School ager with sickle cell disease and chest pain

CXR of acute chest syndrome in sickle cell disease — CXR AP shows bibasilar infiltrates, right greater than left, and a small right pleural effusion.

The diagnosis was acute chest syndrome.

Toddler with hemoptysis and anemia

CXR of pulmonary hemosiderosis — Initial CXR AP (left) shows diffuse alveolar infiltrates primarily in the upper lobes. CXR AP obtained a week later (right) shows resolution of the findings.

The diagnosis was pulmonary hemosiderosis.

Preschooler with malaise

CXR and CT of acute lymphocytic leukemia / ALL — CXR AP and lateral (above) shows left hilar and superior mediastinal lymphadenopathy which is better demonstrated on the axial CT with contrast of the chest (below).

The diagnosis was acute lymphocytic leukemia.

School ager with a cough

CXR of tuberculosis — CXR PA and lateral shows massive bilateral hilar lymphadenopathy with the lungs being clear.

The diagnosis was tuberculosis.

Teenager with malaise

CXR of sarcoidosis — CXR PA and lateral shows bilateral hilar lymphadenopathy, left greater than right, with the lungs being clear.

The diagnosis was sarcoidosis.

School ager with chronic cough

CXR of histoplasmosis — CXR PA and lateral shows bilateral hilar lymphadenopathy, right greater than left, and small miliary nodules throughout the lungs.

The diagnosis was histoplasmosis.

Toddler with refractory wheezing

CXR and CT of Castleman disease — CXR AP (above) shows massive bilateral hilar and mediastinal lymphadenopathy. Axial CT with oral contrast and without IV contrast of the chest and abdomen (below) better demonstrates the bilateral hilar and mediastinal lymphadenopathy (lower left) and shows bilateral retroperitoneal adenopathy anterior to the psoas muscles (lower right).

The diagnosis was Castleman disease.

Preschooler with respiratory distress

CXR and CT of pleuropulmonary blastoma — CXR AP (above) shows complete opacification of the right hemithorax with mediastinal shift to the left. Axial CT with contrast of the chest shows a large mass filling the entire right hemithorax that is solid peripherally and cystic centrally, causing mediastinal shift to the left.

The diagnosis was pleuropulmonary blastoma.

Infant with respiratory distress

CXR and CT of inflammatory myofibroblastic tumor in the chest — CXR AP shows a round opacity laterally in the right lung (above left) which projects in the middle of the chest over the trachea on the lateral (above right). Axial CT without contrast of the chest (below) shows the opacity to be a solid mass without calcification next to the pleura.

The diagnosis was inflammatory myofibroblastic tumor.

Preschooler with cough and fever

CXR of esophageal duplication / esophageal duplication cyst / bronchopulmonary foregut malformation — CXR PA (left) shows a large round opacity located medially in the left hemithorax which is located posteriorly on the lateral (right) over the spine (spine sign).

The diagnosis was esophageal duplication.

Preschooler with cough and fever

CXR of round pneumonia — Initial CXR PA (above left) shows a large round opacity located medially in the right hemithorax which is located posteriorly on the lateral (above right) over the spine (spine sign). CXR PA obtained 5 days later (below) shows interval resolution of the mass.

The diagnosis was round pneumonia.

Preschooler with Wilms tumor

CXR of lung metastasis in Wilms tumor — CXR PA shows a large round opacity just lateral to the left pulmonary artery which is located anteriorly on the lateral view.

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

Preschooler with recurrent upper respiratory infections

Pathological image of congenital pulmonary airway malformation / CPAM / CCAM / congenital cystic adenomatoid malformation — Pathological image shows multiple cystic lesions in the right upper lobe.

The diagnosis was congenital pulmonary airway malformation.

School ager with a hacking cough

CXR of mycoplasma pneumonia — CXR PA and lateral shows a faint focal infiltrate in the posterior basilar segment of the right lower lobe, faintly obscuring the right hemidiaphragm on the PA view and causing a faint spine sign over the lowest vertebral body on the lateral view.

The diagnosis was mycoplasma pneumonia.

