Infant with a persistently distended abdomen who had necrotizing enterocolitis 1 month ago

Enema of necrotizing enterocolitis — AP image from an enema shows two fixed strictures in the colon, the first at the junction of the sigmoid colon and descending colon, and the second at the splenic flexure.

The diagnosis was post necrotizing enterocolitis strictures.

Premature newborn with abdominal distension

The diagnosis was necrotizing enterocolitis.

Newborn with bloody stools

AXR of necrotizing enterocolitis — Supine AXR shows numerous branching linear lucencies throughout the liver consistent in appearance with portal venous gas.

The diagnosis was necrotizing enterocolitis.

Premature newborn with bloody stools

AXR of necrotizing enterocolitis — Supine AXR shows linear pneumatosis intestinalis involving several loops of bowel in the left lower quadrant of the abdomen.

The diagnosis was necrotizing enterocolitis.

Premature newborn with feeding intolerance

AXR of necrotizing enterocolitis — Supine AXR shows diffusely dilated loops of bowel throughout the abdomen. There is no evidence of pneumatosis intestinalis, portal venous gas, or free air.

The diagnosis was necrotizing enterocolitis.

Newborn with abdominal distension and fever

AXR of pneumoperitoneum — Supine (left) and upright (right) AXR show a central fixed air collection that does not appear to conform to bowel and does not demonstrate any of the classic signs of free air.

The diagnosis was pneumoperitoneum.

Infant with bloody stools and vomiting

AXR of pneumoperitoneum — Supine AXR obtained during an intussusception reduction shows air outlining both the inner and outer walls of the small bowel (Rigler’s sign).

The diagnosis was pneumoperitoneum.

Premature newborn with abdominal distension

AXR of pneumoperitoneum — Supine AXR shows increased lucency in the upper abdomen with clear demonstration of the football sign of the falciform ligament being outlined by free air.

The diagnosis was pneumoperitoneum.

Newborn with abdominal distension

AXR of pneumoperitoneum — Supine AXR shows increased lucency in the upper abdomen without clear demonstration of the football sign of the falciform ligament being outlined by free air.

The diagnosis was pneumoperitoneum.

Premature newborn on ventilator with abdominal distension

AXR of pneumoperitoneum — Cross-table lateral AXR shows a large amount of free air superiorly in the abdomen outlining some of the bowel loops and compressing the rest posteriorly.

The diagnosis was pneumoperitoneum.

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.