Teenager with abdominal pain and a history of cystic fibrosis

CT of a dilated but normal appendix in a patient with cystic fibrosis — Axial CT with contrast of the abdomen (above left) shows an irregular contour to the liver and fatty replacement in the pancreatic head. Axial (below left) and coronal (right) CT show the appendix is dilated to a diameter of 12 mm but there are no inflammatory changes around it.

The diagnosis was a dilated but normal appendix in a patient with cystic fibrosis along with liver cirrhosis due to cystic fibrosis and pancreatic insufficiency due to cystic fibrosis.

Teenager with abdominal pain

CT and US of acute cholecystitis — Axial CT with contrast of the abdomen (above) shows a distended gall bladder with gallbladder wall thickening with rim enhancement. Sagittal US of the gallbladder shows diffuse wall thickening of the gallbladder (below left) along with a stone in the neck of the gallbladder causing posterior acoustic shadowing (below right).

The diagnosis was acute cholecystitis.

Newborn with an abdominal mass

US and enema of colonic atresia due to in-utero cecal volvulus — Transverse US of the abdomen (left) shows a large round meconium filled lesion anterior to the right kidney which is at the bottom left of the image. AP image from an enema (right) shows a microcolon with the cecum in the midline of the abdomen. The terminal ileum could not be refluxed.

The diagnosis was a meconium-filled cecum causing in-utero cecal volvulus and subsequent colonic atresia.

School ager who had a Nissen fundoplication 4 years ago who now has gagging while eating

UpperGI of para Nissen herniation — AP (left) and lateral (right) images from an UpperGI exam show the Nissen fundoplication wrap is intact. However, a small portion of the stomach has herniated superiorly and posteriorly through the wrap into the chest. This is best seen on the lateral view.

The diagnosis was Nissen fundoplication malfunction due to a para Nissen herniation.

Infant with sepsis after being taken off of ECMO

CT of abdominal abscess in an infected hematoma — Axial (above) and coronal (below) CT with contrast of the abdomen shows an isodense oval fluid collection inferior to the liver and superior and lateral to the right kidney.

The diagnosis was abdominal abscess in an infected hematoma which was a complication of extracorporeal membrane oxygenation.

Toddler with intermittent abdominal distension

Small bowel follow through of protein losing enteropathy — AP image from a small bowel follow through exam shows diffuse fold thickening throughout the small bowel which is more prominent in the jejunum than in the ileum.

The diagnosis was protein losing enteropathy.

Newborn with respiratory distress

Upper GI and small bowel follow through of ileal stenosis — AXR AP (above) shows a distended abdomen with multiple dilated loops of bowel including an asymmetrically dilated loop of bowel in the right upper quadrant. Delayed images from an UGI small bowel follow through exam (below left) shows contrast entering this dilated loop which is in the distal ileum and eventually passing through this dilated loop and filling the appendix (below right).

The diagnosis was ileal stenosis.

Teenager with dysphagia

Upper GI of esophageal web — Lateral images from an upper GI exam show a persistent anterior indendation and narrowing of the esophagus at the level of the C3 vertebral body which impedes the flow of contrast through it.

The diagnosis was esophageal web.

School ager with sickle cell disease and abdominal pain

US of gangrenous cholecystitis — Sagittal (left) and transverse (right) US of the gallbladder show the gallbladder to be filled with sludge and debris. The gallbladder wall is thickened and in one area was felt to be discontinuous. There were multiple gall stones present in the common bile duct (not pictured).

The diagnosis was gangrenous cholecystitis due to choledocholithiasis in a patient with sickle cell disease.

School ager with abdominal pain

Radiograph of pneumatosis intestinalis of the colon — Initial AXR (left) shows linear appearing air throughout the wall of the ascending colon. AXR obtained 4 hours later (middle) shows cystic as well as linear appearing air throughout the wall of the ascending colon. AXR obtained 12 hours later (right) again shows cystic as well as linear appearing air throughout the wall of the ascending colon.

The diagnosis was pneumatosis intestinalis of the colon.

School ager after feeding tube placement

CXR of feeding tube tip in the left mainstem bronchus — CXR AP shows the tip of the feeding tube projecting over the left mainstem bronchus.

The diagnosis was feeding tube malfunction in the form of the tip of the feeding tube being in the left mainstem bronchus.

Toddler with hemophagocytic lymphohistiocytosis with abdominal pain

AXR of pneumatosis intestinalis of the colon — AXR AP shows serpiginous lucencies in the abdomen representing a marked amount of curvilinear appearing air in the wall of the ascending and transverse colon.

The diagnosis was pneumatosis intestinalis of the colon.

Infant after nasogastric tube placement

CXR of nasogastric tube in the right mainstem bronchus in a patient with bronchopulmonary dysplasia — CXR AP shows the tip of the nasogastric tube to project over the right lower lobe. The lungs are hyperexpanded bilaterally with emphysematous blebs and interstitial scarring

The diagnosis was nasogastric tube malfunction in the form of the tip of the nasogastric tube going down the right mainstem bronchus into the right lower lobe in a patient with bronchopulmonary dysplasia.

