School ager with hypoproteinemia

Upper GI and small bowel follow through of Menetrier disease — AP image from an upper GI and small bowel follow through exam shows markedly enlarged gastric folds in the fundus and body of stomach especially along greater curvature, with sparing of the antrum. The barium is slightly diluted in the jejunum and ileum.

The diagnosis was Menetrier disease.

School ager with right lower quadrant pain

CT of epiploic appendagitis — Coronal (above left and above middle) and sagittal (above right) CT with contrast of the abdomen shows a fat-density ovoid lesion adjacent to the ascending colon with a thin high-density rim and surrounding inflammatory fat stranding and mild colonic wall thickening. The axial CT (below) shows the lesion to have a central hyperdense dot.

The diagnosis was epiploic appendagitis.

Teenager with abdominal pain after eating with remote history of radiation therapy to abdomen

Small bowel follow through of chronic intestinal ischemia — AP image from an upper GI and small bowel follow through exam shows marked thickening of the small bowel folds throughout the jejunum (stack of coins sign).

The diagnosis was chronic small bowel ischemia secondary to chronic radiation induced enteritis.

Teenager with autoimmune hemolytic anemia who has had multiple blood transfusions

CT of hemosiderosis — Axial CT without contrast of the abdomen shows a marked homogeneous increase in liver density which is making the portal veins and hepatic veins appear to be low attenuation in comparison to the liver.

The diagnosis was hemosiderosis.

Teenager post cardiac arrest 1 day ago who had pneumomediastinum on an immediate post resuscitation CXR

AXR of pneumoretroperitoneum — AXR (above) shows air outlining the right kidney and the inferior part of the liver. AXR (below) shows air outlining the ascending and descending colon and bladder.

The diagnosis was pneumoretroperitoneum.

Teenager with hyperinsulinemia and hypoglycemia

MRI of insulinoma — Axial T1 MRI without contrast of the abdomen (above left) shows a small, oval low signal intensity lesion in the tail of the pancreas which is nestled in the splenic hilum. The lesion is high signal intensity on the T2 MRI (above right). T1 MRI with contast in arterial (below left) and venous (below right) phases shows the lesion to fill in over time.

The diagnosis was insulinoma.

Toddler with abdominal pain

AXR of ileus — AXR supine (left) shows the stomach and small bowel and colon to be air filled and dilated to the level of the rectum. AXR upright (right) shows multiple air fluid levels in the small bowel and colon.

The diagnosis was ileus.

Teenager with abdominal pain and increased WBC and CRP

CT of splenic volvulus — Axial CT with contrast of the upper abdomen in the portal venous phase (above left) shows the spleen is absent from the left upper quadrant and is instead seen in the midline of the pelvis (above right). Coronal (below left) and sagittal (below right) CT in the delayed phase show the spleen to be in the midline of the pelvis above the bladder. The splenic vascular pedicle had a whirlpool appearance (not provided).

The diagnosis was splenic volvulus.

Newborn with respiratory distress

UGI of esophagotrachea — CXR AP (left) shows the endotracheal rube tip in the midline to be low in position while the nasogastric tube tip projecting to the left of it is high in position. AP image from an esophagram obtained after the nasogastric tube had been advanced into the distal esophagus (above right) shows simultaneous opacification of the trachea in the midline and the bilateral mainstem bronchi along with esophagus to the left of the trachea. Lateral image from the esophagram (below right) shows the communication between the esophagus and trachea to be long in length.

The diagnosis was esophagotrachea.

Teenager with diarrhea and emesis

CT of salmonella colitis — Axial CT with contrast of the abdomen shows marked thickening of the ascending colon along with multiple enlarged lymph nodes in the right lower quadrant.

The diagnosis was salmonella colitis.

Preschooler with chronic cough

CXR and Upper GI of esophageal bronchus — CXR AP (left) shows near complete opacification of the left hemithorax with mediastinal shift to the left. AP image from an esophagram (right) shows a fistulous connection from the esophagus to the left mainstem bronchus.

The diagnosis was esophageal bronchus.

School ager with hypersplenism

Angiogram of splenomegaly — AP image from a splenic angiogram (left) shows an extremely enlarged spleen. AP image from a splenic angiogram obtained after embolization with polyvinyl alcohol 250 to 350 micron particles (right) shows the spleen to be reduced in size by 75%.

The diagnosis was splenomegaly treated with partial splenectomy via embolization.

Infant with vomiting

Upper GI of gastric antral web — AP image from an upper GI exam shows a persistent thin vertical filling defect which encircles the gastric antrum and causes mild persistent narrowing of the gastric antrum.

