Infant with reactive airway disease

CXR and CT of bronchiolitis obliterans — CXR AP and lateral (above) shows hyperinflation. Axial CT without contrast of the chest shows focal areas of decreased lung density in a lobular patter most prominent in the bilateral upper lobes (below left) and several nodular opacities in the lingula (below right).

The diagnosis was bronchiolitis obliterans.

Teenager on chemotherapy with fever

CXR and CT of invasive aspergillosis — CXR on day 8 of the fever (above left) shows opacities in the left upper lobe and right middle lobe. Axial CT without contrast of the chest on day 13 of the fever (above right) shows parenchymal opacities surrounded by irregular ground glass density (halo sign). CXR on day 20 of the fever (below left) shows interval cavitation of the bilateral lung lesions which on axial CT with contrast of the chest on day 34 of the fever (below right) shows central necrosis in the lesions which is detached from the wall (air crescent sign).

The diagnosis was invasive aspergillosis.

Toddler with wheezing

CT of asthma — Axial CT without contrast of the chest shows bilateral bronchial wall thickening and streaky atelectasis in the lingula and right middle lobe and differential aeration of the pulmonary segments.

The diagnosis was asthma.

Immune suppressed school ager with a fever

CT of invasive aspergillosis — CXR AP (above) shows a triangular appearing lesion in the right middle lobe. Axial CT with contrast of the lung (below) shows a thick walled cavitary lesion in the right lower lobe that contains debris.

The diagnosis was invasive aspergillosis.

Infant with cough and fever

CXR of respiratory syncytial virus pneumonia / RSV — CXR AP and lateral (above) shows right upper lobe collapse and air outlining the inferior border of the heart (continuous diaphragm sign). Left lateral decubitus CXR (below) shows a small right pneumothorax.

The diagnosis was pneumopericardium and pneumomediastinum and right pneumothorax in a patient with respiratory syncytial virus pneumonia.

Toddler with fever, cough, and crackles in the lungs

CXR of respiratory syncytial virus pneumonia / RSV — CXR AP and lateral shows mild central airway thickening and mild lung hyperinflation bilaterally.

The diagnosis was respiratory syncytial virus pneumonia.

Teenager with acute chest pain

CT of mediastinal teratoma — CXR (above left) shows a mass in the left hemithorax. Coronal (above right), axial (below left) and sagittal (below right) CT with contrast of the chest show a large mass of soft tissue and fat density in the anterior mediastinum that compresses the left lung posteriorly and causes mediastinal shift to the right.

The diagnosis was mediastinal teratoma.

Newborn with respiratory distress

CXR of Group B Streptococcus pneumonia — CXR shows diffuse fine interstitial infiltrates bilaterally.

The diagnosis was Group B Streptococcus pneumonia.

Preschooler with cough and fever

CXR and CT of pediatric pleural empyema — CXR (above left) shows near complete opacification of the right hemithorax with no evidence of mediastinal shift. Coronal (above right) and axial (below) CT with contrast of the chest shows a large right pleural fluid collection that has multiple loculations within it which is causing complete collapse of the right lung.

The diagnosis was right pleural empyema in a patient with staphylococcus pneumonia.

Teenager with fever and sickle cell disease

CXR of acute chest syndrome — CXR AP (left) shows a dense opacity in the left lower lobe which on the lateral (right) is seen to be located posteriorly, causing a spine sign. The lateral radiograph also shows the T8 and T10 vertebral bodes to be H-shaped.

The diagnosis was acute chest syndrome and musculoskeletal manifestations of sickle cell disease.

Teenager with a chest wall deformity

CT of pectus excavatum — Axial CT without contrast of the chest shows a marked depression of the sternum towards the spine. The Haller index was 4.

The diagnosis was pectus excavatum.

Infant with stridor and a barky cough

Radiograph of croup — AP radiograph of the airway (left) shows loss of the normal shoulders of the subglottic trachea (steeple sign). Lateral radiograph of the airway (right) shows distension of the hypopharynx, a normal epiglottis and some narrowing of the subglottic trachea.

The diagnosis was croup.

Infant with an echogenic right lung mass on prenatal US

CT of congenital pulmonary airway malformation — Axial (above) and coronal (below) CT with contrast of the chest show a round mass in the right superior hilum that consists primarily of fluid density with a small air bubble in it superiorly.

The diagnosis was congenital pulmonary airway malformation.

