP several months later (below) shows some interval clearing of the reticular infiltrates.

The diagnosis was lymphoid interstitial pneumonia.

Toddler with a cough

CXR and CT of foreign body in left mainstem bronchus — CXR AP at presentation (above left) shows mediastinal shift to the left and complete opacification of the left hemithorax due to complete atlectasis of the left lung. A subsequent CXR AP obtained the next day (not provided) showed reexpansion of the left lung which was symmetrically expanded when compared to the right lung. CXR AP obtained 3 months later (above right) showed the left hemithorax to be hyperlucent when compared to the right hemithorax. Axial CT without contrast of the lungs (below) again shows the relative hyperlunceny of the left hemithorax and a foreign body is seen just beneath the carina filling the proximal left mainstem bronchus (below center).

The diagnosis was airway foreign body in the proximal left mainstem bronchus.