Newborn with a distended abdomen

AXR of pneumoperitoneum — Left lateral decubitus AXR shows free air between the right abdominal wall and the liver.

The diagnosis was pneumoperitoneum.

Preschooler with abdominal pain

CXR of pneumoperitoneum — Upright CXR shows free air beneath the diaphragm.

The diagnosis was pneumoperitoneum.

Toddler with stridor

CXR and Upper GI of esophageal foreign body — Lateral spot films from an UGI show fixed narrowing of the trachea (left + middle) with an esophageal perforation / fistula arising from the anterior wall of the esophagus (right). Endoscopy done earlier in the day removed a set of plastic wheels from a toy car which was felt to have been present for a long time as the esophagus was ulcerated and edematous in the area of perforation.

The diagnosis was esophageal foreign body.

Teenager with pancreatic insufficiency

AXR of cystic fibrosis with pancreatic insufficiency — AXR shows calcifications throughout the pancreas.

The diagnosis was cystic fibrosis with pancreatic insufficiency.

Young adult with hematemesis

UGI of esophageal varices in cystic fibrosis — Lateral images from an UGI shows multiple rounded filling defects extrinsic to the distal esophageal lumen.

The diagnosis was cystic fibrosis with cirrhosis and portal hypertension causing esophageal varices.

Teenager with cystic fibrosis and abdominal pain

AXR and barium enema of distal intestinal obstruction syndrome — AXR (left) shows a distal small bowel obstruction. Water-soluble contrast enema (right) shows the cecum flipped up into the left upper quadrant with the stool-filled terminal ileum outlined by contrast just beneath it.

The diagnosis was distal intestinal obstruction syndrome.

Newborn with failure to pass meconium

Barium enema of uncomplicated meconium ileus — Early (left) image from a water-soluble contrast enema shows a microcolon and reflux of contrast into a non-dilated terminal ileum. Later (right) image from the same enema shows reflux of contrast into dilated loops of ileum, which are above the level of the obstruction by meconium in the terminal ileum.

The diagnosis was uncomplicated meconium ileus.

Newborn with failure to pass meconium

AXR of complicated meconium ileus — AXR shows an obstructive bowel gas pattern and a thin network of calcifications extending throughout the lower abdomen.

The diagnosis was complicated meconium ileus.

Newborn with failure to pass meconium

Barium enema of meconium plug syndrome — AXR shows a distal bowel obstruction. Water-soluble contrast enema shows normal caliber of the ascending and transverse colon and rectum, but decreased caliber of the descending (left) colon.

The diagnosis was meconium plug syndrome.

Newborn with failure to pass meconium

Clinical image of meconium plug — Clinical image shows a contiguous plug of meconium that was expelled by the patient after a water-soluble contrast enema.

The diagnosis was meconium plug syndrome.

Infant with respiratory distress

CXR and CT of esophageal duplication — CXR shows a subtle double density over the left side of the heart in the paraspinal region. Axial CT with contrast of the chest shows a soft tissue mass in the posterior mediastinum on the left.

The diagnosis was esophageal duplication.

Infant with a prolapsing rectal mass

Barium enema and MRI of rectal duplication — AP and lateral images from a barium enema show an intraluminal lesion in the rectum. Axial and sagittal T2 MRI shows a cystic mass anterior to the rectum.

The diagnosis was rectal duplication.

Female preschooler who stools out of her vagina and rectum

Barium enema of colonic duplication — Injection through the vagina (left) shows a normal caliber colon which is malpositioned with the descending colon on the right side of the abdomen and the cecum in the left lower quadrant. Injection through the rectum (right) shows a second colon of normal caliber that was again malpositioned. There was no communication between the two colons.

The diagnosis was colonic duplication.

Infant with difficulty feeding

UGI of duodenal duplication — 3 lateral images from an UGI show persistent narrowing of the second portion of the duodenum caused by a round extrinsic mass.

The diagnosis was duodenal duplication.

Toddler with difficulty feeding

UGI and US of gastric duplication — Lateral image from an UGI shows narrowing of the antrum of the stomach, which persisted throughout the exam. Sagittal US of the same region shows a cystic mass with an echogenic central rim.

The diagnosis was gastric (antral) duplication which also involved the first portion of the duodenum.

Preschooler with an incidental chest mass

CXR and CT of esophageal duplication — CXR shows a right sided retrohilar mass and a chest CT with contrast shows the mass to be non-enhancing, posterior to the right bronchi, and next to the esophagus.

The diagnosis was esophageal duplication.

Newborn with palpable lower abdominal mass

CT of mesenteric cyst — Axial CT with contrast of the abdomen shows a large simple cystic mass in the left side of the abdomen.

The diagnosis was mesenteric cyst.

Newborn with palpable right upper quadrant mass

US of mesenchymal hamartoma — Transverse and sagittal US images of the liver shows a large complex septated liver mass.

The diagnosis was mesenchymal hamartoma.

Newborn with palpable liver mass and elevated AFP

CT of liver hemangioma — Axial CT with contrast of the abdomen in the arterial phase (upper left) and then 1, 7 and 15 minutes later (lower right) shows a large liver mass that has an enhancing rim and a low density center which slowly filled in on delayed images.

The diagnosis was liver hemangioma.

Newborn with cystic abdominal mass on prenatal US

US of ileal duplication cyst — Transverse (above) and sagittal (below) US of the abdomen shows a cystic abdominal mass with an echogenic central rim.

The diagnosis was ileal duplication.

Newborn with a liver cyst on prenatal US

US of choledochal cyst — Transverse US of the liver shows a cystic lesion distinct from the gallbladder in the liver. Hepatobiliary imaging showed it communicating with the biliary tree.

The diagnosis was choledochal cyst.

Newborn with vomiting

UGI of annular pancreas — Lateral image from an upper GI exam shows complete obstruction at the second part of the duodenum.

The diagnosis was annular pancreas.

Newborn with vomiting

UGI of jejunal atresia — AP image from an upper GI exam shows dilation of the duodenum and extreme dilation of the proximal jejunum. There was no distal passage of contrast on delayed images.

The diagnosis was jejunal atresia.

Toddler with vomiting with feeding

UGI of jejunal stenosis — Delayed image from an upper GI with small bowel follow through exam shows the jejunum to be extremely dilated (left side of image) while the ileum is decompressed (right side of image).

The diagnosis was jejunal stenosis.

Newborn with bilious vomiting

UGI of malrotation with midgut volvulus — Two AP images from an upper GI exam show the duodenal-jejunal junction to be to the left of the spine but to be low lying. The proximal jejunum has a spiral appearance.

The diagnosis was malrotation with midgut volvulus.