Newborn with several days of bilious vomiting

Surgical image — Surgical image shows the entire small bowel, from the jejunum to the terminal ileum, to be infarcted.

The diagnosis was malrotation with midgut volvulus.

Preschooler with right hip pain for 2 weeks

CT of perforated appendicitis — AP radiograph of the right femur was unremarkable. Coronal STIR MRI of the right hip and femur was unremarkable aside from incidental bright pelvic free fluid noted just above the bladder. Coronal 2D reconstruction from a CT with IV and oral contrast of the abdomen shows a large complex fluid collection containing air and a central calcification in the right lower quadrant which was lying next to the psoas muscle.

The diagnosis was perforated appendicitis with an abscess containing an appendicolith.

Toddler in a motor vehicle accident who is obtunded

The diagnosis was hypoperfusion complex.

School ager with a handlebar injury and abdominal pain

CT of bowl trauma / bowel perforation — Initial axial CT with contrast of the abdomen (left images) shows no solid organ injury but a moderate amount of free fluid in the abdomen and pelvis. Repeat axial CT with contrast of the abdomen obtain a day later due to increasing abdominal pain (right images) shows a marked increase in the free fluid within the abdomen and pelvis.

The diagnosis was bowel perforation.

Toddler who has been abused

CT of duodenal hematoma — Contiguous slices from an axial CT with IV and oral contrast of the abdomen shows medial to the ascending colon the contrast-filled lumen of the duodenum narrowing to a point as it nears the midline (above) and then being narrowed as it crosses anterior to the spine (below).

The diagnosis was duodenal hematoma.

Teenager who crashed their all terrain vehicle with abdominal pain

CT of renal trauma / renal laceration and ureteral trauma / ureteral transection and splenic trauma / splenic laceration — Axial and coronal CT with contrast of the abdomen immediate phase (above) shows low density in the superior and inferior poles of the left kidney and fluid in the left perirenal and pararenal spaces. There is also a large area of low density in the spleen. Delayed phase CT images (below) show extravasation of urine out of the ureter into the left pararenal space.

The diagnosis was left renal laceration with ureteral transection and splenic laceration.

Preschooler who fell 20 feet out a window with abdominal pain

CT of adrenal trauma / adrenal laceration and liver trauma / liver laceration — Axial CT with contrast of the abdomen shows a large amount of fluid in the region of the right adrenal gland and areas of low density in the middle and posterior aspects of the right lobe of the liver.

The diagnosis was right adrenal hemorrhage and liver laceration.

School ager who fell off their scooter 4 days ago and has increasing abdominal pain

CT of pancreatic trauma / pancreatic laceration — Axial CT with contrast of the abdomen shows a linear low density just anterior to the portal vein at the junction of the pancreatic head and pancreatic body. There is a large amount of peripancreatic fluid.

The diagnosis was pancreatic laceration / transection.

Teenager in a motor vehicle accident with abdominal pain

CT and US of pancreatic trauma / traumatic pancreatitis — Axial CT with contrast of the abdomen (above) shows an enlarged pancreatic head with some mild intrahepatic biliary dilation and non-visualization of the common bile duct. Transverse US of the pancreas obtained a day later (below) shows an enlarged hypoechoic pancreatic head.

The diagnosis was pancreatitis causing common bile duct obstruction.

School ager status post handlebar injury and abdominal pain

CT of inhomogenous enhancement of the spleen and liver laceration — Axial CT with contrast of the abdomen shows a stellate area of low density in the right lobe of the liver. The spleen does not have a laceration, instead it demonstrates inhomogenous opacification due to the image being obtained in the arterial phase – note how dense the contrast in the aorta is.

The diagnosis was inhomogenous enhancement of the spleen and a liver laceration.

School ager in a motor vehicle accident with abdominal pain

CT of splenic trauma / splenic laceration — Axial CT with contrast of the abdomen shows multiple areas of low density in the spleen, a perisplenic fluid collection, and a large amount of free fluid in the pelvis

The diagnosis was splenic laceration with hemoperitoneum.

School ager in a motor vehicle accident with abdominal pain

CT of periportal halo — Axial CT with contrast of the abdomen shows no laceration in the liver and linear low density surrounding the portal venous system.

The diagnosis was periportal halo.

School ager in a motor vehicle accident with abdominal pain

CT of liver trauma / liver laceration — Axial CT with contrast of the abdomen shows an area of low density in the right lobe of the liver and a large amount of free fluid in the pelvis.

