School ager with right lower quadrant pain

US of infectious colitis — Transverse US of the cecum (to the left of the image) shows circular circumferential thickening of colonic wall and a hyperechoic submucosal layer.

The diagnosis was infectious colitis.

Teenager with fever, elevated WBC and right lower quadrant pain

US of acute appendicitis — Sagittal US of the right lower quadrant shows a noncompressible blind ending J-shaped tubular structure (in the upper half of the image) with a transverse diameter of 8 mm with periappendiceal hyperechogenicty of the periappendiceal fat.

The diagnosis was acute appenditicis.

Teenager with chronic right lower quadrant pain

UGI and SBFT of Crohn disease — Spot images of the terminal ileum from an upper GI small bowel follow through show diffuse luminal narrowing of the terminal ileum associated with mucosal ulceration along with a nodular and cobblestone appearance to the terminal ileum.

The diagnosis was Crohn disease.

Toddler with abdominal pain and vomiting

AXR and US of ileocolic intussusception — AXR AP (left) shows a non-obstructive bowel gas pattern and a round soft tissue mass in the right upper quadrant obscuring the inferior margin of the liver (Currarino sign). Transverse US of the mass (right) shows it to have a hyperechoic center and a hypoechoic rim (Target sign). The mass was successfully reduced, recurred and was rereduced successfully.

The diagnosis was ileocolic intussusception.

School ager in a motor vehicle collision

CT of splenic laceration — Axial CT with contrast of the abdomen shows multiple areas of low density throughout the spleen.

The diagnosis was splenic laceration.

Infant with bilious vomiting

UGI of normal rotation of the bowel — AP image from an UGI exam (above) shows the duodenal jejunal junction to project to the left of the spine in its normal position. Later image from the exam (below) shows the jejunum to be on the right side, rather than the left side, of the abdomen.

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

School ager who fell off a table and then had the table fall on to them

CT of contusion of pancreas — Axial CT with contrast of the abdomen shows a heterogenous appearance to the pancreatic head (middle left and below left) which is also appreciated on the coronal image (above right) just medial to the contrast filled duodenum. There was a large amount of free fluid in the pelvis (below right)

The diagnosis was contusion of the pancreatic head.

School ager with right lower quadrant pain

CT of acute appendicitis — Axial CT with contrast of the abdomen shows in the right lower quadrant an extremely large, fluid-filled, tubular structure containing several punctate calcifications within it and having some inflammatory changes surrounding it.

The diagnosis was acute appendicitis with multiple appendicoliths.

School ager hit by a car while riding their bike

CT of pancreatic transection — Axial CT with contrast of the abdomen (above) shows a near-complete transection of the pancreatic body along with a large amount of free fluid deep in the pelvis (below)

The diagnosis was transection of the pancreatic body.

Teenager with right lower quadrant pain

US of acute appendicitis — Transverse US of the right lower quadrant (above) shows a dilated, blind ending, non-compressible tubular structure (between the calipers) that is draped across the right psoas muscle and whose tip lies just above the right iliac vessels. Sagittal US of the right lower quadrant (below) showed the tubular structure to have a diameter of 9 mm

The diagnosis was acute appendicitis.

Infant with projectile vomiting

US and UGI of malrotation with midgut volvulus — Transverse US of the pylorus (left) showed a normal appearing pylorus and showed the superior mesenteric vein to be directly above the superior mesenteric artery (the round structure with an echogenic rim in the center of the image), raising suspicion for malrotation. AP image from an UGI exam (right) shows the duodenal jejunal junction to be over the right pedicle of the spine and to be below the level of the duodenal bulb.

The diagnosis was malrotation with midgut volvulus.

School ager with right lower quadrant pain

CT of carcinoid tumor of the appendix — Axial CT with contrast of the abdomen (above) shows on top of the right psoas muscle and right iliac vessels in the right lower quadrant a dilated, fluid-filled tubular structure containing a calcification . Coronal CT (below) shows two calcifications within the tubular structure which is just medial to the cecum and surrounded by inflammatory changes.

The diagnosis was acute appendicitis with multiple appendicoliths. Pathological examination additionally revealed a carcinoid tumor of the appendix.

Preschooler who hit their throat on the rim of a plastic chair and now has throat pain and hemoptysis

CT and UGI of esophageal perforation — Sagittal CT without contrast of the neck (left) shows pneumomediastinum anterior to the spine. Lateral image from an esophagram (right) shows contrast extravasating outside the esophagus at the level of C4.

The diagnosis was esophageal perforation due to blunt trauma.

Infant with failure to thrive who has been vomiting since birth

UGI of malrotation without midgut volvulus — Serial images from an UGI exam show the ligament of Treitz is to the right of the spine and at approximately the level of the duodenal bulb. There was free passage of contrast through the duodenum and no evidence of duodenal or proximal jejunal obstruction.

