Preschooler who is being treated for Wilms tumor and is immune suppressed and is septic

US of candidial microabscesses in spleen — Transverse (left) and sagittal (right) US images of the spleen show multiple, round anechoic lesions within the spleen.

The diagnosis was candidial microabscesses in the spleen.

Preschooler with colicky abdominal pain

US of pancreatitis caused by pancreatic duct stone — Transverse US of the pancreatic head (above) shows just to the right of midline a round echogenic lesion with posterior shadowing in the center of the pancreatic head while transverse US of the pancreatic body (below) shows a dilated pancreatic duct throughout the body of the pancreas.

The diagnosis was a large stone in the pancreatic head portion of the pancreatic duct causing pancreatic duct obstruction and pancreatitis.

Teenager with intractable back pain

US of pancreatoblastoma — Transverse US of the abdomen shows a large solid mass in the pancreatic head encasing the hypoechoic portal-mesentero venous junction in the center of the image.

The diagnosis was pancreatoblastoma.

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

CT of omental infarction — Axial CT with contrast of the abdomen shows diffuse mesenteric fat stranding which is most prominent along the right side of the abdomen. The appendix (not pictured) measured 7-8 mm in diameter and was considered via measurement to be indeterminate for acute appendicitis.

The diagnosis was omental infarction which was seen along with a normal appendix in the operating room.

Infant with vomiting and failure to thrive

Upper GI of organoaxial volvulus — AP image from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach.

The diagnosis was organoaxial gastric volvulus.

Teenager with an incidentally noted paraspinal mass on a CXR

Upper GI of organoaxial gastric volvulus and hiatal hernia — Early AP (above left) and later AP (above right) and lateral (below) images from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach. The stomach is also noted to have slid through the esophageal hiatus into the chest.

The diagnosis was organoaxial gastric volvulus in a patient with a hiatal hernia.

Infant with cough and vomiting

Upper GI of organoaxial gastric volvulus — Early AP (above left) and later AP (above right) and lateral (below) images from an upper GI shows rotation of the stomach along its long axis with reversal of the greater and lesser curvatures of the stomach.

The diagnosis was organoaxial gastric volvulus.

Toddler with drainage of stool from the umbilicus

Meckel’s scan of Meckel's diverticulum — AP delayed image (left) from a Tc-99m pertechnetate scan (Meckel’s scan) shows a focal round concentration of radiotracer in the right lower quadrant superior and lateral to the midline bladder which is seen in the middle of the lower abdomen superior to the bladder on the lateral (right) delayed image.

The diagnosis was Meckel diverticulum with a patent omphalomesenteric duct.

Teenager with a cystic abdominal mass

Surgical image shows a large thin-walled cystic structure arising from the mesentery of the small bowel.

The diagnosis was mesenteric cyst.

School ager with gross hematuria who is post bone marrow transplant and has received cyclophosphamide

Transverse (above) and sagittal (below) US of the pelvis shows an extremely thick-walled bladder containing echogenic debris and clots.

The diagnosis was hemorrhagic cystitis due to cyclophosphamide therapy.

Infant with vomiting and abdominal distension

Clinical image of currant jelly stools in intussusception — Clinical image shows currant jelly stools.

The diagnosis was ileocolic intussusception.

Infant with coughing and gagging when feeding

Upper GI of tracheal aspiration — Lateral image from an upper GI shows barium in the trachea anteriorly as well as in the pharynx and esophagus posteriorly.

Ultrapremature newborn with massive abdominal distension who has passed only a little meconium after 4 days

Enema of meconium obstruction of prematurity — AXR AP (above) shows massively dilated loops of bowel throughout the entire abdomen. AXR AP taken at the beginning of an enema performed with water-soluble contrast (lower left) shows meconium filling almost the entire colon. AXR AP taken later in the exam (lower right) shows reflux of contrast into massively dilated loops of small bowel. Several hours after the enema, the patient passed a large amount of meconium and the abdomen became completely decompressed.

