Infant with projectile vomiting

Color US of Whirlpool sign of malrotation with midgut volvulus — Transverse color US of the upper abdomen in the midline (above) shows the mesenteric vessels swirling around themselves (Whirlpool sign). The superior mesenteric vein was above the superior mesenteric artery. Upper GI exam (below) shows the duodenal jejunal junction to be to the left of the spine but to be lower in position than the duodenal bulb and the proximal jejunum appears to spiral downwards away from it.

The diagnosis was malrotation with midgut volvulus.

Infant with 2 days of abdominal pain, vomiting, and currant jelly stools

AXR of small bowel obstruction due to ileocolic intussusception — AXR supine (above left) shows multiple dilated loops of small bowel and AXR upright (above right) shows multiple air-fluid levels. There is no air in the colon. AP image from an air enema (below) shows a soft tissue mass outlined by air in the hepatic flexure which was then easily reduced to the ileocecal valve on the first attempt but could not be reduced further on subsequent attempts. In the operating room the terminal ileum and cecum were found to be necrotic and were resected.

The diagnosis was small bowel obstruction caused by ileocolic intussusception.

Infant with projectile vomiting

AXR and US of hypertrophic pyloric stenosis — AXR AP (left) shows a hugely distended air-filled stomach with distal bowel gas. Sagittal US of a posteriorly positioned pylorus (right) shows the pyloric channel to be lengthened (25 mm) and the pyloric muscle to be thickened (4 mm). The anechoic gallbladder is positioned anteriorly to the pylorus.

The diagnosis was hypertrophic pyloric stenosis.

Teenager with fever of unknown origin

Small bowel follow through exam of Crohn disease of the terminal ileum — AXR from a small bowel follow through exam (left) shows diffuse narrowing of the terminal ileum and separation of the loops of terminal ileum due to mesenteric fat infiltration. Spot image of the terminal ileum (right) shows a nodular and cobblestone appearance to the narrowed loops of the terminal ileum.

The diagnosis was Crohn disease.

Newborn with absent anus and stool coming out of the vagina

US of low anorectal malformation — CXR AP (left) shows a hemivertebra at L1 causing spinal curvature convex left. Transverse US of the pelvis (above right) shows in the midline anteriorly an anechoic fluid-filled bladder with a round echogenic stool-filled rectum posterior to it while a transverse US of the perineum (below right) shows a very short distance between the calipers superiorly on the skin and inferiorly on the anterior wall of the rectum.

The diagnosis was low anorectal malformation and congenital scoliosis.

Infant with decreased stool output and fever

Enema of Hirshsprung enterocolitis — AXR AP (above) shows an obstructive bowel gas pattern with multiple dilated loops of small bowel. AP image from an enema (below left) shows the contour of the entire colon to have an irregular, serrated appearance. The terminal ileum was refluxed. Lateral image from the enema (below right) shows the diameter of the rectum to be less than the diameter of the sigmoid colon (recto-sigmoid inversion).

The diagnosis was Hirschsprung disease with concomitant Hirschsprung enterocolitis.

Infant with 2 days of bilious emesis

Air enema of ileocolic intussusception — AXR AP (left) shows a nonobstructive bowel gas pattern and a soft tissue mass over the spine, with its left border outlined by air in the transverse colon. AP image from an air enema (right) shows a large round soft tissue mass in the hepatic flexure that was successfully reduced, evidenced by a large amount of air being refluxed into the small bowel.

The diagnosis was ileocolic intussusception.

School ager post motor vehicle accident

CT of bearclaw laceration of the liver — Axial CT with contrast of the abdomen shows a low density bear claw shaped lesion in the right lobe of the liver that is lateral to and inferior to the gall bladder.

The diagnosis was liver laceration.

Newborn with Trisomy 21 who has large residuals after feeding

UGI of duodenal atresia — AP (above) and lateral (below) images from an UGI exam show a dilated stomach and first part of the duodenum. On a delayed image obtained 15 minutes later, no contrast was seen to have passed out of the duodenum into the remainder of the bowel.

The diagnosis was duodenal atresia in a patient with Trisomy 21.

Teenager who fell while running and has left upper quadrant pain

CT of laceration of the spleen — Axial CT with contrast of the abdomen shows a triangular area of low density in the center of the spleen.

The diagnosis was splenic laceration.

Teenager with chronic abdominal pain

CT of mesenteric cyst — Image from a small bowel follow through exam (above) shows the small bowel to be entirely opacified and to be elevated out of the pelvis with the exception of a single loop in the middle of the pelvis. Axial CT without intravenous and with oral contrast of the abdomen (below) shows a large low density multiseptated mass in the pelvis.

The diagnosis was mesenteric cyst.

Newborn with vomiting

UGI of dudodenal stenosis — AXR AP obtained after gastric decompression via nasogastric tube (above) shows gas present through the bowel. AP image from an upper GI exam (below) shows the stomach and first and second parts of the duodenum to be extremely dilated. On a delayed image obtained 15 minutes later, a small amount of contrast was seen to have passed out of the duodenum into the small bowel.

The diagnosis was duodenal stenosis.

Preschooler with abdominal pain that had a large mirror fall on their abdomen

CT without intravenous contrast using incorrect technique for the assessment of blunt abdominal trauma — Axial CT without contrast of the abdomen shows grossly unremarkable unenhanced solid organs of the abdomen without free air or free fluid.