The diagnosis was liver laceration with hemoperitoneum.

Newborn with new abdominal distension with a patent ductus arteriosus who is receiving indomethacin to close it

AXR of pneumoperitoneum — Right lateral decubitus radiograph of the abdomen shows a large amount of free air within the abdomen.

The diagnosis was indomethacin-induced bowel perforation.

Infant with hypoplastic left heart syndrome on prostaglandin E to keep their ductus arteriosus patent who is continuously vomiting with feeds

UGI and US of prostaglandin E induced gastritis — Two lateral images from an upper GI (above) show persistent narrowing of the pylorus causing relative gastric outlet obstruction. Sagittal (left below) and transverse (right below) US of the pylorus shows the central echogenic gastric mucosa to be thickened and the pyloric muscle outside of it to be normal in diameter. The patient was also noted to be malrotated.

The diagnosis was prostaglandin E induced gastritis.

School ager with recent recurrent pneumonias who underwent esophageal atresia repair 5 years ago

Upper GI of esophageal atresia with recurrent fistula — Lateral image from an upper GI exam shows a contrast filled esophagus (posteriorly) connecting to the trachea (anteriorly) through a superiorly oriented fistula (in the middle).

The diagnosis was recurrent fistula after repair of esophageal atresia.

School ager who choked while eating tacos who is status post esophageal atresia repair 12 years ago

Upper GI of esophageal atresia — AP image from an upper GI shows marked luminal narrowing at the esophageal anastomosis between the dilated proximal esophageal pouch and the distal esophagus with a large filling defect in the proximal pouch. At endoscopy a large piece of meat was removed from above the anastomosis and the anastomosis was successfully dilated.

The diagnosis was a stricture at the esophageal anastomosis after repair of esophageal atresia.

Toddler who cannot swallow solid foods who is status post esophageal atresia repair a year ago

AP image from an upper GI shows ~ 75% luminal narrowing at the esophageal anastomosis between the dilated proximal esophageal pouch and the distal esophagus. This narrowing was subsequently successfully treated with dilation.

The diagnosis was a stricture at the esophageal anastomosis after repair of esophageal atresia.

Newborn with difficulty handling secretions who subsequently developed tracheomalacia

CXR AP (left) shows a nasogastric tube that cannot be advanced further in the esophagus. Vintage upper GI lateral image (right) shows a dilated proximal esophageal pouch compressing the airway. In current practice, there is no indication for doing an upper GI with positive contrast material.

The diagnosis was esophageal atresia with distal tracheo-esophageal fistula.

Infant with esophageal atresia without tracheo-esophageal fistula undergoing pre-operative imaging

AP image from an upper GI performed with a bougie dilator placed into the proximal esophageal pouch through the oropharynx and a bougie dilator placed through a gastrostomy tube site into the distal esophagus with both dilators held under tension shows a 2 cm gap between the proximal and distal esophageal segments.

The diagnosis was esophageal atresia with a long gap between the proximal and distal segments.

Infant with several episodes of aspiration pneumonia in the last year

CXR shows diffuse infiltrates in the right upper and lower lobes and hyperexpansion. An upper GI showed a fistula between the esophagus and trachea.

The diagnosis was esophageal atresia with H-type tracheo-esophageal fistula.

Infant with recurrent pneumonias

2 lateral images from an upper GI shows contrast in the esophagus as expected (posteriorly) and in the airway unexpectedly (anteriorly). An H-type fistula is clearly seen connecting the airway and the esophagus.

The diagnosis was esophageal atresia with H-type tracheo-esophageal fistula.

Newborn with inability to handle secretions

CXR AP and Lateral shows a nasogastric tube that cannot be further advanced into the distal esophagus.

The diagnosis was esophageal atresia without tracheo-esophageal fistula.

Newborn with failure to pass a nasogastric tube and a distended abdomen

CXR | AXR shows a nasogastric tube in the proximal esophagus and a massively distended abdomen. Transverse US image of the upper abdomen (below) shows a dilated duodenal bulb (left) and a dilated stomach (right), a double-bubble sign.

The diagnosis was esophageal atresia without tracheo-esophageal fistula and duodenal atresia.

Newborn with difficulty handling secretions in whom a nasogastric tube could not be passed

AXR shows a gasless abdomen. Segmentation anomalies are noted in the sacrum suggesting the presence of VATER syndrome.

The diagnosis was esophageal atresia without tracheo-esophageal fistula.