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

AXR of pediatric nasogastric tube being transpyloric in position — CXR AP shows the tip of the nasogastric tube to be in the third portion of the duodenum.

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

Teenager with imperforate anus at birth

Radiograph of radial ray hypoplasia due to VACTERL association — AP radiograph of the hand shows absence of the first digit and hypoplasia of the trapezium, scaphoid and distal radius.

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.

Newborn on continuous positive airway pressure with a distended abdomen

AXR of aerophagia due to CPAP — AXR AP shows multiple dilated loops of bowel throughout the abdomen. The nasogastric tube tip projects over the body of the stomach.

The diagnosis was aerophagia due to continuous positive airway pressure.

Infant after nasogastric tube placement

CXR of nasogastric tube in right mainstem bronchus — CXR AP shows a tracheostomy tube in normal position and a nasogastric tube whose tip is in the right lower lobe.

The diagnosis was nasogastric tube malfunction due to placement of the nasogastric tube into the trachea and right mainstem bronchus.

Infant with gastroschisis that suffered complete small bowel necrosis due to ischemia

Enema of short bowel syndrome — AP image from an enema shows contrast initially filling the rectum (inferiorly) which is then seen to flow into the transverse colon (to the left) which then flows into the duodeum (in the middle) before it flows into the stomach (to the right).

The diagnosis was short bowel syndrome with the duodenum anastomosed to the transverse colon.

Infant after feeding tube placement

AXR of feeding tube in appropriate position in the proximal jejunum — AXR AP shows the tip of the nasogastric tube is in the stomach. The tip of the feeding tube is seen to cross the midline through the pylorus, descend through the duodenum, and then course through the proximal jejunum.

The diagnosis was correct position of the feeding tube.

Teenager who had received radiation therapy for Wilms tumor

UGI and SBFT of radiation induced enteritis — AP image from an upper GI and small bowel follow through exam shows mild thickening of the small bowel folds throughout the jejunum (stack of coins sign).

The diagnosis was mild radiation induced enteritis.

Asymptomatic young adult 12 hours after placement of a nasogastric tube during cardiac surgery whose position was not checked after placement

CXR of nasogastric tube tip in the left mainstem bronchus — CXR AP shows the tip of the nasogastric tube to be in the left mainstem bronchus.

The diagnosis was nasogastric tube malfunction with the tip of the nasogastric tube in the left mainstem bronchus.

Toddler with cavernous transformation of the portal vein

Upper GI of esophageal varices in portal hypertension — AP (left) and lateral (right) images of the esophagus from an upper GI exam show multiple longitudinal luminal filling defects in the distal esophagus representing esophageal varices.

The diagnosis was esophageal varies due to portal hypertension.

Young adult who is coughing after feeding tube placement

AXR of feeding tube tip in the left mainstem bronchus — Initial AXR (left) shows the tip of the feeding tube in the left mainstem bronchus. Subsequent AXR after feeding tube repositioning (right) shows the feeding tube tip to be in the fundus of the stomach.

The diagnosis was feeding tube malfunction with the feeding tube tip in the left mainstem bronchus.

Toddler who had a Nissen fundoplication for gastroesophageal reflux a year ago who is now retching with feeding

Upper GI of para-Nissen herniation — AP (left) and lateral (right) images from an upper GI exam show the Nissen fundoplication wrap to be intact around the fundus of the stomach. However, part of the stomach has herniated above the level of the wrap.

The diagnosis was Nissen fundoplication malfunction in the form of a para-Nissen herniation.

Newborn with abdominal distension after nasogastric tube placement

CXR of nasogastric tube curled back upon itself in the esophagus — CXR AP shows a nasogastric tube curling back upon itself within the esophagus with the tip of the nasogastric tube located above the thoracic inlet.

The diagnosis was nasogastric tube malfunction with the nasogastric tube curled in the esophagus.