Teenager with weaker pulses in the left arm when compared to the right arm

MRA of arterial thoracic outlet syndrome — MRA with contrast of the chest performed via a right forearm injection with the arms in a neutral (adducted) position (above) shows a normal appearance to the subclavian arteries. MRA was then performed with the arms in a raised (abducted) position (below) which shows development of a moderate stenosis in the proximal left subclavian artery.

The diagnosis was left arterial thoracic outlet syndrome.

Young adult with progressive shortness of breath and adenoma sebaceum, seizures, and mental retardation

CXR and CT of lymphangioleiomyomatosis in a patient with tuberous sclerosis — CXR PA (above) shows bilateral basilar interstitial infiltrates with variably sized cystic spaces. Axial CT without contrast of the right lung (below left) shows a prominent reticular interstitial pattern with fibrosis and widely distributed thin walled cystic spaces. In the left lung (below right), there are similar findings along with a loculated pneumothorax that had been treated with sclerotherapy in the past.

The diagnosis was lymphangioleiomyomatosis in a patient with tuberous sclerosis.

Teenager who was short of breath for a week

CXR and CT of spontaneous pneumothorax due to apical bleb — CXR PA (above left) shows a large amount of air in the right pleural space with some mediastinal shift to the left. There is a round cystic structure in the right lung apex. Coronal (above right) and axial (below) CT without contrast of the chest shows the cystic structure to be a large bleb in the apex of the right lung.

The diagnosis was spontaneous pneumothorax.

Teenager with cough, fever and shortness of breath

CXR and CT of granulomatosis with polyangiitis — CXR AP and lateral (above) show bilateral thick walled cavitary nodules in the lungs. Axial CT with contrast of the chest (below) shows just how thick walled the cavitary nodules are in the left lung. Multiple smaller non-cavitary nodules are seen scattered throughout both lungs.

The diagnosis was granulomatosis with polyangiitis.

Female infant with left breast swelling

US of neonatal mastitis with galactoceles — Transverse US of the retroaerolar regions of the right breast (left) and left breast (right) show mild bilateral skin thickening with bilateral diffusely hyperechoic breast tissue containing multiple anechoic lesions.

The diagnosis was bilateral neonatal mastitis with bilateral galactoceles.

Male school ager with a palpable mass underneath the nipple in the right breast

US of gynecomastia — Transverse US of the right breast (left) shows a retroaerolar, primary hypoechoic mass in the subcutaneous breast tissue. A transverse US of the same area in the normal left breast (right) is provided for comparison.

The diagnosis was right gynecomastia.

School ager with shortness of breath

CXR and CT of lymphangioleiomyomatosis — CXR PA (above left) shows large bilateral pleural effusions. Axial CT with contrast of the chest (above right) shows the pleural effusions to be septated. The lung parenchyma (middle) was normal while the bones (below) had multiple cystic bone lesions in the right scapula, vertebral bodies and bilateral ribs.

The diagnosis was lymphangioleiomyomatosis with bilateral chylous effusions.

Premature newborn with respiratory distress

CXR of high position of neurally adjusted ventilatory assist catheter / NAVA catheter — CXR AP (left) shows the tip of the nasogastric tube to project over the body of the stomach. The tip of the NAVA tube projects over the proximal esophagus. Repeat CXR AP obtained after repositioning of the NAVA tube (right) shows the tip of the NAVA tube to now project in correct position over the body of the stomach alongside the tip of the nasogastric tube.

The diagnosis was neurally adjusted ventilatory assist (NAVA) catheter malfunction with the tip of the NAVA tube initially being too high in position in the esophagus.

Premature newborn now 2 months old with respiratory distress just switched to NAVA

Neurally Adjusted Ventilatory Assist (NAVA) catheter malposition in the right mainstem bronchus — CXR AP shows the tip of the NAVA catheter to project over the right mainstem bronchus. The tip of the nasogastric tube projects over the fundus of the stomach. A VP shunt is also present coursing along the left chest.

The diagnosis was Neurally Adjusted Ventilatory Assist (NAVA) catheter malfunction with malposition of the tip of the NAVA catheter in the right mainstem bronchus.

Former premature infant requiring ventilatory support

CXR of correct NAVA catheter placement in patient with chronic lung disease. — CXR AP shows a NAVA catheter with its tip projecting over the body of the stomach, a nasogastric tube with its tip projecting over the body of the stomach, and a left upper extremity PICC with its tip projecting over the brachiocephalic vein. There are fine interstitial infiltrates present throughout the lungs

The diagnosis was normal position of the NAVA catheter in a patient with chronic lung disease.

Infant who was difficult to intubate

CT of tracheal stenosis — Coronal CT without contrast of the chest shows the trachea to be narrowed over a length of 2 cm from the thoracic inlet downward. At its narrowest, the trachea measured only 2 mm in diameter. There was also narrowing of the proximal right mainstem bronchus at its origin.

The diagnosis was tracheal stenosis.

