Newborn with failure to pass meconium and bilious vomiting

Enema of meconium plug syndrome — AP image from a contrast enema exam (left) shows a long filling defect in the colon within a normal caliber colon. The cecum was noted to be in the left mid abdomen. The terminal ileum was not refluxed. AP image from an upper GI exam (right) shows that while the duodenal jejunal junction projects over the left pedicle of the spine it is much lower in position than the duodenal bulb.

The diagnosis was malrotation without midgut volvulus in a patient with meconium plug syndrome.

Toddler with 4 days of abdominal pain and feculent vomiting

US and radiograph and air enema of ileocolic intussusception caused by Meckel diverticulum — Transverse US of the right lower quadrant (above) shows a round structure with a hyperechoic center and a hypoechoic rim (target sign). AXR supine (below left) shows multiple dilated loops of air-filled small bowel. Final AP image from an air enema exam (below right) shows an air filled colon with a large oval soft tissue mass in the cecum.

The diagnosis was an ileocolic intussusception resulting in a distal small bowel obstruction. The ileocolic intussusception could not reduced by air enema and at surgery the lead point for the ileocolic intussusception was found to be a Meckel diverticulum.

School ager with abdominal pain

CT and US of target sign and pseudokidney sign in ileocolic intussusception — Axial CT with contrast of the abdomen (above left) shows a mass involving the ascending colon which has a target sign appearance which on sagittal CT (above right) has a pseudokidney appearance. Transverse US of the ascending colon mass (below left) again demonstrates a target sign while the sagittal US of the mass (below right) again demonstrates a pseudokidney sign.

The diagnosis was ileocolic intussusception due to lymphoid hyperplasia with the lead point of the intussusception being mesenteric lymph nodes.

School ager with abdominal pain who just had a cardiac arrest

CT of Meckel diverticulum causing distal small obstruction due to small bowel volvulus around the Meckel diverticulum resulting in a closed loop obstruction and small bowel ischemia of the ileum and pneumatosis intestinalis from necrosis in the ileum — AXR AP (above left) shows multiple dilated loops of small bowel and a decomopressed colon. Coronal CT with contrast of the abdomen (above right) shows normal caliber and normal enhancement of the proximal jejunum loops in the left upper quadrant. The distal ileum loops in the right lower quadrant are dilated and do not enhance. There is pneumatosis intestinalis in the walls of the most lateral loop of ileum. Axial CT (below) again shows the pneumatosis in the walls of the most lateral loop of ileum on the right and again shows the difference in bowel wall enhancement between the normal jejunum on the left and the abnormal ileum on the right.

The diagnosis was Meckel diverticulum causing distal small obstruction due to small bowel volvulus around the Meckel diverticulum resulting in a closed loop obstruction and small bowel ischemia of the ileum and pneumatosis intestinalis from necrosis in the ileum.

Preschooler with recurrent abdominal pain

CT and US of recurrent ileocolic intussusception caused by juvenile polyps — Axial CT with contrast of the abdomen (above) at initial presentation shows a large round soft tissue mass in the region of the ascending colon that has alternating circles of soft tissue density and fat density which give it a target sign appearance. Transverse US of the abdomen obtained two weeks later (below) shows recurrence of a nearly identical appearing soft tissue mass in the region of the ascending colon that has alternating circles of decreased and increased echogenicity giving it a target sign appearance.

The diagnosis was initially ileocolic intussusception which had been reduced successfully but had recurred two weeks later and which again was reduced successfully. Surgical exploration subsequently revealed multiple juvenile polyps acting as the lead point for the recurrent ileocolic intussusception.

Teenager who swallowed a foreign body

AXR of chain necklace gastrointestinal foreign body — AXR AP (above) shows a radiopaque foreign body in the cecum. Endoscopic image (below left) shows the foreign body within the cecum. Gross pathological image (below right) shows the foreign body to be a chain necklace.

The diagnosis was gastrointestinal foreign body.

Preschooler status post esophageal atresia repair who now acutely cannot handle secretions and is having a sensation of choking

Upper GI of gastrointestinal foreign body impacted in the esophagus of a patient post repair of esophageal atresia — AP (above left) and lateral (above right) images from an esophagram show a large, irregular filling defect in the proximal esophagus that is both above and below the waist in the esophagus that is the site of the esophageal anastomosis. The patient underwent endoscopy and the surgical image (below) shows a ball of paper that was removed from the patient’s esophagus.

The diagnosis was gastrointestinal foreign body impacted in the esophagus of a patient post repair of esophageal atresia.

School ager with abdominal pain

CT of Meckel diverticulum causing small bowel volvulus and a closed loop obstruction resulting in small bowel ischemia — Coronal (above left) CT with contrast of the abdomen shows in the center just above the bladder a C-shaped dilated small bowel loop with a thickened wall that is not enhancing. On the sagittal image (above right) the dilated, thickened and nonenhancing small bowel loop is seen anteriorly in the abdomen and superior to the bladder. On the axial image (below) the small bowel loop is in the center of the pelvis.

The diagnosis was Meckel diverticulum causing small bowel volvulus and a closed loop obstruction resulting in small bowel ischemia.

Toddler with dysphagia

Normal fluoroscopic appearance of the esophagus — AP and lateral radiographs from an upper GI exam shows normal caliber of the esophagus with no extrinsic compressions on it. The esophageal mucosa is normal appearing.

The diagnosis was normal fluoroscopic appearance of the esophagus.

