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.

Preschooler with cough and fever

CXR of military tuberculosis — CXR AP shows right hilar lymphadenopathy and innumerable small pulmonary nodules that are uniformly distributed throughout the lungs.

The diagnosis was miliary tuberculosis pneumonia.

School ager with a cough

Airway radiograph of airway foreign body in the pyriform sinus — Lateral radiograph of the airway shows a linear radiopaque foreign body in the airway anterior to the C2 and C3 vertebral bodies.

The diagnosis was airway foreign body in the pyriform sinus.

Newborn with hydrops fetalis after bilateral chest tube placement

CXR of chest tube in the subcutaneous tissues. — CXR AP shows body wall thickening. The tip of the left chest tube is in the left pleural space and there is a small left pleural effusion. The tip of the right chest tube is in the right subcutaneous tissues. There is a small right pleural effusion

The diagnosis was chest tube malfunction with the tip of the right chest tube in the subcutaneous tissues of the right chest wall in a patient with hydrops fetalis.

Toddler who was seen to eat something they should not have eaten

CXR of a foreign body in the airway and the esophagus in the form of an earing — CXR AP (left) shows a linear radiopaque object projecting over the trachea. CXR lateral (right) shows the anterior portion of the radiopaque object to project over the trachea and its posterior portion to project over the esophagus.

The diagnosis was an earing whose wire was an airway foreign body and whose ornament was a gastrointestinal foreign body.

Toddler with cough and fever

CXR of pulmonary tuberculosis — CXR AP shows an extensive amount of right hilar lymphadenopathy.

The diagnosis was tuberculosis pneumonia.

Infant with chronic cough and wheezing

CT of neuroendocrine cell hyperplasia — Coronal (above) and axial (below) CT without contrast of the chest shows focal increased lucency in the right middle lobe and lingula indicating hyperinflation of the right middle lobe and lingula.

The diagnosis was neuroendocrine cell hyperplasia.

Infant with cough and fever

CXR of pulmonary tuberculosis — CXR AP (above) shows a large amount of right hilar adenopathy. Axial CT without contrast of the chest (below left) shows right hilar and subcarinal adenopathy while the CT (below right) shows the right lower lobe atelectasis caused by the adenopathy.

The diagnosis was tuberculosis pneumonia.

Toddler with wheezing

CXR of pulmonary tuberculosis — CXR AP taken in expiration shows hyperinflation of the right lung with mediastinal shift to the left due to asymmetrical air trapping in the right lung on expiration.

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

Preschooler with cough and fever

CXR of tuberculosis pneumonia — CXR AP and lateral show bilateral hilar lymphadenopathy and dense consolidation in the right middle lobe.

The diagnosis was tuberculosis pneumonia.

Toddler with new coughing and wheezing

CXR of airway foreign body in right mainstem bronchus — Inspiratory CXR (above) shows normal symmetrical aeration of the lungs bilaterally. Expiratory CXR (below) shows asymmetrical increased aeration (seen as increased lucency) of the right middle and lower lobes compared to the remainder of the lungs due to air trapping in the right middle and lower lobes.

The diagnosis was airway foreign body due to a peanut in the distal right mainstem bronchus.

Toddler with fever

CXR of miliary tuberculosis pneumonia — CXR AP shows innumerable small pulmonary nodules that are uniformly distributed throughout the lungs.

The diagnosis was miliary tuberculosis pneumonia.

School ager who started coughing after eating peanuts

CXR of peanut in left mainstem bronchus — Inspiratory CXR AP (left) is normal and shows the lungs to be clear and to be symmetrically aerated and no radiopaque foreign body is seen. Expiratory CXR AP (right) shows a normal decrease in the volume in the right lung in expiration while there is no decrease in the volume in the left lung in expiration (air trapping) and there is mediastinal shift to the right.

The diagnosis was airway foreign body in the form of a peanut in the left mainstem bronchus.

School ager with a cough for a week

CXR of chronic airway foreign body due to a screw in the right mainstem bronchus — Initial CXR AP and lateral (above) show symmetrical aeration of the lungs and a radiopaque object in the right mainstem bronchus along with dense opacities in the right middle and right lower lobes. CXR AP obtained after bronchoscopic removal of the foreign body (below) shows persistent opacity in the right middle lobe.

The diagnosis was a chronic airway foreign body in the form of a screw that had been present in the right mainstem bronchus for a week.

School ager with cough and fever

CXR and CT of pulmonary tuberculosis — CXR AP and lateral (above) shows a right paratracheal mass. Axial CT with contrast of the chest (below) shows multiple confluent right paratracheal lymph nodes that extend inferiorly to the level of the carina.

The diagnosis was pulmonary tuberculosis.

Toddler with a cough after being seen placing a peanut in their mouth

Decubitus CXR of airway foreign body — Right lateral decubitus CXR (left) shows deflation of the right lung when placed in a dependent position. Left lateral decubitus CXR (right) shows lack of deflation of the left lung when placed in a dependent position and note the left lung remains hyperlucent when compared to the right lung.

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

Preschooler with cough and fever

CXR of tuberulosis pneumonia — CXR lateral (right) shows hilar lymphadenopathy which lateralizes to the left on the CXR AP (left) which also shows a dense consolidation in the left upper lobe.

The diagnosis was primary tuberculosis pneumonia in the left upper lobe.

School ager with shortness of breath

CXR and CT of mediastinal teratoma — CXR AP (above) shows a large mass filling the thorax. Axial CT without contrast of the chest (below) shows a heterogenous mass centered in the anterior mediastinum that has a large round low density component in the right thorax and several focal areas of high density scattered within it.

The diagnosis was mediastinal teratoma.

Preschooler with sore throat, stridor, and drooling

Radiograph of epiglottitis — Lateral radiograph of the airway at presentation (left) shows a swollen epiglottis (thumb sign) and thickened aryepiglottic folds. Lateral radiograph of the airway taken after 3 days of antibiotic therapy (right) shows an interval decrease in the amount of swelling of the epiglottis and aryepiglottic folds.

The diagnosis was epiglottitis.

Toddler with stridor who previously had undergone endotracheal intubation for a long period

Radiograph of tracheal granuloma — AP radiograph of the airway shows asymmetric narrowing of the proximal trachea due to a semi-circular mass arising from the right side of the proximal trachea.

The diagnosis was tracheal granuloma.

Toddler with stridor

Radiograph of croup — AP radiographs of the airway in inspiration (left) and expiration (right) show symmetric subglottic narrowing of the proximal trachea (left) leading to the loss of the normal shoulders of the subglottic trachea due to subglottic edema (church steeple sign).

The diagnosis was croup.