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.

School ager who is immune suppressed with difficulty swallowing

UGI of candida esophagitis — Higher (left) and lower (right) AP images of the esophagus from an upper GI exam show there to be throughout the esophagus longitudinally oriented linear lesions which are separated by normal mucosa and small round ulcers.

The diagnosis was candida esophagitis.

Teenager who had a difficult cecostomy tube exchange and now has pain with use of the cecostomy tube

Cecostomy tube injection showing cecostomy tube in the retroperitoneum — AXR AP (left) shows the cecostomy tube lying medial in position to the cecum. AP image during injection of water soluble contrast through the cecostomy tube (above right) shows opacification of the retroperitoneum rather than the cecum. After the cecostomy tube was removed and replaced, an AP image during injection of water soluble contrast through the new cecostomy tube (below right) shows opacification of the cecum.

The diagnosis was cecostomy tube malfunction with the tip of the cecostomy tube in the retroperitoneum.

School ager with abdominal pain after motor vehicle accident

CT of liver laceration and adrenal hemorrhage — AXR AP (above) obtained after an outside upper GI exam which demonstrated normal bowel rotation shows contrast filling multiple dilated loops of small bowel. Initial AP image from an enema (below left) shows a microcolon with contrast almost reaching the cecum. Later image from the enema (below right) shows reflux of contrast into dilated loops of distal ileum in the right lower quadrant.

The diagnosis was liver laceration with associated right adrenal hemorrhage.

Newborn with bilious vomiting

Enema of successful reduction of uncomplicated meconium ileus — AXR AP (above) obtained after an outside upper GI exam which demonstrated normal bowel rotation shows contrast filling multiple dilated loops of small bowel. Initial AP image from a water soluble enema (below left) shows a microcolon with contrast almost reaching the cecum. Later image from the enema (below right) shows reflux of contrast into dilated loops of distal ileum in the right lower quadrant.

The diagnosis was uncomplicated meconium ileus that was successfully reduced.

Teenager with chronic vomiting

UGI of malrotation without midgut volvulus — AP image from an UGI exam (above) shows a redundant second portion of the duodenum to the right of the spine. AP image from later in the exam (below) shows the duodenal-jejunal junction to project over the middle of the spine and to be much lower in position than the duodenal bulb.

The diagnosis was malrotation without midgut vovulus.

Toddler with bilious vomiting, crampy abdominal pain, bloody stools

Air enema of ileocolic intussusception with edematous ileocecal valve mimicking residual ileocolic intussusception — AXR AP (left) showed an unremarkable bowel gas pattern. An air enema encountered a round soft tissue mass in the ascending colon which had been reduced to the ileocecal valve (above right) before reflux of large amount of air into the small bowel was seen. Post procedure AXR (below right) shows the large amount of air refluxed into the small bowel but there was a persistent round soft tissue mass at the ileocecal valve. US exam of this region then showed this round soft tissue mass was an edematous ileocecal valve.

The diagnosis was ileocolic intussusception that was successfully reduced with an edematous ileocecal valve mimicking a residual ileocolic intussusception.