Newborn now 3 weeks old with respiratory distress

CXR of chlamydia pneumonia — CXR AP and lateral shows bilateral interstitial infiltrates, more prominent in the right lung.

The diagnosis was chlamydia pneumonia.

School ager with a cough after bone marrow transplant

CXR and CT of invasive aspergillosis — CXR AP and lateral (above) shows a round opacity on the lateral view posteriorly projecting over a mid-thoracic vertebral body. Axial CT without contrast of the chest shows a cavitary lesion in the superior segment of the right lower lobe that has a halo sign peripherally with the parenchymal density surrounded by an irregular ground glass density and an air crescent sign with an area of central necrosis detached from the wall of the lesion.

The diagnosis was invasive aspergillosis.

Infant with severe combined immune deficiency and respiratory distress

CXR of Pneumocystis jiroveci pneumonia / PCP / PJP — CXR AP shows bilaterally diffuse, symmetrical, fine reticular infiltrates.

The diagnosis was Pneumocystis jiroveci pneumonia.

Toddler with human immunodeficiency virus infection and respiratory distress

CXR of lymphocytic interstitial pneumonitis / LIP — CXR AP shows bilaterally diffuse, symmetrical, nodular infiltrates.

The diagnosis was lymphoid interstitial pneumonia.

School ager with a small deformed right chest

Clinical image of Poland syndrome — Clinical image shows a relative decreased amount of soft tissue over the right chest wall and inversion of the right nipple.

The diagnosis was Poland syndrome.

Teenager with a small deformed right chest wall and a small right hand

CXR and CT of Poland syndrome — CXR PA and lateral shows thinning of the soft tissues over the right chest. The upper right ribs are deformed and there is mild scoliosis. Axial CT without contrast of the chest shows the asymmetry of the thoracic cavity and the concavity of the right chest wall. The right breast is absent, the right pectoralis major and right pectoralis minor muscles are absent, and the right serratus anterior and latissimus dorsi muscles are decreased in size.

The diagnosis was Poland syndrome.

Teenager with a sunken chest

CT of pectus excavatum — 3D reconstruction from a CT without contrast of the chest (above) and an axial CT from the same exam (below) shows posterior indentation of the sternum towards the spine. The Haller index was calculated to be 5.3.

The diagnosis was pectus excavatum.

Teenager with a protuberant chest

CXR of pectus carinatum — CXR PA and lateral shows anterior protrusion of the middle and inferior aspects of the sternum.

The diagnosis was pectus carinatum.

School ager with Wilms tumor status post left pneumonectomy being surveilled for pulmonary metastases

CXR and upper GI of iatrogenic surgically created diaphragmatic hernia — Post-operative CXR AP (above) shows complete opacification of the left hemithorax with an air-fluid level within it. AP (lower left) and lateral (lower right) images from an upper GI exam shows herniation of the fundus of the stomach into the left hemithorax.

The diagnosis was post-operative occurrence of a diaphragmatic hernia.

Teenager without symptoms after a large left congenital diaphragmatic hernia repair over 10 years ago

CXR and upper GI of recurrent congenital diaphragmatic hernia / Bochdalek hernia — CXR PA and lateral (above) shows loops of bowel in the left lower chest posteriorly. This finding had been present and unchanged post-operatively for over 10 years. AP and lateral images from a small bowel follow through (below) shows colon in lower left chest.

The diagnosis in the operating room was recurrent congenital diaphragmatic hernia with colon and spleen in the lower left hemithorax.

School ager with right lower quadrant pain, fever, and elevated white blood cell count

Upper GI exam of congenital diaphragmatic hernia / Bochdalek hernia — AXR AP (above) is remarkable for a paucity of bowel gas in the abdomen. CXR PA (below left) obtained at the same time to rule out right lower lobe pneumonia as a cause of referred right lower quadrant pain shows dense opacity throughout the left hemithorax. CXR PA (below right) obtained during an upper GI and small bowel follow through exam shows a large amount of small bowel in the left hemithorax.

The diagnosis was delayed presentation of a left congenital diaphragmatic hernia. In the operating room the patient was also found to have acute appendicitis.