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.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR AP shows air in the pulmonary interstitium bilaterally, in a branching pattern radiating outwards from the hila.

The diagnosis was pulmonary intestitial emphysema.

Preschooler with fever, drooling and sore throat

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

The diagnosis was epiglottitis.

Young adult with chronic cough and hemoptysis

CXR of pulmonary hemorrhage after cystic fibrosis — CXR AP and lateral show bilaterally hyperexpanded lungs with a coarse interstitial pattern, bronchial wall thickening and bilateral lower lobe bronchiectasis. The opacity in the medial aspect of the right lower lobe was new when compared to prior serial CXRs.

The diagnosis was cystic fibrosis with new pulmonary hemorrhage in the right lower lobe.

School ager with a chronic cough

CXR, CT, angiogram of pulmonary sequestration — Axial CT without contrast of the chest (above) shows an ill-defined solid soft tissue mass in the posterior and medial aspect of the left lower lobe. CXR AP (below left) shows a double density sign projecting to the left of the spine over the medial aspect of the cardiac silhouette. AP image from the arterial phase of an angiogram (below right) shows the left lower lobe mass has an arterial supply arising from the subdiaphragmatic aorta.

The diagnosis was left lower lobe pulmonary sequestration.

Preschooler with fever and drooling

Radiograph of epiglottitis — Lateral radiograph of the airway (left) shows swelling of the epiglottis (thumb sign) and areyepiglottic folds. Followup lateral radiograph of the airway after a week of antibiotic therapy (right) shows a near normal appearance of the epiglottis and areyepiglottic folds.

The diagnosis was epiglottitis.

Toddler with stridor

Radiograph of croup — AP radiograph of the airway (left) shows symmetric subglottic narrowing in the first several centimeters of the trachea leading to loss of the normal shoulders of the subglottic trachea (steeple sign) due to subglottic edema. AP radiograph of the now normal airway taken a month after the resolution of symptoms (right) shows clear delineation of the normal shoulders of the subglottic trachea.

The diagnosis was croup.

Teenager who has just had a Nuss bar placed

CXR of correct position of Nuss bar — CXR AP shows no evidence of pneumothorax. The Nuss bar stabilizers bilaterally are in their correct position in relation to the Nuss bar.

The diagnosis was normal post operative appearance of the Nuss bar used for correction of pectus excavatum.

Teenager after Nuss bar placement

CXR of Nuss bar malfunction with Nuss bar stabilizer loosening — Immediate post operative CXR AP (above) shows normal connection and position of the two Nuss bar stabilizers. CXR AP (below) obtained 3 months later shows the right Nuss bar stabilizer is sliding off the Nuss bar.

The diagnosis was Nuss bar malfunction with loosening of the right Nuss bar stabilizer.

Teenager who had a Nuss bar placed 3 months ago

CXR of Nuss bar stabilizer separation from Nuss bar — CXR AP shows the right Nuss bar stabilizer is normally connected to the Nuss bar but the left Nuss bar stabilizer is no long connected to the Nuss bar.

The diagnosis was Nuss Bar malfunction with the left Nuss bar stabilizer separated from the Nuss bar.

School ager with respiratory distress

Radiograph of papilloma — Lateral radiograph of the airway shows a large lobulated mass arising from the anterior surface of the trachea that is nearly occluding the trachea.

The diagnosis was papilloma.

Infant with an echogenic left lung mass on prenatal US

CXR and angiogram of pulmonary sequestration — CXR AP (above) shows a faint triangular opacity in the medial aspect of the left lower lobe. 3 sequential images from the arterial phase of an aortic angiogram obtained 7 months later (below) show a lesion in the medial aspect of the left lower lobe that receives its arterial blood supply from the subdiaphragmatic aorta.

The diagnosis was pulmonary sequestration in the left lower lobe.

Young adult with fever and respiratory distress

CXR of inflammatory myofibroblastic tumor — CXR AP and lateral (above) shows a well circumscribed, non-calcified, solid, round lesion in the right mid lung. AP image from a vintage tomogram (below) better demonstrates the lesion in the lung parenchyma.

The diagnosis was inflammatory myofibroblastic tumor.