Infant with cystic fibrosis and abdominal pain

Radiograph of pneumatosis intestinalis — AXR AP (above) shows bubbly appearing air in the walls of the ascending colon, transverse colon, descending colon and sigmoid colon. There is also linear appearing air in the walls of the descending colon and sigmoid colon. Left lateral decubitus radiograph of the abdomen (below) shows no evidence of free air.

The diagnosis was pneumatosis intestinalis of the colon.

Premature newborn with gastrointestinal bleeding after replacement of the nasogastric tube

AXR of nasogastric tube causing gastric perforation — Baseline CXR AP obtained yesterday (left) shows a nasogastric tube coursing through the esophagus and then curving towards the stomach on the left side of the abdomen. AXR AP after nasogastric tube replacement (right) shows a straight course to the newly placed nasogastric tube whose tip projects in the midline at the level of the L3 vertebral body. There is a faint oval lucency in the midline of the upper abdomen at the level of the T10 and T11 vertebral bodies.

The diagnosis was nasogastric tube malfunction in the form of gastric perforation caused by placement of a nasogastric tube resulting in pneumoperitoneum.

Immune compromised preschooler with abdominal pain

AXR of pneumatosis intestinalis — AXR AP shows marked curvilinear air throughout the bowel wall of the transverse, descending and sigmoid colon and rectum.

The diagnosis was pneumatosis intestinalis of the colon.

School ager who is vomiting when they are being fed through the jejunostomy port of their gastrojejunostomy tube

AXR of jejunostomy catheter tip that has migrated back into the stomach — AXR AP shows that the tip of the jejunostomy tube projects over the body of the stomach.

The diagnosis was gastrojejunostomy malfunction in the form of migration of the gastrojejunostomy tip into the stomach.

Infant with abdominal pain

AXR of CT of pneumatosis intestinalis of the colon — AXR AP (above left) shows extensive curvilinear air throughout the wall of the colon from the cecum to the rectum. There is contrast in the bladder from the contemporaneously performed CT. Axial (above right) and coronal (below) CT with contrast of the abdomen show a large amount of air in the wall of the colon throughout the entire colon.

The diagnosis was pneumatosis intestinalis of the entire colon of unknown etiology.

School ager whose gastrostomy tube fell out and has just been replaced

Upper GI of gastrostomy tube tip in the stomach — AP (above) and lateral (below) radiographs obtained after the injection of water soluble contrast through the gastrostomy tube show normal appearing gastric rugae. There is no leakage of contrast out of the stomach.

The diagnosis was correct position of the gastrostomy tube tip within the stomach.

Premature newborn now 9 months old with abdominal distension

AXR of pneumatosis intestinalis of the colon — AXR AP (above) shows curvilinear air throughout the wall of the colon from the cecum to the rectosigmoid colon which is also appreciated on the AXR left lateral decubitus (below). There was no free air or portal venous gas.

The diagnosis was pneumatosis intestinalis of the colon of unknown etiology.

School ager who recently had their gastrostomy tube replaced and now have abdominal pain with tube feeds

AXR of the tip of the gastrostomy tube in the peritoneal space rather than in the stomach. — AXR AP obtained after the injection of water soluble contrast through the gastrostomy tube shows contrast throughout the peritoneum which is outlining the liver and spleen and pooling in the pelvis. The contrast in the bladder is from a CT exam performed earlier in the day.

The diagnosis was gastrostomy tube malfunction with the tip of the gastrostomy tube in the peritoneal space rather than in the stomach.

Premature newborn with a rising lactate level

AXR and US of spontaneous intestinal perforation with dirty ascites — AXR AP (above left) shows a nasogastric tube projecting over the left upper quadrant of the abdomen. There is a collection of air in the mid-abdomen that does not appear to conform to being within bowel. There is no portal venous gas or pneumatosis intestinalis. Transverse US of the abdomen (above right) shows echogenic ascites in the abdomen surrounding the loops of bowel. AXR left lateral decubitus (below) shows a large amount of air between the abdominal wall and the liver. Subsequent placement of a surgical drain returned stool.

The diagnosis was spontaneous intestinal perforation resulting in pneumoperitoneum and complicated ascites.

Premature newborn now 1 month old with blood in their stools

AXR of necrotizing entercolitis — AXR AP (above) shows an extremely dilated bowel gas pattern with cuvilinear air in the wall of the entire colon. There is increased lucency in the center of the image just beneath the diaphragm. AXR left lateral decubitus (below) shows a small amount of air between the abdominal wall and the liver. There is also an extensive amount of branching air seen within the liver.

The diagnosis was necrotizing enterocolitis resulting in pneumatosis intestinalis, portal venous gas, and pneumoperitoneum.

Premature newborn with bloody stools

AXR of pneumatosis intestinalis of whole colon in necrotizing enterocolitis — AXR AP shows bubbly appearing air in the wall of the entire colon from the cecum to the sigmoid colon.

The diagnosis was pneumatosis intestinalis of the whole colon in a patient with necrotizing enterocolitis.

Premature newborn with increasing residuals

Radiograph of pneumatosis intestinalis in necrotizing enterocolitis — The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.

The diagnosis was pneumatosis intestinalis of the ascending colon and proximal transverse colon in a patient with necrotizing enterocolitis.