School ager with recurrent abdominal pain

AXR of constipation — AXR shows a massive amount of stool from the cecum to the rectum.

The diagnosis was constipation.

Toddler with a lower abdominal midline mass

CT of colonic duplication — Axial CT with IV and oral contrast of the abdomen show a large midline mass which appears to contain air and stool (and no oral contrast) that extends from the lower abdomen (top) all the way to the rectum which it displaces posteriorly and to the right (bottom).

The diagnosis was colonic duplication.

Newborn with failure to pass meconium

Enema of colonic atresia — AXR (left) shows multiple dilated loops of bowel with an extremely dilated loop of bowel in the lower abdomen. AP (above right) and lateral (below right) images from an enema show a microcolon with contrast reaching the level of the cecum but not refluxing the terminal ileum, despite multiple attempts.

The diagnosis was colonic atresia.

Unjaundiced preschooler with vomiting and abdominal pain

CT and cholangiogram of choledochal cyst Type I — Axial (above left) and coronal (above right) CT without contrast of the abdomen show a large cystic lesion between the right kidney and pancreas with extensive surrounding inflammation. The gall bladder was normal. AP image from intraoperative cholangiogram (below) shows the lesion represents diffuse dilation of the common bile duct with free passage of contrast into the small bowel.

The diagnosis was choledochal cyst Type I.

Teenager with right lower quadrant pain and WBC=30,000

US of acute appendicitis with appendicolith — Sagittal US of the right lower quadrant (above) shows a dilated, non-compressible, blind ending tubular structure measuring 10 mm in diameter with an echogenic focus at its tip causing posterior shadowing. Transverse US of the cecum (below) shows it to be thickened in appearance.

The diagnosis was acute appendicitis with an appendicolith at the tip of the appendix. In the operating room, the inflammed appendix was adherent to an inflamed cecum.

Newborn with direct hyperbilirubinemia

Hepatobiliary scan of biliary atresia — Transverse US of the liver (above) at the level of the main portal vein shows the liver and intrahepatic and extrahepatic biliary tree to be unremarkable. The gall bladder (not shown) was small and collapsed, although the patient had been fasting for 12 hours before the exam. Serial images from a hepatobiliary scan performed after pretreatment with phenobarbital obtained up to 5 minutes after the injection of radiotracer (below left) show prompt uptake of radiotracer by the liver but no excretion of radiotracer into the biliary tree, gall bladder, or bowel. Delayed image obtained at 24 hours after injection of radiotracer (below right) again fails to show excretion of radiotracer into the biliary tree, gall bladder, or bowel.

The diagnosis was biliary atresia.

Newborn with failure to pass meconium

AXR of anorectal malformation — AXR (above) shows multiple dilated loops of bowel within the abdomen that are progressively more dilated as they near the rectum. Prone cross-table lateral radiograph of the abdomen obtained after 10 minutes in the prone position (below) with a radio-opaque BB on the anus shows a short distance between the anus and the gas in the rectum.

The diagnosis was a low anorectal malformation.

School ager with intermittent abdominal pain

UGI and SBFT of lymphoid hyperplasia — Spot images from an upper GI small bowel follow through show multiple round filling defects, which represent pseudopolyps, throughout the terminal ileum which is normal in caliber.

The diagnosis was lymphoid hyperplasia.

Preschooler with abdominal pain

CT and US of acute cholecystitis — Axial (above left) and sagittal (above right) CT with contrast of the abdomen shows an enlarged gallbladder with diffuse wall thickening and pericholecystic fluid. Transverse (below left) and sagittal (below right) US of the abdomen again shows gallbladder wall thickening and pericholecystic fluid and a large amount of sludge in the gall bladder.

The diagnosis was acute cholecystitis.

Teenager with vomiting after posterior spinal fusion 1 week ago

UGI of superior mesenteric artery syndrome — AP image from an upper GI exam shows extremely dilated first and second portions of the duodenum. There was continuous to and fro motion of contrast in the duodenum and over 15 minutes no contrast passed across the spine and through the duodenal C-loop.

The diagnosis was superior mesenteric artery syndrome.

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.