The diagnosis was incorrect CT technique without the use of intravenous contrast for the assessment of blunt abdominal trauma.

Infant with cecal perforation just after birth status post diverting colostomy who now presents for reanastomosis a year later

Enema of a microcolon in complicated meconium ileus — AP image from an enema shows an unused microcolon.

The diagnosis was complicated meconium ileus causing cecal perforation postnataly.

Newborn who was dusky after feeding and had bilious aspirates from their stomach

AXR of malrotation with midgut volvulus presenting with a double bubble sign — AXR AP shows a very dilated stomach and proximal duodenum (double bubble sign) along with some distal bowel gas.

Infant with vomiting for 2 days and bloody stools for 1 day

AXR and air enema of ileocolic intussusception — AXR supine (left) shows multiple dilated loops of small bowel. AXR upright (right) shows a round soft tissue mass filling the lumen of the mid transverse colon. AP image from an air enema (below) shows reduction of the soft tissue mass to the cecum just before it disappeared and a large amount of air was observed to reflux into the terminal ileum.

The diagnosis was ileocolic intussusception causing a distal small bowel obstruction which was successfully reduced.

Newborn with bilious vomiting and a normal upper GI exam

Enema of total colonic Hirschsprung diseae — Lateral image from an enema (right) shows the caliber of the rectum to be slightly narrower than the caliber of the sigmoid colon in the center of the AP image of the enema (left) although no definite transition zone was observed. The remainder of the colon was of a normal caliber.

The diagnosis was total colonic Hirschsprung disease.

Teenager with right lower quadrant pain and fever

CT and small bowel followthrough of Crohn disease of the terminal ileum and cecum — Axial CT with intravenous and oral contrast of the abdomen (above) shows marked thickening of the wall of the cecum and narrowing of the lumen of the cecum. Images of the terminal ileum from an upper GI and small bowel follow through exam (below) show luminal narrowing and nodularity giving a cobblestone appearance along with mucosal ulcerations.

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

School ager with right lower quadrant pain and fever

US and CT of acute appendicitis with perforation with an appendicolith and a pelvic abscess — Sagittal US of the right lower quadrant (above left) shows a dilated, non-compressible, blind ending tubular structure between the calipers while a transverse US of the right lower quadrant (above right) shows echogenic fat surrounding an oval echogenic structure in the center of the image that has posterior shadowing. Axial CT with intravenous and oral contrast of the abdomen (below) shows a large cystic and septated mass in the center of and to the right of the pelvis that has an oval calcification in it anteriorly.

The diagnosis was acute appendicitis with perforation with an appendicolith in the center of a pelvic abscess.

School ager with abdominal pain after a motor vehicle accident

CT of jejunal perforation — Axial CT with intravenous and oral contrast of the abdomen from the day of admission (above) shows a small amount of free fluid in the pelvis. There was no evidence of solid organ injury or free air. Repeat CT with intravenous and oral contrast from one day later due to increasing abdominal pain (below) shows a marked increase in the amount of free fluid present.

The diagnosis was jejunal perforation due to bowel trauma.

Infant with bilious vomiting and abdominal distension

UGI of false positive malrotation with midgut volvulus — AXR upright (left) shows multiple dilated loops of small bowel with air fluid levels. Sagittal US of the abdomen (above right) shows multiple dilated loops of peristalsing small bowel, however an intussusception was not seen. AP image from an upper GI exam (below right) shows the duodenal-jejunal junction to be low in position and to be to the right of the spine.

The diagnosis was Meckel diverticulum causing a small bowel obstruction and a false positive diagnosis of malrotation with midgut volvulus due to displacement of the duodenal-jejunal junction by dilated loops of small bowel.

Newborn with bilious vomiting

UGI of normal rotation of the bowel — AP image from an upper GI exam shows a normal appearing duodenal C loop with the duodenal-jejunal junction projecting to the left of the spine at the same level as the duodenal bulb. The jejunum is on the left side of the abdomen.

The diagnosis was normal rotation of the bowel and thus no evidence of malrotation with midgut volvulus.

Toddler with crampy abdominal pain

AXR and air enema of ileocolic intussusception — AXR AP (left) shows a non-obstructive bowel gas pattern and a soft tissue mass in the hepatic flexure obscuring the inferior margin of the liver (Currarino sign). AP image from an air enema (above right) shows the soft tissue mass has been reduced from the hepatic flexure to the cecum. AXR AP taken after the air enema (below right) shows disappearance of the soft tissue mass from the cecum and reflux of a large amount of air into the terminal ileum.

The diagnosis was ileocolic intussusception that was successfully reduced.

Newborn with an anterior abdominal wall defect

AXR of gastroschisis — AXR AP shows multiple loops of bowel in the midline outside of the abdomen that were not encased by and sac and thus were wrapped in a temporary gauze dressing.

The diagnosis was gastroschisis.

Teenager with abdominal pain and vomiting

UGI and SBFT of Crohn disease of terminal ileum — AXR AP (left) shows dilated loops of small bowel and a radiopaque coin projecting over the pelvis. AP images from an upper GI and small bowel follow through exam show the coin cannot pass through the terminal ileum (above right) because the the terminal ileum is ulcerated, nodular and narrowed (below right).

The diagnosis was Crohn disease of the terminal ileum resulting in a stricture of the terminal ileum causing a distal partial small bowel obstruction.