Newborn with vomiting who had a triple bubble sign on prenatal US

UGI of jejunal stenosis — Early (above) image from an UGI exam shows dilation of the stomach, duodenum, and proximal jejunum. Later image from the same exam (below) shows contrast progressing through the remainder of the jejunum, which is of a normal caliber.

The diagnosis was jejunal stenosis.

Premature newborn with abdominal distension 2 weeks after recovery from a documented episode of necrotizing enterocolitis

Enema of colonic strictures after necrotizing enterocolitis — AXR AP (left) shows multiple dilated loops of bowel throughout the abdomen. AP image from early in a barium enema (above right) shows a fixed narrowing in the sigmoid colon while AP image from later in the enema (below right) shows additional areas of fixed narrowing beneath the splenic flexure, at the splenic flexure and beneath the hepatic flexure.

The diagnosis was multiple colonic strictures after necrotizing enterocolitis.

Infant with bilious vomiting

US and air enema of ileocolic intussusception — AXR AP (above left) shows multiple dilated loops of small bowel. AP image from an UGI exam to rule out malrotation as the source of bilious vomiting (above right) shows normal position of the ligament of Treitz. Transverse US of the abdomen (middle left) shows a soft tissue mass with a target sign while sagittal US (below left) shows the mass to have a pseudokidney sign. When the enema tip was inserted in the rectum the patient passed a bloody stool. AP image from an air enema (below right) shows a mass in the hepatic flexure which was reduced on the first attempt.

The diagnosis was ileocolic intussusception.

School ager with massive lower GI bleeding

CT of Meckel diverticulum — AP and lateral images from a Technetium-99m Meckel scan (above left) show no areas of abnormal uptake of radiotracer in the abodmen. Axial CT with contrast of the abdomen (above right) shows a small, round, primarily solid soft tissue mass just to the right of the midline between the loops of bowel that on coronal (below left) and sagittal (below right) images is seen to be tubular in appearance and connecting to the anterior abdominal wall near the umbilicus.

The diagnosis was Meckel diverticulum.

Teenager with abdominal pain after a motor vehicle accident

CT of liver laceration — Axial CT with contrast of the abdomen shows a low density lesion in the posterior aspect of the right lobe of the liver.

The diagnosis was liver laceration.

School ager with crampy abdominal pain

CT of small bowel-small bowel intussusception due to Burkitt lymphoma — Axial CT with contrast of the abdomen (above) shows a round soft tissue mass on the left side of the pelvis that has a target sign appearance. Coronal (below left) and sagittal (below right) CT show multiple large mesenteric lymph nodes and that the soft tissue mass arises in the pelvis and also has a pseudokidney sign appearance.

The diagnosis was small bowel-small bowel intussusception due to Burkitt lymphoma.

School ager gymnast who fell onto a balance beam

CT of active splenic bleeding — Axial CT with contrast of the abdomen (above) shows a low-density laceration in the center of the spleen with a round focus of high intensity in the middle of it felt to represent active bleeding. Axial CT with contrast of the pelvis (below) shows a large amount of fluid in the pelvis posterior to the bladder.

The diagnosis was splenic trauma with active splenic bleeding and a large amount of hemoperitoneum.

Newborn with a family history of malrotation

UGI of malrotation without midgut volvulus — AP image from an UGI exam performed through a feeding tube whose tip is in the duodenal bulb shows the entire duodenum, the ligament of Treitz and the proximal jejunum to lie in the right side of the abdomen. There is no evidence of obstruction or midgut volvulus.

The diagnosis was malrotation without midgut volvulus.

Infant with crampy abdominal pain and a mass protruding from the rectum

Air enema of intussusception reduction — AXR scout image (above left) shows a non-obstructive bowel gas pattern. AP image from the start of an air enema begun after manual reduction of the mass into the rectum (above right), shows the tip of the rectal catheter in contact with the mass in the rectum. AP image from later in the study (below left) shows the mass now in the transverse colon near the splenic flexure. Despite multiple attempts the intussusception could not be reduced further and the exam was ended when air was seen outlining the liver and both sides of the wall of the small bowel (Rigler’s sign)(below right). In the operating room the intussusception was reduced manually and a site of perforation could not be found.

The diagnosis was ileocolic intussusception extending all the way out of the rectum, that could not be reduced successfully and which resulted in pneumoperitoneum.

Newborn with bilious vomiting who continued to have bilious vomiting after a Ladd procedure

UGI of malrotation with midgut volvulus before and after a Ladd procedure — AP (above left) and lateral (above right) images from an upper GI exam on day of life 1 show dilation of the first part of the duodenum and a spiral or corkscrew appearance of the second and third parts of the duodenum with the ligament of Trietz projecting over the midline of the spine and lower than the first part of the duodenum. AP (below left) and lateral (below right) images from an upper GI obtained several days after a Ladd procedure show the first part of the duodenum now to be normal in caliber while the second and third parts of the duodenum continue to have a spiral or corkscrew appearance with the ligament of Trietz continuing to project over the midline of the spine and lower than the first part of the duodenum.

The diagnosis was malrotation with midgut volvulus on the initial upper GI exam and malrotation without midgut volvulus after a Ladd procedure on the repeat upper GI exam.

Toddler with bloody stools

Air enema of ileocolic intussusception — AXR AP (left) shows a non-obstructive bowel gas pattern and a suggestion of a soft tissue mass in hepatic fluxure. AP image from an air enema (right) shows a round soft tissue mass in the hepatic flexure which was successfully reduced. The next day the pediatric radiologist received a box of pastries from the grateful family.