Infant with respiratory distress

CXR and CT of mediastinal teratoma — CXR PA (above left) shows a large mediastinal mass in the left hemithorax causing mediastinal shift to the right while the CXR lateral (above right) shows the mass filling the anterior mediastinum. Axial CT with contrast of the chest (below) shows the mass is heterogenous in nature containing low density fat, high density calcification and soft tissue. The CT also shows the mass arising from the anterior mediastinum and extending primarily to the left resulting in mediastinal shift to the right.

The diagnosis was mediastinal teratoma.

Newborn with respiratory distress

CXR of evolution of congenital diaphragmatic hernia — CXR AP at 1 hour of life (above) shows the endotracheal tube and mediastinum to be shifted to the right by a large mass in the left hemithorax. The endotracheal tube tip is at the level of the carina. CXR AP at 2 hours of life (below left) shows the large mass in the left hemithorax to now consist of multiple thick walled air bubbles that are causing further mediastinal shift to the right. CXR AP at 3 hours of life (below right) shows even more thick walled air bubbles in the left hemithorax resulting in even more mediastinal shift to the right.

The diagnosis was left sided congenital diaphragmatic hernia that is filled with loops of small bowel that are filling with air over time.

Teenager with asthma and fever

CXR of allergic bronchopulmonary aspergillosis — CXR AP shows a right lower lobe infiltrate with a finger in glove appearance due to several bronchiectatic airways being filled with impacted mucous.

The diagnosis was allergic bronchopulmonary aspergillosis.

Preschooler with a sore throat, fever and drooling

Airway fluoroscopy of epigottitis — Lateral images of the airway from an airway fluoroscopy exam show a swollen epiglottis (thumb sign) and thickened aryepiglottic folds. The palatine tonsil is also noted to be hypertrophied.

The diagnosis was epiglottitis and incidental palatine tonsil hypertrophy.

Toddler with stridor

Radiograph of croup — AP radiograph of the airway (right) shows symmetric subglottic narrowing of the trachea leading to loss of the normal shoulders of the subglottic trachea (church steeple sign). AP radiograph of a normal airway for comparison (left) shows the normal shoulders of the subglottic trachea.

The diagnosis was croup.

Infant with respiratory distress

Normal inspiratory and expiratory CXR — Initial CXR AP (left) shows the heart to be enlarged and the pulmonary vascularity to be congested and there are low lung volumes. Repeat CXR AP obtained 5 minutes later in inspiration (right) shows the heart to be normal in size and the pulmonary vascularity is not congested and there are normal lung volumes.

The diagnosis was normal expiratory and inspiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

School ager with respiratory distress

Inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

The diagnosis was normal inspiratory and expiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

Infant with respiratory distress

Difference between pediatric inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

The diagnosis was normal inspiratory and expiratory radiographs of the chest, with the expiratory radiograph mimicking cardiogenic pulmonary edema.

School ager with cough and fever

CXR of streptococcus pneumonia — CXR PA (left) shows an opacity medially in the right lower chest which the lateral (right) shows to be located posteriorly resulting in a spine sign.

The diagnosis was streptococcus pneumonia in the posterior right lower lobe.

Toddler with recurrent right upper lobe pneumonias

Tomogram and bronchogram of tracheal bronchus — Vintage tomogram of the chest (above) shows an opacity medially in the right upper lobe. There are two lucent bronchi arising from the right lateral wall of the trachea just above the level of the carina. These two bronchi arising from the trachea are better demonstrated on the vintage bronchogram (below).

The diagnosis was tracheal bronchus.

Infant who had surgery for congenital heart disease 2 weeks ago and now is developing respiratory distress

CXR of chylothorax — CXR AP shows a large right pleural effusion which when tapped had a milky appearance.

The diagnosis was chylothorax.

Premature newborn with respiratory distress

CXR of Wilson Mikity syndrome — CXR AP at 1 day of life (above) shows bilateral symmetrical ground glass opacities throughout the lungs which have low lung volumes. CXR AP obtained at 30 days of life (middle) shows prominent bilateral interstitial fibrosis with cystic interstitial changes throughout the lungs which have increased lung volumes. CXR AP obtained at 90 days of life (below) shows faint bilateral interstitial fibrosis with cystic interstitial changes throughout the lungs which have even more increased lung volumes.

The diagnosis was Wilson Mikity syndrome.