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.

School ager with abdominal pain and emesis

US of Meckel diverticulum — Transverse US of the abdomen (below) shows a non-peristalsing cystic lesion in the center of the image superiorly. Transverse US (above) shows a dilated loop of small bowel with an air-fluid level within it.

The diagnosis was Meckel diverticulum with a band of tissue coming off of it causing a small bowel volvulus and closed loop bowel obstruction resulting in small bowel ischemia.

Teenager developing a large body mass index due to steroid use who is having problems with their gastrostomy tube feedings

Fluoroscopy of gastrostomy tube tip inside its tract and outside of the stomach — Lateral image of the abdomen is obtained during injection of the gastrostomy tube shows that the gastrostomy tube balloon is outside of the stomach and contrast is flowing along the gastrostomy tube track into the stomach.

The diagnosis was gastrostomy tube malfunction due to the gastrostomy tube being pulled back along its tract as the patient’s body mass index increased and the gastrostomy tube was too short.

Newborn with a cystic right adnexal mass on prenatal US

US of ileal duplication — Transverse (above) and sagittal (below) US of the abdomen shows a cystic lesion with septations that has a hyperechoic inner rim (echogenic rim sign).

The diagnosis was ileal duplication.

Toddler with problems feeding through the jejunostomy port of their gastrojejunostomy tube

Fluoroscopic study of jejunostomy tube tip migration into stomach — AXR (above) shows the tip of the jejunostomy tube projects over the body of the stomach. AP (below left) and lateral (below right) images obtained after injecting water soluble contrast through the jejunostomy port of the gastrojejunostomy tube shows contrast outlining the rugae of the stomach. There is no contrast in the duodenum or jejunum.

The diagnosis was gastrojejunostomy tube malfunction with the tip of the jejunostomy tube having been pulled back into the stomach.

Infant with bilious vomiting

Upper GI of malrotation with midgut volvulus — AP images from an upper GI exam with the duodenum collapsed (above) and distended (below) show the duodenal jejunal junction to lie over the left pedicle of the spine but to be below the level of the duodenal bulb. The proximal jejunum is in the right upper quadrant.

The diagnosis was malrotation with midgut volvulus.

Infant who is having difficulty being fed through their feeding tube

AXR of kink in feeding tube — AXR AP shows the tip of the nasogastric tube to be in the body of the stomach. The tip of the feeding tube is transpyloric in position at the duodenal jeujunal junction. However, the feeding tube lumen is kinked in the body of the stomach.

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

Newborn vomiting up their feeds

AXR of jejunal atresia — AXR AP shows extreme dilation of the stomach to the left of the spine, the duodenum to the right of the spine and a loop of proximal jejunum inferior to the stomach and to the left of the spine – a triple bubble sign.

The diagnosis was jejunal atresia.

Toddler after nasogastric tube placement

AXR of transpyloric nasogastric tube — CXR AP shows the tip of the nasogastric tube to project near the ligament of Treitz.

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

School ager with abdominal pain

CT of enlarged but normal appendix in cystic fibrosis — Axial CT with contrast of the abdomen (above left) shows a low density liver due to fatty infiltration and a low density pancreas with calcifications that has a round low density fluid collection near the pancreatic head. The appendix in the right lower quadrant posterior to the cecum is dilated in diameter up to 10 mm but has no periappendiceal inflammation (above right and below). There is stool mixed with air in the terminal ileum medial to the cecum (above right and below).

The diagnosis was fatty infiltration of the liver, acute pancreatitis with pseudocyst and chronic pancreatitis, distal intestinal obstruction syndrome, and normal appearance of the appendix in a patient with cystic fibrosis.

Teenager with left lower quadrant pain

CT of gastrostomy tube tip in subcutaneous tissues — Axial (above left) and sagittal (above right) CT with contrast of the abdomen shows the anchoring balloon and tip of the gastrostomy tube are in the subcutaneous tissues of the anterior abdominal wall rather than in the stomach. Lateral image from an injection of the gastrostomy tube (below) shows contrast flowing through the gastrostomy tube track and entering the stomach. Again, the gastrostomy tube anchoring balloon and tip of the gastrostomy tube are not in the stomach.

The diagnosis was gastrostomy tube malfunction with migration of the gastrostomy tube tip out of the stomach.

