Infant with chronic lung disease post intubation

CXR of endotracheal tube in left mainstem bronchus — CXR AP shows the tip of the endotracheal tube projecting over the proximal left mainstem bronchus. There are fine interstitial infiltrates in the lungs bilaterally.

The diagnosis was endotracheal tube malfunction with the tip of the endotracheal tube in the left mainstem bronchus in a patient with chronic lung disease.

School ager status post left chest tube placement with bloody output from the chest tube and a decreased hematocrit after chest tube placement

CT of chest tube puncturing an intercostal blood vessel causing active bleeding — Arterial (above) and venous (below) phase axial CT with contrast of the chest shows a large hematoma inside the ribs at the chest tube insertion site. There is also a blush of contrast near the chest tube that increases on delayed imaging representing active bleeding.

The diagnosis was a chest tube malfunction in the form of a chest tube puncturing an intercostal blood vessel causing active bleeding.

Preschooler with a cough and fever

CXR and chest CT of pulmonary tuberculosis — CXR AP (above) shows prominence of the left hilum. Axial CT without contrast of the chest in soft tissue windows (below left) shows left hilar lymphadenopathy while the lung windows (below right) show next to the left hilar lymphadenopathy an infiltrate with a tree-in-bud pattern in the posterior left lung.

The diagnosis was tuberculosis pneumonia.

Newborn with respiratory syncytial virus pneumonia who is post intubation

CXR of endotracheal tube in right mainstem bronchus — CXR AP shows the tip of the endotracheal tube to be in the right mainstem bronchus. There is hyperaeration of the right lung.

The diagnosis was endotracheal tube malfunction in the form of intubation of the right mainstem bronchus in a patient with respiratory synctial virus pneumonia.

Teenager with recurrent fevers

CT of pulmonary tuberculosis — Axial CT with contrast of the chest (above) shows a small thick-walled cavitary lesion in the left upper lobe along with some associated opacities peripheral to it as well as in the right upper lobe. MIP axial CT with contrast of the chest (below) shows the entire left lower lobe to be filled with tree-in-bud opacities. There is also a nodular opacity in the anterior right lung.

The diagnosis was tuberculosis pneumonia.

Infant with a cough whose whole family has postive PPD and Quantiferon tests

CXR of primary pulmonary tuberculosis — CXR AP and lateral show a dense infiltrate in the right middle lobe along with right hilar adenopathy.

The diagnosis was tuberculosis pneumonia.

School ager with chronic stridor who had been intubated earlier in life

Radiograph of tracheal granuloma — AP radiograph of the airway shows a subglottic mass arising from the right wall of the trachea causing airway narrowing at the level of third and fourth cervical vertebral bodies.

The diagnosis was tracheal granuloma.

Newborn delivered via caesarean section with respiratory distress

CXR of transient tachypnea of the newborn — Initial CXR AP (above) shows normal lung expansion and fine interstitial infiltrates bilaterally. No pleural effusion is seen. CXR AP taken 1 day later (below) shows interval complete resolution of the previously seen fine interstitial infiltrates.

The diagnosis was transient tachypnea of the newborn.

Teenager from Africa with a positive Quantiferon test

CXR and CT of pulmonary tuberculosis — CXR PA and lateral (above) shows prominence of the superior mediastinum and left hilum. Axial CT with contrast of the chest (below) shows extensive left hilar and subcarinal lymphadenopathy.

The diagnosis was tuberculosis pneumonia.

School ager with respiratory distress

CXR and CT of prominent thymus — CXR AP (above) shows an abnormal soft tissue density to the left of the spine in the left suprahilar region. Axial CT with contrast of the chest (below) shows in the anterior mediastinum an enlarged thymus which is homogenous in appearance and without any focal lesions.

The diagnosis was prominent thymus.

Teenager with respiratory distress and blood coming from the endotracheal tube

CXR and CT of pulmonary hemorrhage — CXR AP (above) shows bilateral diffuse asymmetrical airspace opacities which are more confluent in the right lung. There is a moderate in size right pleural effusion. Coronal CT with contrast of the chest (below) also shows right lower lobe atelectasis caused by the pleural effusion.

The diagnosis was pulmonary hemorrhage.

Infant with respiratory distress

CXR and specimen radiograph of mesenchymal hamartoma of the chest wall — CXR AP and lateral (above) show a cystic expansile lesion arising from the posterior aspect of the right 8th rib causing distortion of the adjacent bony thorax. Specimen radiograph (below) shows the partially calcified soft-tissue mass arising from the rib.

The diagnosis was mesenchymal hamartoma of the chest wall.

Preschooler with recurrent episodes of respiratory distress over several years

CXR of chronic granulomatous disease — Initial CXR AP (above) shows an opacity in the medial aspect of the right lower lobe which took a year to resolve radiographically. CXR AP obtained 2 years after the initial CXR (below left) shows a dense opacity in the medial aspect of the right upper lobe which was only slightly reduced in size on a CXR obtained a year later (below right).

The diagnosis was chronic granulomatous disease.

School ager with respiratory distress

CXR of pulmonary alveolar proteinosis — CXR AP shows bilateral diffuse and symmetrical interstitial infiltrates which are miliary in appearance.

The diagnosis was pulmonary alveolar proteinosis.

Preschooler with chronic respiratory distress and a long-standing abnormal CXR

CXR and CT of chronic airway foreign body in the form of a mucous plug — CXR AP and lateral (above) show an opacity in the left upper lobe that was stable over several months. Coronal CT with contrast of the chest (below) shows complete atelectasis of the left upper lobe. There is a soft tissue density present in the lumen of the left mainstem bronchus interrupting the continuity of the left mainstem bronchus. At bronchoscopy this was found to be a very thick mucous plug.

The diagnosis was chronic airway foreign body due to an impacted mucous plug.

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.