Newborn immediately status post repair of left congenital diaphragmatic hernia

CXR of hypoplastic lung bud postoperatively in congenital diaphragmatic hernia — CXR AP (left) shows the hypoplastic lung bud which cannot immediately expand to fill the hemithorax in the apex of the left hemithorax and therefore there is also air in the left pleural space. Note that this is not a pneumothorax and should not be drained via a chest tube. CXR AP obtained 2 days later (right) shows the left pleural space is now filled with fluid rather than air, and again this should not be drained by a chest tube. As the lung bud expands, the pleural effusion will decrease in size.

The diagnosis was development of a left pleural effusion to fill the potential space in the left hemithorax after repair of a left congenital diaphragmatic hernia.

Infant with a whooping cough

CXR of pertussis pneumonia — CXR AP and lateral show bilateral streaky perihilar infiltrates giving the heart contour a shaggy appearance.

The diagnosis was pertussis pneumonia.

Toddler who is post-op from cardiac surgery with respiratory distress

CXR and US of diaphragm paralysis — CXR AP (above) shows elevation of the left hemidiaphragm. Sagittal M-mode US of the right hemidiaphragm (lower left) shows normal sinuous motion of the right hemidiaphragm while sagittal M-mode US of the left hemidiaphragm (lower right) shows no motion of the left hemidiaphragm.

The diagnosis was paralysis of the left hemidiaphragm.

Preschooler with stridor and drooling

Gross pathological image of epiglottitis — Gross pathological image shows a swollen epiglottis in the midline of the specimen with thickened aryepiglottic folds visible lateral to it.

The diagnosis was epiglottitis.

Teenager with chest pain and shortness of breath

CXR and CT of thymoma — CXR PA and lateral (above) shows a mass centered in the anterior mediastinum with a right pleural effusion. Axial images from a CT with contrast of the chest shows a large solid anterior mediastinal mass that has a few areas of calcification (lower left) and fat (lower right) within it.

The diagnosis was thymoma.

School ager with cough and fever

CXR of COVID-19 pneumonia — CXR AP shows bilateral diffuse ground glass opacities in the mid to lower lungs. No lymphadenopathy or pleural effusions were seen.

The diagnosis was COVID-19 pneumonia.

Infant who had undergone emergency thoracotomy for cardiac massage during a cardiac arrest 6 months before and now has a lump under the left arm

CXR of pulmonary herniation — CXR AP in inspiration (above) shows the left 5th intercostal space at the side of the previous thoracotomy to be deformed. CXR AP in expiration (below) shows interval development of a cystic structure in the soft tissues of the left chest wall.

The diagnosis was pulmonary herniation through the left 5th intercostal space secondary to incorrectly repaired thoracotomy incision.

School ager with hypoxia who has Eisenmenger syndrome due to a ventricular septal defect and a brain abscess

CXR and CT of septic emboli in the lungs / septic pulmonary emboli — CXR AP (above) shows prominence of the central pulmonary arteries and multiple round lesions of varying size throughout both lungs which on the axial CT with contrast of the chest (below) are shown to have indistinct margins.

The diagnosis was septic emboli in the lungs in a patient with Eisenmenger syndrome.

Newborn with respiratory distress

CXR of pulmonary lymphangiectasia — CXR AP and lateral shows mild cardiomegaly and diffuse interstitial infiltrates with no evidence of pleural effusions.

The diagnosis was pulmonary lymphangiectasia.

Infant with respiratory distress

CXR and bronchogram and pulmonary angiogram of pulmonary agenesis — CXR AP and lateral (above) shows complete opacification of the left hemithorax and tracheal and mediastinal shift to the left and hyperexpansion of the right lung. CXR AP taken during a bronchogram (below left) shows absence of the left mainstem bronchus. AP image from a pulmonary angiogram (below right) shows a normal appearing right main pulmonary artery and absence of the left pulmonary artery.

The diagnosis was pulmonary agenesis.

School ager with cough and fever

CXR of bronchial atresia — Inspiratory CXR AP (upper left) shows increased lucency in the left upper lobe when compared to the right upper lobe while expiratory CXR AP (upper right) shows air trapping in the left upper lobe. Magnified view of the upper lobes (below) better shows a round lesion in the lower portion of the left upper lobe which represents mucous trapped distally to an area of atresia in a bronchus.

The diagnosis was bronchial atresia.

School ager with a cough

CXR of Kartagener syndrome — CXR AP shows situs inversus with the cardiac apex in the right hemithorax, the stomach bubble in the right abdomen and mild thickening of the airways centrally.

The diagnosis was Kartagener syndrome.