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.

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.