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.

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.

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 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.

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.