The diagnosis was gastric antral web.

Teenager with abdominal pain and bloody diarrhea

AXR of thumbprinting in ulcerative colitis — AXR shows thumbprinting throughout the transverse colon.

The diagnosis was ulcerative colitis.

School ager with right lower quadrant pain

CT of omental torsion — Axial CT with contrast of the abdomen shows a right-sided, round, low density inflammatory mass that is anteromedial to the liver, adherent to the anterior abdominal wall, connected to the omentum, with a target-sign appearance (on the image below).

The diagnosis was omental torsion.

Teenager with abdominal pain

CT of Budd Chiari syndrome — Axial (above) and coronal (below left) CT with contrast of the abdomen in the portal venous phase show heterogenous enhancement of the liver due to hepatic congestion. Coronal CT MIP (below right) suggests a narrowing of the inferior vena cava just below the cavoatrial junction. US (not provided) showed a web at this level in the inferior vena cava and a thrombus in the left hepatic vein.

The diagnosis was Budd Chiari syndrome.

Teenager with jaundice and ulcerative colitis

ERCP of primary sclerosing cholangitis — AP image from an ERCP exam shows a beaded appearance to the biliary tree with multiple strictures causing multiple focal dilations of the biliary ducts. Overall, there is a pruned appearance to the intrahepatic biliary tree.

The diagnosis was primary sclerosing cholangitis.

School ager with a stomach ache

US and CT of undifferentiated embryonal sarcoma of the liver — Transverse US of the liver (above) shows a large heterogenous mass in the right lobe of the liver that is primarily hyperechoic in appearance, with multiple hypoechoic regions within it. Axial CT with contrast of the abdomen in the portal venous phase (below left) shows a large lesion in the right lobe of the liver with peripheral vascular enhancement. Coronal image in the delayed phase (below right) shows the mass to have a primarily necrotic center.

The diagnosis was undifferentiated embryonal sarcoma of the liver.

School ager with dysphagia

Esophagram showing esophageal stricture due to epidermolysis bullosa — AP (left) and lateral (right) images from an esophagram show a persistent long narrowing in the mid esophagus.

The diagnosis was an esophageal stricture due to epidermolysis bullosa.

Newborn with hypoxic ischemic encephalopathy

CXR of esophageal temperature probe tip too low in position in the stomach — CXR AP shows a nasogastric tube coursing in the esophagus with its tip in the body of the stomach. The twisted wire probe coursing next to the nasogastric tube with its tip in the body of the stomach represents an esophageal temperature probe. Another twisted wire temperature probe is present in the left axilla.

The diagnosis was esophageal temperature probe malfunction with the tip positioned too low in the stomach in a patient with hypoxic ischemic encephalopathy.

Newborn with hypoxic ischemic encephalopathy who is undergoing cooling

CXR of esophageal temperature probe in correct position — CXR AP shows a nasogastric tube coursing in the esophagus with its tip in the body of the stomach. The twisted wire probe coursing next to it with its tip in the mid-to-distal esophagus represents an esophageal temperature probe. Another twisted wire temperature probe is present in the left axilla.

The diagnosis was esophageal temperature probe in a correct position in a patient with hypoxic ischemic encephalopathy.

Teenager with heartburn

CXR of esophageal pH probe malposition — CXR AP shows an esophageal pH probe. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque dot in the center of it) is at the gastroesophageal junction.

The diagnosis was esophageal pH probe malfunction with the pH probe sensor being too low in position.

Teenager with symptoms of gastroesophageal reflux

CXR of correct position of the esophageal pH probe sensor / measurement lead — CXR AP shows an esophageal pH probe. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque stripe in the center of it) is 3-5 cm above the gastroesophageal junction.

1 month old with gastroesophageal reflux

CXR of correct position of esophageal pH probe sensor / measurement lead — CXR AP shows the tip of the nasogastric tube to be in the stomach. The position of the esophageal pH probe sensor / measurement lead (the radiolucent cylinder with the radiopaque stripe in the center of it) is 3-5 cm above the gastroesophageal junction.

The diagnosis was correct position of the esophageal pH probe sensor / measurement lead.

School ager who just had his cecostomy tube exchanged

Cecostomy tube injection showing cecostomy tube in the correct position in the cecum — AXR AP (left) shows the coiled cecostomy tube tip projecting over the right lower quadrant over what appears to be the cecum. AP image obtained after injecting the cecostomy tube with water-soluble contrast (right) shows the cecostomy tube tip is located in the cecum.

The diagnosis was normal position of the cecostomy tube in the cecum.