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.

Newborn with an echogenic right chest mass on prenatal ultrasound

CXR and CT of congenital pulmonary airway malformation type I — CXR AP and lateral (above) show a round heterogenous mass in the right upper lobe. Axial CT without contrast of the chest (below) shows a dominant central cyst in the lung surrounded by many smaller cysts.

The diagnosis was congenital pulmonary airway malformation type I.

School ager with substernal distress associated with exercise

CXR and US and CT of Morgani hernia — CXR AP and lateral (above) shows an anteromedial soft tissue density in the right cardiophrenic angle obscuring the right heart border. Sagittal US of the chest performed anteriorly and just to the right of the midline (below left) shows liver extending above the level of the diaphragm. Axial CT with contrast of the chest (below right) shows liver in the right cardiophrenic angle just to the right of the heart in the right hemithorax.

The diagnosis was a right-sided Morgagni hernia containing liver.

Newborn with an echogenic left lower lung mass on prenatal ultrasound

CT of congenital pulmonary airway malformation Type I — CXR at birth (above left) shows an ill-defined large mass in the lower left chest obscuring the heart border and causing mediastinal shift to the right. Axial CT without contrast of the chest at birth (above right) shows the left chest mass to contain multiple cysts that are filled with air and fluid. CXR at 10 months (below left) shows the large lower left chest mass to now be hyperlucent. Axial CT without contrast of the chest at 10 months (below right) shows the left chest mass to contain multiple large air-filled cysts.

The diagnosis was congenital pulmonary airway malformation Type I.

Newborn with respiratory distress and new abdominal distension

CT of congenital diaphragmatic hernia — CXR (left) shows massive pneumoperitoneum and right pneumothorax which outlines a mass in the lower right chest which is causing mediastinal shift to the left. Coronal CT with contrast of the chest (above right) shows liver herniating through a lateral defect in the diaphragm into the lower right chest and lying above the right diaphragm (below right).

The diagnosis was congenital diaphragmatic hernia containing liver as outlined by pneumothorax and pneumoperitoneum.

Former premature newborn now 1 year old with chronic respiratory distress

CXR and CT of bronchopulmonary dysplasia — CXR (above) shows hyperexpansion and fine interstitial infiltrates. Axial CT without contrast of the chest (below) shows diffuse alveolar and interstitial lung disease bilaterally that is more prominent in the perihilar regions.

The diagnosis was bronchopulmonary dysplasia.

School ager one year after viral pneumonia with progressive respiratory distress

CXR and CT of bronchiolitis obliterans with organizing pneumonia — CXR (above) shows bilateral basilar infiltrates and blunting of the left costophrenic angle. Axial CT without contrast of the lung (below) shows bilateral lower lobe bronchiectasis and mild interstitial prominence, the upper lobes appeared normal.

The diagnosis was bronchiolitis obliterans with organizing pneumonia.

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.