Infant with an abdominal mass

MRI of inflammatory myofibroblastic tumor — Coronal T1 MRI without (upper left) and with (upper right) contrast of the abdomen shows a large well circumscribed bi-lobed solid mass that enhances homogeneously in the abdomen and that along with the axial T2 image (below) is shown to not arise from any of the solid organs of the abdomen.

School ager with retching

CXR and upper GI of hiatal hernia — CXR AP shows an air fluid level at the level of the diaphragm. Lateral spot image from an upper GI shows the fundus of the stomach sliding through the esophageal hiatus into the chest.

The diagnosis was hiatal hernia.

Preschooler with a purpuric skin rash and abdominal pain

Small bowel follow through of Henoch-Schonlein purpura — AXR AP (left) and spot image of the terminal ileum (right) from a small bowel follow through show bowel wall fold thickening (thumbprinting) throughout the jejunum and ileum.

The diagnosis was Henoch-Schonlein purpura.

Preschooler with reflux

Upper GI of esophagitis and esophageal stricture from gastroesophageal reflux — Lateral spot image from an upper GI shows multiple small ulcerations in the esophageal mucosa and a fixed tight narrowing of the distal esophagus in the middle of the image which never opened up during the exam. Gastroesohageal reflux was also demonstrated throughout the exam

The diagnosis was a distal esophageal stricture due to esophagitis from gastroesophageal reflux.

Teenager with a liver lesion

Axial and coronal CT with contrast of the abdomen arterial phase imaging (left) shows an enhancing round lesion in the dome of the liver that has a central scar which fills in on the portal venous phase imaging and becomes isodense with the surrounding liver parenchyma (center). Axial T1 MRI with Eovist (hepatocyte specific) contrast of the abdomen in the arterial phase (right upper) again shows the enhancing round lesion with a central scar that fills in the portal venous phase imaging (right center) and then retains its contrast on the delayed phase imaging (right lower).

The diagnosis was focal nodular hyperplasia.

School ager with abdominal pain

AXR of constipation — AXR AP shows a marked amount of stool in the ascending colon that decreases somewhat in the transverse and descending colon but that massively distends the rectum to fill almost the entire pelvis.

The diagnosis was constipation.

Preschooler with abdominal pain

AXR and small bowel follow through of ascariasis — AXR AP (left) shows numerous round soft tissue densities projecting throughout the small bowel centrally located within the abdomen. AXR AP from a small bowel follow through (right) shows numerous linear tubular filling defects within the small bowel.

The diagnosis was ascariasis.

School ager with vomiting when eating

CXR and upper GI of achalasia — CXR PA and lateral (above) shows a dilated esophagus with an air-fluid level within it. AP and lateral images from an upper GI (below) show an extremely dilated esophagus with fluid-fluid level within it that terminates in a beak at the gastroesophageal junction.

The diagnosis was achalasia.

Teenager with bloody diarrhea

Enema of pseudopolyps in ulcerative colitis — AP AXR (left) and magnified AP spot image of the splenic flexure (right) from a double contrast barium enema shows a large number of small polypoid lesions throughout the colon with the space between the polyps appearing to be denuded and ulcerated.

The diagnosis was pseduopolyps in a patient with ulcerative colitis.

Teenager with abnormal pigmentation around the mouth

Small bowel follow through of Peutz-Jeghers syndrome — AP (left) and lateral (right) spot images from an upper GI show several round filling defects in the proximal jejunum, the most notable being in the left-most aspect of the AP image.

The diagnosis was a hamartomatous polyp in a patient with Peutz-Jeghers syndrome.

School ager with rectal bleeding

Small bowel follow through of juvenile polyp — Spot image of the jejunum from a small bowel follow through shows a polypoid filling defect in the center of the bowel lumen whose stalk attaches to the bowel mucosa.

The diagnosis was juvenile polyp.

Teenager with rectal bleeding

Enema of familial adenomatous polyposis — AP spot image of the hepatic flexure of the colon from a double contrast barium enema shows contrast coating multiple polypoid lesions which arise from the mucosal surface of the colon and extend into the colonic lumen.

The diagnosis was adenomatous polyps in a patient with familial adenomatous polyposis.