Teenager with a liver mass

CXR of lung metastases in fibrolamellar hepatocellular carcinoma — CXR AP shows multiple large round non-calcified lesions in the lungs bilaterally.

The diagnosis was lung metastases in a patient with fibrolamellar hepatocellular carcinoma.

Preschooler with respiratory distress

CXR of congenital pulmonary airway malformation Type I — CXR AP and lateral shows a large septated cystic lesion filling nearly the entire left hemithorax and causing mass effect with depression of the left hemidiaphragm and mediastinal shift to the right.

The diagnosis was congenital pulmonary airway malformation Type I.

Newborn with respiratory distress

CXR and bronchogram of bronchial atresia of the right middle lobe — CXR AP (above) shows subtle increased lucency of the right middle lobe. AP and oblique images from a vintage bronchogram 3 years later performed by injecting contrast in the right mainstem bronchus (below) shows a hyperlucent and hyperexpanded right middle lobe and contrast filling the airways of the collapsed right upper lobe and the right lower lobe but no contrast filling the airways of the hyperexpanded right middle lobe.

The diagnosis was bronchial atresia of the right middle lobe.

Newborn with respiratory distress

CXR and bronchogram of pulmonary agenesis — CXR AP and lateral (above) shows the right hemithorax, which is completely opacified, to be smaller in size than the left hemithorax and there is hyperexpansion of the left lung and mediastinal shift to the right. AP image from a vintage bronchogram (below) shows contrast filling the airways of the left upper lobe, lingula and left lower lobe. There is no contrast in the right hemithorax.

The diagnosis was pulmonary agenesis of the right lung.

School ager with a small deformed right chest

CXR of Poland syndrome — CXR shows thinning of the soft tissues over the right chest and relative increased lucency of the right hemithorax when compared to the left hemithorax.

The diagnosis was Poland syndrome of the right chest wall.

Teenager with hemoptysis and large weight loss over 6 months

CXR and CT of lung metastases from embryonal cell carcinoma of testicle — CXR PA and lateral (above) shows a large round solid lesion in the right upper lobe. Axial CT without contrast of the chest (below left) shows a large solid lesion in the right upper lobe and a small solid lesion in the left upper lobe posteriorly. There is an additional solid lesion in the right lower lobe (below right).

The diagnosis was lung metastases due to embryonal cell carcinoma of the testicle.

School ager who started coughing while eating pizza 1 week ago and now is febrile

CXR of chronic airway foreign body in left mainstem bronchus — CXR AP shows extensive atelectasis and consolidation in the lingula and left lower lobe with tracheal and mediastinal shift to the left. There is a small left pleural effusion.

The diagnosis was a chronic airway foreign body in the left mainstem bronchus which on bronchoscopy was found to be a crayon.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR shows air branching throughout the pulmonary interstitium in the left lung.

The diagnosis was left-sided pulmonary interstitial emphysema in a patient with respiratory distress syndrome.

Toddler with progressive respiratory distress and no history of foreign body ingestion

CXR of congenital lobar emphysema — CXR AP and lateral show overinflation of the right upper lobe that is herniating across the midline.

Preschooler post motor vehicle accident who was subsequently noted to have a history of epigastric pain while lying down

CXR of Morgagni hernia — AP radiograph of the thoracic spine (left) shows a loop of bowel containing haustra in the lower chest just above the diaphragm. CXR lateral (right) shows a loop of bowel in the anterior chest.

The diagnosis was Morgagni hernia.

Newborn with a left-sided chest mass on prenatal ultrasound

CXR of congenital diaphragmatic hernia — CXR AP shows complete opacification of the left hemithorax with mediastinal shift to the right and a small right pneumothorax. The arterial ECMO canula tip projects over the aortic arch and the venous ECMO canula tip projects over the right atrium. The nasogastric tube tip projects over the mid-esophagus.

The diagnosis was normal position of the extracorporeal membrane oxygenation catheters in a patient with left congenital diaphragmatic hernia.

Newborn with a right chest mass on prenatal ultrasound

CXR of diaphragmatic hernia — CXR shows opacification of the right hemithorax with several air filled loops of bowel within it and mediastinal shift to the left.

The diagnosis was right-sided congenital diaphragmatic hernia.

School ager in a motor vehicle collision

CXR and CT of pulmonary laceration — CXR AP (above) shows extensive opacification of the right middle and lower lobes with a small cystic structure in the middle. Axial CT with contrast of the chest (below) shows a multiseptated lesion containing air and blood in the right lower lobe.

The diagnosis was pulmonary laceration / traumatic hematopneumatocele.

School ager with heart murmur

CXR and CT of mediastinal teratoma — CXR AP and lateral (above) shows a large anterior mediastinal mass causing tracheal deviation to the right. Axial CT without contrast of the chest (below left) shows the mass to be low density and to contain calcium. Axial CT with contrast of the chest (below right) shows the mass to have rim enhancement and to be primarily fluid-filled.

The diagnosis was mediastinal teratoma.