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.

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.

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.

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.

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.

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.