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.

Newborn with respiratory distress

CXR and UGI of tracheal atresia — CXR AP and lateral (above) shows a nasogastric tube with its tip in the mid-esophagus. AP image from an UGI exam performed by injecting the nasogastic tube (below left) shows simultaneous opacification of the tracheobroncial tree and esophagus. Lateral image from the UGI exam (below right) shows the atretic origin of the trachea (black arrow). The tip of the endotracheal tube (which is in the esophagus) is at approximately the same level.

The diagnosis was tracheal atresia.

School ager with respiratory distress

CXR of hydatid disease — CXR PA and lateral shows a large mass without calcification in the posterior aspect of the right lung which on cross sectional imaging was seen to be cystic in nature.

The diagnosis was hydatid disease.

Teenager with noisy breathing at night

CXR and CT of tracheobronchial papillomatosis — CXR AP (above left) shows multiple thin walled cystic and solid lesions in both lungs. Axial CT without contrast of the chest (right) shows multiple cystic and solid lesions in the lungs bilaterally. AP image of the airway (below left) shows a mural tracheal mass arising from the left side of the trachea which nearly completely occludes the airway.

The diagnosis was tracheobronchial papillomatosis.

Newborn with respiratory distress

CXR and CT of pulmonary agenesis — CXR AP (above) shows complete opacification of the left hemithorax with mediastinal shift to the left. Axial CT without contrast of the chest (below) show hyperexpansion of the right lung with herniation across the midline, mediastinal shift to the left, and non-visualization of the left mainstem bronchus.

The diagnosis was left pulmonary agenesis.

School ager with cough and fever and chest pain

CXR and CT of lung abscess — CXR AP (above) shows two air filled cavities in the right upper lobe in an otherwise completely opacified right hemithorax. Axial CT with contrast of the chest (below) shows a large right pleural effusion, right lung consolidation and a cavitary lesion in the right upper lobe.

The diagnosis was a developing lung abscess due to Streptococcal pneumonia.

Infant with cough and wheezing

CXR and CT of extrapulmonary sequestration — CXR AP (above) shows a round density projecting to the left of the 8th and 9th thoracic vertebral bodies. Axial CT without contrast of the chest (below) better shows a solid left paraspinal mass. In the operating room it was seen to lay outside the lung and to have its arterial supply coming from the aorta.

The diagnosis was extralobar pulmonary sequestration.

Toddler with respiratory distress

CXR and CT of post-infectious pneumatocele — CXR AP (above) shows the arterial catheter tip projecting over the aortic arch and the venous catheter tip projecting over the right atrium. There is bilateral diffuse airspace disease and bilateral pleural effusions. A cystic lesion is seen in the right lower lobe. Axial CT without contrast of the chest (below left) shows the cystic lesion is thin walled and communicates with the bronchial tree and has multiple septations (below right).

The diagnosis was pneumatocele due to pneumococcal pneumonia in a patient on ECMO.

Teenager with cough, fever and halitosis

CXR and CT of lung abscess — CXR PA and lateral (above) show a large round cavitary lesion with an air fluid level in the right lower lobe. Axial CT with contrast of the chest (below) shows a large round intraparenchymal fluid collection in the right lower lobe with thick nodular walls and an air fluid level.

The diagnosis was lung abscess in a patient with bacterial pneumonia.

Toddler with respiratory distress

CXR and CT of bronchopleural fistula — CXR AP (above) shows diffuse bilateral airspace disease and a right sided pneumothorax that is almost completely drained by a right chest tube. Axial CT with contrast of the chest (below left) shows air and fluid and a chest tube in the right pleural space and an enhancing rim sign of the pleura. There is also a bronchopleural fistula from the superior segment of the right lower lobe to the necrotic lung and pleural space (below right).

The diagnosis was bronchopleural fistula and pleural empyema in a patient with streptococcus pneumonia.

Teenager with past history of Wilms tumor

CXR and CT of lung metastasis in Wilms tumor — CXR AP (above) shows a soft tissue density projecting in the right cardiophrenic angle. Axial CT with contrast of the chest (below) shows a soft tissue mass in the right posterior costophrenic sulcus.

The diagnosis was lung metastasis in a patient with Wilms tumor.

Toddler with respiratory distress

CXR and CT of post-infectious pneumatocele — CXR AP (above left) initially shows an infiltrate in the left lower lobe that on a CXR AP one week later (above right) has developed a cystic cavity in the middle of it. A left pleural effusion is also now present. Axial CT with contrast of the chest (below) shows the cystic cavity is thin walled and septated. Left lower lobe consolidation and left pleural effusion remain present.

The diagnosis was post-infectious pneumatocele due to pneumococcal pneumonia.

School ager with cough and fever

CXR and CT of lipoblastoma — CXR PA and lateral (above) shows a right sided chest mass in the posterior mediastinum. Axial CT with contrast of the chest (below) shows a homogeneous mass, of fat density, with a few septations, in the right posterior mediastinum causing some anterior displacement of the right mainstem bronchus.

The diagnosis was lipoblastoma in the posterior mediastinum.

School ager with fever and cough

CXR and CT of pleural empyema — CXR AP (above) shows consolidation in the right upper lobe and a large right pleural effusion. Axial CT with contrast of the chest (below) shows a large right pleural effusion with an enhancing rim causing atelectasis of the adjacent lung.

The diagnosis was pleural empyema.

Premature newborn now 2 months old with respiratory distress

CXR and CT of pneumatocele — CXR (above) and axial CT without contrast of the chest (below) shows diffuse interstitial thickening and a large, round, unilocular thin-walled cyst in the posterobasal aspect of the right lower lobe. The bronchus of the posterobasal segment of the right lower lobe was seen to extend into it.

The diagnosis was pneumatocele due to positive pressure ventilation in a patient with chronic lung disease.

Teenager with hypertension

CT of histoplasmosis — Coronal CT with contrast of the chest (left) shows a large round soft tissue nodule with a calcified center in the lateral aspect of the left hemithorax. Axial CT (above right) shows calcified mediastinal lymph nodes near the descending aorta and better demonstrates the calcification in the lung nodule (below right).

The diagnosis was histoplasmosis.

School ager with right scapular and right chest pain

CXR and CT of Ewing Sarcoma of the rib / Askin Tumor — CXR AP and lateral (above) show a large right sided chest mass whose obtuse angles with the chest wall suggest it is extrapleural in origin. Axial CT without contrast of the chest (below) shows the mass to be arising from a rib and to be causing periosteal reaction.

The diagnosis was Ewing sarcoma of the rib (Askin tumor).

School ager with an upper respiratory infection

CXR and CT of congenital pulmonary airway malformation type I — CXR AP and lateral (above) shows a large cystic lesion in the right upper lobe. Axial CT with contrast of the chest (below) shows the lesion consisted of a single cyst.

The diagnosis was congenital pulmonary airway malformation type I.

School ager being evaluated for lung transplantation

CXR and CT of cystic fibrosis — CXR AP and lateral (above) show bilaterally hyperexpanded lungs with a coarse interstitial pattern, bronchial wall thickening and bronchiectasis. Axial CT without contrast of the chest show thickened interlobular septa and bronchiectasis in the bilateral upper (below left) and lower (below right) lobes.

The diagnosis was cystic fibrosis.

Newborn with respiratory distress

CXR and CT of congenital lobar emphysema — CXR AP (above) and axial CT without contrast of the chest (below) show hyperinflation of the right middle lobe causing mediastinal shift to the left and partial collapse of the right upper and lower lobes.

The diagnosis was congenital lobar emphysema of the right middle lobe.