Infant with difficulty feeding

UGI of duodenal web — Image from an upper GI exam shows a wind-sock deformity at the junction of the second and third portions of the duodenum.

The diagnosis was duodenal web.

School ager with Trisomy 21 and vomiting with feeding

AXR and UGI of duodenal stenosis — AXR (above) shows the tip of the nasogastric tube within a very dilated duodenal bulb. There is extensive distal bowel gas. Spot image from an upper GI exam (below) shows a fixed area of narrowing between the first and second portions of the duodenum through which contrast passed slowly.

The diagnosis was duodenal stenosis.

Newborn with a distended abdomen

AXR of duodenal atresia — Supine (left) and upright (right) AXR shows large air fluid levels in the duodenal bulb (to the right of the spine) and in the stomach (to the left of the spine). There is no distal bowel gas.

The diagnosis was duodenal atresia.

Newborn who can’t handle their secretions

CXR of esophageal atresia with distal fistula — CXR shows a nasogastric tube coiled within a dilated proximal esophagus. There is gas in the stomach.

The diagnosis was esophageal atresia with distal fistula.

Preschooler with hepatosplenomegaly

AXR of acute lymphocytic leukemia — AXR shows diffuse enlargement of the liver and spleen.

The diagnosis was acute lymphocytic leukemia.

Toddler with hepatomegaly

MRI of mesenchymal hamartoma — Axial T1 weighted without contrast (above) and T2 weighted (below) MRI of the abdomen shows a mass in the right lobe as well as in the medial segment of the left lobe of the liver, measuring 13 x 13 x 7 cm in size and having a cystic and solid appearance.

The diagnosis was mesenchymal hamartoma.

Infant with hepatomegaly

CT and US and angiogram of hepatoblastoma — Axial CT without (above left) and with (above right) contrast of the abdomen shows a large, coarsely calcified, heterogenously enhancing liver mass. US image (below left) shows its multinodular nature and an angiogram (below right) shows its neovascularity.

The diagnosis was hepatoblastoma.

Teenager with hepatomegaly

US of hepatocellular carcinoma — Sagittal US of the liver shows it to be enlarged and multinodular in appearance.

The diagnosis was hepatocellular carcinoma.

Toddler with jaundice

US and nuclear medicine scan of choledochal cyst — Sagittal US of the liver (left) shows a cystic mass in the liver that appeared to communicate with the biliary tree. Image from a hepatobiliary scan (right) shows radiotracer uptake in the lesion, confirming its communication with the biliary tree.

The diagnosis was choledochal cyst.

Infant with hepatomegaly

MRI of liver hemangioma — Coronal T1 weighted MRI without (left) and with (right) contrast of the abdomen shows a round, well-circumscribed lesion in the right lobe of the liver that has ring enhancement and that was seen to fill in on delayed images.

The diagnosis was a hemangioma.

Newborn with failure to pass meconium

AXR of anorectal malformation — AXR shows a distal bowel obstruction with gas down to the rectum. On physical exam the anus was absent.

The diagnosis was a high anorectal malformation.

Newborn with failure to pass meconium

Enema of Hirschsprung disease — AP and lateral views from an enema shows the rectum and sigmoid colon to be smaller in diameter than the rest of the colon.

The diagnosis was Hirschsprung disease.

Newborn with failure to pass meconium

Enema of colonic atresia — The AXR (left) shows a distal bowel obstruction. The enema (right) shows a microcolon with opacification of only the descending colon.

The diagnosis was colonic atresia.

Newborn with failure to pass meconium

Enema of ileal atresia — Enema shows a microcolon with an inability to reflux contrast into the dilated loops of distal small bowel.

The diagnosis was ileal atresia.

Newborn with failure to pass meconium

Enema of meconium plug syndrome — Enema shows the left colon to be smaller in caliber than the rest of the colon. There is a long meconium filling defect throughout the colon.

The diagnosis was meconium plug syndrome.

Newborn with failure to pass meconium

Enema of meconium ileus — Enema shows on the early AP view (left) a microcolon and on the later lateral view (right) reflux of contrast into a dilated terminal ileum.

The diagnosis was uncomplicated meconium ileus.