School ager with chronic vomiting

Normal fluoroscopic appearance of stomach, duodenum, jejunum, ileum and colon — AP image from a small bowel follow through exam shows contrast in the stomach, small bowel, and ascending colon. The stomach is noted to normal appearing gastric rugae. The dudodenal bulb is well distended. The duodenal jejunal junction (ligament of Treitz) projects over the left pedicle of the spine at T12. The normal appearing jejunum (on the left side of the abdomen) has a feathery appearance. Compared to the normal appearing ileum (on the right side of the abdomen) the jejunum has a greater caliber and has thicker and more numerous folds than the ileum. The haustra of the cecum and ascending colon are normal in appearance.

The diagnosis was normal fluoroscopic appearance of the stomach and duodenum and jejunum and ileum and colon.

Teenager with abdominal pain after liver biopsy

US of hemobilia — Transverse (above) and sagittal (below) US of the gallbladder show it to be diffusely filled with echogenic material.

The diagnosis was hemobilia as a complication from liver biopsy.

Toddler who had a renal transplant 3 days ago and who now has abdominal distension

US of gallbladder hydrops — Transverse (above) and sagittal (below) US of the liver shows an extremely dilated gallbladder that is filled with anechoic fluid. Ascites is also present inferior to the liver on the sagittal image.

The diagnosis was gallbladder hydrops.

Teenager with periumbilical abdominal pain

HIDA exam and MRCP of gallbladder agenesis — Serial AP images from a hepatobiliary scintigraphy exam (above) show good uptake of radiotracer in the liver and subsequent good excretion of radiotracer into the small bowel via the biliary system. The gallbladder was not visualized. 3D MIP image from a MCRP exam (below) shows a normal appearing intra and extrahepatic biliary tree. The gallbladder was not visualized.

The diagnosis was gallbladder agenesis.

Newborn with a loopy abdomen

AXR and enema of jejunal atresia

The diagnosis was jejunal atresia.

Newborn who suffered a profound hypoxic event after being discharged home

AXR of bowel perforation — AXR AP (above) shows a large oval lucency in the midline of the upper abdomen. Cross table lateral AXR (below) shows a large amount of air between the abdominal wall and the liver. There is also air outlining both sides of the bowel wall of a loop of bowel (Rigler’s sign).

The diagnosis was pneumoperitoneum due to small bowel perforation due to bowel ischemia from the hypoxic event.

Newborn with a liver lesion on prenatal ultrasound

US of simple hepatic cyst — Sagittal (left) and transverse (right) US of the liver shows a well-circumscribed, round, anechoic lesion in the right lobe of the liver.

The diagnosis was simple hepatic cyst.

School ager with low albumin levels

Small bowel follow through of hypoalbuminemia — AP image from early in a small bowel follow through exam with contrast filling the jejunum shows regular and smooth diffuse thickening of the small bowel folds in the jejunum.

The diagnosis was hypoalbuminemia.

Teenager with abdominal pain

CT of simple splenic cyst — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen shows a very large, thin walled, low density, non-septated lesion with undulating contours in the spleen.

The diagnosis was a simple splenic cyst.

Teenager with malabsorption

Small bowel follow through of tropical sprue — AP image from late in a small bowel follow through exam shows small bowel dilatation and jejunoileal fold pattern reversal in which the loops of jejunum in the center of the image resemble loops of ileum.

The diagnosis was sprue.

Teenager with post prandial epigastric pain

CT of median arcuate ligament syndrome — Sagittal MIP (left) and 3D (right) CT with contrast of the abdomen in the venous phase obtained in expiration shows focal narrowing of the superior aspect of the proximal celiac trunk resulting in it having a hooked or J appearance with the absence of associated atherosclerosis.

The diagnosis was median arcuate ligament syndrome.

Preschooler who had Wilms tumor in the left kidney treated with radiation a year ago with difficulty stooling

Barium enema of radiation induced enteritis of colon — AP image from an enema shows a fixed narrowing of the descending colon from the splenic flexure to the sigmoid colon with dilation of the colon proximal to it. The extremely dilated cecum is in the midline of the pelvis.

The diagnosis was radiation induced enteritis involving the descending colon in a patient with Wilms tumor.

Teenager with a large body mass index and elevated liver transaminases

US of hepatic steatosis — Sagittal US of the liver shows diffusely increased echogenicity of the liver parenchyma, especially when compared to the echogenicity of the parenchyma of the right kidney.

The diagnosis was hepatic steatosis.

Schoolager with vomiting after recent radiation therapy

Small bowel follow through of acute radiation enteritis — AP image from a small bowel follow through exam shows diffuse luminal narrowing of the distal jejunum and proximal ileum in the center of the image.

The diagnosis was acute radiation induced enteritis.

School ager with right lower quadrant pain

CT of mesenteric adenitis — Coronal CT with contrast of the abdomen (left) shows an air-filled appendix of normal diameter in the middle of the image just beneath the bifurcation of the iliac vessels. There are also multiple enlarged lymph nodes present throughout the mesentery, particularly in the left upper quadrant (right).

The diagnosis was mesenteric adenitis.

Infant with projectile vomiting

US of a normal pylorus muscle — Sagittal US of the pylorus shows the pylorus muscle is not thickened (above left) and is not lengthened (below left) while transverse US of the pylorus (right) again shows the pylorus muscle to not be thickened.

The diagnosis was a normal pylorus muscle