The diagnosis was ileocolic intussusception.

Infant with crampy abdominal pain

Barium enema and air enema of intussusception — Outside AXR (above left) has a suggestion of a soft tissue mass in the hepatic flexure. Lateral spot image from an outside barium enema (above middle) shows a coiled spring appearance to the ascending colon. Post procedure outside AXR (above right) shows barium refluxed into the appendix but not into the terminal ileum. The soft tissue mass remains at the hepatic flexure. AP image from a repeat air enema at our institution (below left) shows a soft tissue mass outlined by air in the cecum. Post procedure AP image after the air enema (below right) shows a massive amount of air refluxed into the terminal ileum.

The diagnosis was unsuccessful outside barium enema reduction of an ileocolic intussusception that was subsequently successfully reduced via air enema at our institution.

School ager with a fever of unknown origin

CT of inflammatory myofibroblastic tumor — Axial (left) and coronal (right) CT with contrast of the abdomen show a large, solid, heterogeneously enhancing mass in the left upper quadrant inferior to the stomach and spleen and anterior to the kidney whose organ of origin is uncertain.

The diagnosis was inflammatory myofibroblastic tumor.

Teenager with abdominal pain after motor vehicle accident

CT of splenic laceration — Axial CT with contrast of the abdomen shows a laceration through the center of the spleen (above) and a large amount of hemoperitoneum in the pelvis (below).

The diagnosis was splenic trauma.

Infant with bloody stools

Barium enema of ileocolic intussusception — AXR obtained after an outside barium enema shows the cecum to have a coiled spring appearance. There is no reflux of contrast into the terminal ileum.

The diagnosis was ileocolic intussusception that was not reduced successfully.

Newborn with failure to pass meconium

Enema of ileal atresia — AXR supine (above left) and AXR left lateral decubitus (above right) show multiple dilated loops of bowel with no gas in the rectum. AP (below left) and lateral (below right) views of an enema show the colon to be small in diameter throughout its length (microcolon) and to contain filling defects representing pellets of meconium. The terminal ileum could not be refluxed despite multiple attempts to do so.

The diagnosis was ileal atresia.

Infant with projectile vomiting

US of hypertrophic pyloric stenosis — Sagittal (left) and transverse (right) US of the pylorus shows the pyloric muscle to be lengthened and thickened, measuring 21 mm in length and 5 mm thick.

The diagnosis was hypertrophic pyloric stenosis.

Toddler with crampy abdominal pain

US of ileocolic intussusception — AXR (left) was unremarkable. Sagittal US of the right lower quadrant (middle) showed a pseudokidney sign in the ascending colon. Air enema encountered a mass at the ileocecal valve which was rapidly reduced with reflux of a large amount of air into the terminal ileum (right).

The diagnosis was ileocolic intussusception.

Infant with projectile vomiting, weight loss and severe dehydration

AXR and US of hypertrophic pyloric stenosis — AXR (above) shows an extremely distended stomach with peristaltic waves (caterpillar sign). Sagittal (below left) and transverse (below right) US of the pylorus shows the pylorus muscle to be thickened and elongated in length, measuring 3.9 mm thick and 20 mm in length.

The diagnosis was hypertrophic pyloric stenosis.

Preschooler with a right abdominal mass and elevated alpha fetal protein

CT and MRI of hepatoblastoma — Axial CT with contrast of the abdomen (above left) shows a large, inhomogenous multifocal mass on the right side of the abdomen that enhances less than the liver and that did not appear to arise from the right adrenal gland or right kidney. Axial T2 (above right) and axial (below left) and coronal (below right) T1 MRI with contrast of the abdomen show the mass arising from and involving nearly the entire liver and encasing the portal veins.

The diagnosis was hepatoblastoma.

Infant with projectile vomiting

US of hypertrophic pyloric stenosis — Sagittal US of the pylorus (middle) shows the calipers on the hypoechoic pyloric muscle which is thickened and elongated, measuring 3.7 mm thick and 20 mm in length. Transverse US of the pylorus (right) shows the circumferentially thickened and hypoechoic pyloric muscle whose boundaries are marked by the calipers surrounding the echogenic mucosa in the center of it.

The diagnosis was hypertrophic pyloric stenosis.

Former premature infant now a toddler with an abdominal mass

CT of hepatoblastoma — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen shows a large mass in the right lobe of the liver with punctate calcifications that is heterogenous in appearance and with a low density center, encases the portal veins, and enhances less than the liver.

The diagnosis was hepatoblastoma.

Newborn with anterior abdominal wall defect

AXR of gastroschisis — Preop AXR (left) shows no bowel gas within the abdomen and multiple bowel loops outside of and to the right of the abdomen without an encasing sac. Postop AXR AP (above right) and lateral (below right) show the bowel loops still outside the scaphoid abdomen but now encased within a silo.

The diagnosis was gastroschisis.

Preschooler status post ingestion

AXR of button battery in the stomach — Initial AXR (left) shows a round radiopaque object with a halo and double rim in the antrum of the stomach that on a later AXR (right) shows a beveled edge.

The diagnosis was button battery as a gastrointestinal foreign body.

Toddler whose toy was noted to be missing a battery

AXR of button battery in the stomach — AXR shows a round radiopaque foreign body with a halo and double rim projecting over the antrum of the stomach.

The diagnosis was a button battery as a gastrointestinal foreign body.