Preschooler who has eaten something they should not have eaten

AXR of rare earth construction magnets in the stomach — AXR AP (left) and AXR lateral (right) show 4 radiopaque linear objects that are joined together in the mid abdomen.

The diagnosis was gastrointestinal foreign body in the form of 4 rare earth construction set magnets that are joined together.

Toddler who has eaten something they should not have eaten

AXR of 3 coins in the stomach that are stuck together and mimicking a button battery — AXR AP shows a radiopaque foreign body in the fundus of the stomach which has a combination of beveled edges and step offs.

The diagnosis was gastrointestinal foreign body which was presumed to be a button battery but upon endoscopic removal was found to be a nickel and two smaller penny coins that were stuck together and mimicking a button battery.

Preschooler with a history of a foreign body ingestion

Radiograph of a button battery in the stomach — AXR AP (left) shows a round radiopaque object in the region of the pylorus of the stomach that has a lucent halo around it. Zoomed up image of the object (right) better shows the lucent halo.

The diagnosis was gastrointestinal foreign body in the form of a button battery.

Toddler who is choking on something

CXR of button battery ingestion in a patient with a Morgagni hernia — CXR AP (above left) shows a round radiopaque object with a halo of lucency around it in the neck and there is a dense opacity in the medial aspect of the right lower lobe. CXR lateral (above right) shows the round object to be in the esophagus posterior to the airway and there is a loop of bowel coursing up from the abdomen to the chest anterior to the heart. Axial (below left) and sagittal (below right) CT without contrast of the chest shows the loop of bowel anterior and medial in location in the right chest to have haustra and therefore to be colon.

The diagnosis was a gastrointestinal foreign body in the form of a button battery in the esophagus in a patient who also had a Morgagni hernia.

Teenager with abdominal pain

US and MRI of focal nodular hyperplasia — Transverse US of the liver (above left) shows a round hyperechoic lesion in the liver. Coronal T2 MRI without contrast of the abdomen (above right) shows the lesion in the right lobe of the liver to have slightly increased signal intensity aside from the center of the lesion which has high signal intensity. Axial T1 MRI with contrast of the abdomen obtained in early phase imaging (below left) shows near uniform enhancement of the lesion aside from the center of the lesion while delayed phase imaging (below right) shows delayed stellate-like enhancement of the center of the lesion while the rest of the lesion is now isointense to liver.

The diagnosis was focal nodular hyperplasia.

School ager with cystic fibrosis and abdominal pain

CT of cystic fibrosis causing liver cirrhosis and pancreatic insufficiency — Coronal CT with contrast of the abdomen (above) shows a marked nodular contour to the liver and multiple dilated veins around the spleen. Coronal CT with contrast of the abdomen (below) shows diffuse fatty replacement of the pancreas.

The diagnosis was cystic fibrosis causing cirrhosis of the liver and esophageal varices and cystic fibrosis causing pancreatic insufficiency.

Newborn with difficulty feeding

Upper GI of congenital esophageal stenosis — CXR (left) shows a dilated air-filled structure just to the right of the spine. AP (middle) and lateral (right) images from an upper GI exam show two fixed focal areas of narrowing in the distal esophagus causing dilation of the esophagus proximal to those areas of narrowing.

The diagnosis was congenital esophageal stenosis.

Teenager with chronic neurologic impairment who has fever and constipation

CT of stercoral colitis — Axial CT with contrast of the abdomen (above) shows marked diffuse wall thickening and mucosal enhancement of the transverse colon. Wall thickening and mucosal enhancement is also present but less pronounced in the descending colon on the coronal CT (below left) and rectum (below right). The colon is filled with a marked amount of stool from the cecum to the rectum.

The diagnosis was a marked amount of chronic constipation resulting in stercoral colitis.

Toddler who was seen to swallow something

AXR of gastrointestinal foreign body in the form of ingested rare earth magnets — AXR AP shows 13 small round radiopaque objects that are joined together in a chain.

The diagnosis was gastrointestinal foreign body in the form of a chain of rare earth magnets.

Immune suppressed patient with odynophagia

UpperGI of candida esophagitis — AP images from an UpperGI show multiple longitudinally oriented lesions in the under-distended esophagus which are separated by normal mucosa and small round ulcers.

The diagnosis was candida esophagitis.

Preschooler with anemia and a palpable epigastric mass

CT of trichobezoar — Coronal (above) and axial (below) CT with contrast of the abdomen show the stomach distended by a large mass that has a swirled appearance and that fills the entire stomach and the duodenal bulb.

The diagnosis was trichobezoar that after removal was found to have caused a gastric ulcer which eroded into the liver.