Preschooler after an alkaline (lye) ingestion

UpperGI of corrosive esophagitis due to lye ingestion — Lateral image from an upper GI exam obtained 2 weeks after the ingestion (left) shows mild esophageal ulceration and atony of the esophagus. Lateral image from an upper GI exam obtained 4 weeks after the ingestion (right) shows multiple stricture in the mid and distal esophagus.

The diagnosis was corrosive esophagitis due to an alkaline (lye) ingestion.

School ager with long standing dysphagia and no other significant history

Upper GI of congenital esophageal stenosis — AP (left) and lateral (right) images from an upper GI exam show a fixed, smoothly tapered, concentric, long narrowing of the esophageal lumen of the mid to distal esophagus.

The diagnosis was congenital esophageal stenosis.

Toddler after feeding tube placement

CXR of feeding tube tip malposition in the cervical esophagus — CXR AP shows a feeding tube which courses into the stomach and then loops back upon itself and reenters the esophagus and whose tip lies at the level of C6.

The diagnosis was feeding tube malfunction with malposition of the feeding tube tip in the cervical esophagus.

School ager who 6 years ago had massive hilar lymphadenopathy which eventually resolved with new cough and fever

CXR and CT of recurrent pulmonary fungal infection in chronic granulomatous disease — CXR AP and lateral (above) shows massive bilateral hilar lymphadenopathy and bilateral multiple small lung nodules. Axial CT with contrast of the chest in soft tissue (below left) and lung (below right) windows shows the lymphadenopathy and lung nodules to contain punctate calcifications.

The diagnosis was recurrent pulmonary fungal infection in a patient with chronic granulomatous disease.

Premature newborn after replacement of a nasogastric tube

CXR of a nasogastric tube that has perforated out of the esophagus into the right upper quadrant of the abdomen — Baseline CXR AP (left) shows the tip of the nasogastric tube to project appropriately over the body of the stomach. CXR AP after nasogastric tube replacement (right) shows the tip of the feeding tube to project over the right upper quadrant of the abdomen.

The diagnosis was nasogastric tube malfunction with the tip of the nasogastric tube placed outside the stomach.

School ager with abdominal pain

Small bowel followthrough of Crohn disease — Spot image from an upper GI small bowel followthrough exam (left) shows a long segment of ileum on the right of the image that has lost its normal folds, is narrowed in caliber, and has a cobblestone appearance. Spot image of the terminal ileum (right) shows it also lacks its normal folds and is narrowed in caliber. Inflammatory changes are also noted in the cecum.

The diagnosis was Crohn disease affecting the distal ileum and terminal ileum.

Toddler after a gastrostomy tube change

Fluoroscopy of gastrostomy tube tip in peritoneal cavity — AP radiograph of the abdomen after injection of water soluble contrast through the gastrostomy tube shows contrast outlining the spleen and several loops of small bowel. There is no contrast in the stomach.

The diagnosis was gastrostomy tube malfunction with the tip of the gastrostomy tube in the peritoneal cavity.

School ager with fevers who is 1 week postop from surgery for perforated appendicitis

CT of abdominal abscesses — Axial CT with contrast of the abdomen and pelvis shows low density fluid collections with enhancing rims anterior to the spleen (above), in the right pelvis (middle) and posterior to the bladder and anterior to the rectum (below).

The diagnosis was perisplenic, pelvic, and perirectal abdominal abscesses due to perforated appendicitis.

Teenager whose gastrostomy jejunostomy tube was replaced with difficulty 1 day before and now has abdominal pain and pneumoperitoneum on AXR

Jejunostomy tube injection showing jejunostomy tube tip is in peritoneum. — AP image obtained after injection of contrast through the jejunostomy port shows that contrast is not in the jejunum and instead is in the peritoneum.

The diagnosis was gastrostomy jejunostomy tube malposition in the form of the jejunostomy tube tip being in the peritoneal cavity.

Infant with vomiting after feeding

UGI of gastroesophageal reflux — AP sequential images from an upper GI exam show contrast flowing in a retrograde manner from the stomach back up into the esophagus, reaching ultimately the level of the thoracic inlet (not shown).

The diagnosis was a moderate to marked amount of gastroesophageal reflux.

Infant whose feeding tube cannot be flushed and fed through

CXR of aneurysmal dilation of feeding tube — CXR AP shows a feeding tube with its tip projecting over the proximal jejunum. Incidentally noted is an aneurysmal dilation of the feeding tube just beneath the level of the thoracic inlet.

The diagnosis was feeding tube malfunction due to aneurysmal dilation of its proximal portion.