Teenager with no history of esophageal surgery who is having repeated food bolus impactions in the esophagus

CT and upper GI of eosinophilic esophagitis — Axial CT without contrast of the chest (above) shows posterior to the trachea a dilated proximal esophagus due to food being impacted within it. AP (below left) and lateral (below right) images from an upper GI exam after the food bolus was removed from the esophagus show multiple ring-like narrowings encircling the proximal esophagus. The remainder of the esophagus was unremarkable.

The diagnosis was eosinophilic esophagitis.

Infant with failure to thrive

AXR and upper GI of annular pancreas — Left lateral decubitus AXR (above left) shows an air filled duodenal bulb and an air filled stomach (double bubble sign) with some distal bowel gas. Transverse US of the pylorus (below left) shows from left to right a fluid filled duodenal bulb, normal pylorus, and fluid filled stomach (double bubble sign). AP image from an upper GI exam (below right) shows a distended stomach and duodenal bulb with the remainder of the duodenal C-loop having a normal caliber.

The diagnosis was annular pancreas.https://pediatricimaging.org/diseases/annular-pancreas/

Teenager with substernal dysphagia

Upper GI of achalasia — Three lateral images from an upper GI exam shows dilation of the proximal esophagus which narrows to a beak distally which never opens up. A barium pill would not pass through the distal esophagus into the stomach.

The diagnosis was achalasia.

Preschooler after acid ingestion

Upper GI of gastritis due to acid ingestion — AP image from an upper GI exam shows a very distended stomach with a large air fluid level within it. Gastric emptying was extremely slow due to marked narrowing of the gastric antrum caused by gastritis. The esophagus was normal in appearance

The diagnosis was corrosive gastritis due to acid ingestion causing gastric outlet obstruction.

Preschooler with nausea and vomiting who had a congenital diaphragmatic hernia repaired 4 years ago

AXR of small bowel obstruction due to abdominal adhesions — AXR supine (left) shows multiple dilated loops of small bowel that have a stacked appearance. AXR upright (right) shows multiple air fluid levels within those loops of small bowel.

The diagnosis was abdominal adhesions from the prior surgery causing a distal closed loop small bowel obstruction.

Teenager with bloody stools

Enema of ulcerative colitis — AP image from an enema shows narrowing of the descending colon which was persistent along with fine mucosal ulcerations in the descending colon.

The diagnosis was ulcerative colitis.

Preschooler with bilious vomiting

Upper GI of malrotation with midgut volvulus — AP image from an upper GI exam shows that while the duodenal jejunal junction projects over the left pedicle of the spine, it is beneath the level of the duodenal bulb and thus is low in position.

The diagnosis was malrotation with midgut volvulus.

Infant after nasogastric tube placement

The diagnosis was nasogastric tube malfunction due to the tip of the nasogastric tube being transpyloric in position.

Teenager with imperforate anus at birth

The diagnosis was VACTERL association with radial ray hypoplasia.

Infant who cannot be fed through their feeding tube

Radiograph of kinked feeding tube — AXR AP shows the tip of the feeding tube to be at the duodenal-jejunal junction. In the antrum of the stomach the feeding tube is curled back upon itself and kinked at this location.

The diagnosis was feeding tube malfunction due to a kink in the feeding tube.

Newborn with an imperforate anus

Radiograph of VACTERL association with vertebral body anomalies — AP radiograph of the spine (left) shows multiple segmentation anomalies in the sacrum. Sagittal US of the left kidney (above right) is unremarkable while sagittal US of the right renal fossa (below right) shows a prominent right adrenal gland and absence of the right kidney.

The diagnosis was VACTERL association with vertebral body anomalies and agenesis of the right kidney.

Infant after nasogastric tube placement

CXR of transpyloric placement of nasogastric tube — CXR AP shows the tip of the nasogastric tube projects over the second portion of the duodenum.

The diagnosis was nasogastric tube malfunction due to transpyloric placement of the tip of the nasogastric tube.

School ager with abdominal pain

CT of solid pseudopapillary tumor of the pancreas — Axial CT with contrast of the abdomen (left) shows a large cystic mass arising from the inferior aspect of the head of the pancreas which is better appreciated on the coronal CT (right) which also demonstrates a claw sign around the mass. There is no evidence of pancreatitis.

The diagnosis was solid pseudopapillary tumor of the pancreas which was necrotic.

Preschooler after feeding tube placement

AXR of normal position of the tip of the feeding tube in the proximal jejunum — AXR AP shows a feeding tube that appears to loop back upon itself within the stomach before it exits through the pylorus and courses through the duodenum with its tip in the proximal jejunum.

The diagnosis was normal position of the tip of the feeding tube in the proximal jejunum.