The diagnosis was malrotation without midgut volvulus.

School ager with emesis after posterior spinal fusion 8 months ago

CT of superior mesenteric artery syndrome — Axial CT with contrast of the abdomen (above) shows the dilated stomach anteriorly in the abdomen and the dilated duodenum posterior to it on the right side of the abdomen that then tapers in diameter as it reaches the superior mesenteric artery in the midline above the spine. Coronal image (below) demonstrates the tremendously dilated nature of the stomach and duodenal bulb.

The diagnosis was superior mesenteric artery syndrome.

Newborn with 3 days of bilious vomiting

UGI of malrotation with midgut volvulus — Serial AP images from an UGI exam show dilation of the first and second parts of the duodenum, the ligament of Treitz projects over the midline of the spine and lower than the duodenal bulb, and the third portion of the duodenum has a spiral or corkscrew appearance.

The diagnosis was malrotation with midgut volvulus.

Teenager with right upper quadrant pain and sickle cell disease

US of gallstones in sickle cell disease — Sagittal (above) and transverse (below) US of the gallbladder show multiple small round echogenic mobile objects within the gallbladder that cause posterior shadowing.

The diagnosis was cholelithiasis due to sickle cell disease.

Newborn with failure to pass meconium

Enema of meconium plug syndrome — AXR AP (above left) shows a dilated bowel gas pattern. AP image from an enema (above right) shows a normal caliber colon with the descending colon being slightly smaller in diameter than the rest of the colon. Large filling defects representing meconium are seen throughout the colon. The terminal ileum was refluxed. Clinical image (below) shows a foot-long piece of meconium that was evacuated by the patient after the exam.

The diagnosis was meconium plug syndrome.

Newborn with bilious vomiting

UGI of malrotation with midgut volvulus — AP image from an UGI exam shows dilation of the first and second parts of the duodenum. The ligament of Treitz was located in the middle of the spine and was in a lower position than the duodenal bulb. The proximal jejunum was in the right upper quadrant.

The diagnosis was malrotation with midgut volvulus.

Premature newborn with respiratory distress

CXR and AXR of pneumoperitoneum — CXR AP (above) shows increased lucency in the upper abdomen. Left lateral decubitus AXR (below) shows a large amount of free air between the abdominal wall and the liver.

The diagnosis was pneumoperitoneum due to spontaneous intestinal perforation.

Infant with bilious vomiting

UGI of false positive malrotation with midgut volvulus — Early AP image from an UGI exam (above) showed the ligament of Treitz to project over the midline of the spine and at the same level as the duodenal bulb. Later image (below left) showed the proximal jejunum in the right upper quadrant. Final image (below right) after following contrast through to the colon showed the cecum to be on the right side of the abdomen but to be high in position. The patient was surgically explored and in the operating room the ligament of Treitz was seen in the left upper quadrant and there was normal rotation of the bowel.

The diagnosis was false positive diagnosis of malrotation with midgut volvulus.

Teenager on an exclusively vegetable-protein-xanthum diet with increasing abdominal distension and vomiting

AXR and CT of phytobezoar — AXR (left) shows a mottled structure filling the entire width of the upper abdomen. Coronal CT with contrast of the abdomen (middle and right) shows the structure is the stomach distended with particulate material. The patient was given cellulase and an AXR one day later showed the stomach to be empty.

The diagnosis was phytobezoar.

Teenager in a motor vehicle accident

CT of traumatic pancreatic pseudocyst — Axial CT with contrast of the abdomen shows a low density fluid-filled structure just to the left of midline and posterior to the body of the pancreas.

The diagnosis was right pancreatic pseudocyst after pancreatic trauma.

Newborn with bilious vomiting

UGI of malrotation with midgut volvulus — AP image from an UGI exam (left) shows dilation of the stomach and first and second parts of the duodenum. There is an abrupt transition in bowel contour at the ligament of Treitz which projects low in position and over the middle of the spine. The jejunum then appears to spiral away downstream. AP image from later in the exam (right) better shows the spiraling / corkscrew appearance of the proximal jejunum.

The diagnosis was malrotation with midgut volvulus.

Infant with feeding intolerance after recovering from a documented episode of necrotizing enterocolitis

Enema of colonic strictures after necrotizing enterocolitis — AXR (left) shows dilated loops of bowel throughout the abdomen. AP image from an enema (above right) shows narrowing of the colon at the rectosigmoid colon, splenic flexure and cecum. AP image from later in the exam (below right) shows dilated loops of small bowel filled with contrast above the level of the narrowing in the cecum.

The diagnosis was multiple colonic strictures after necrotizing enterocolitis.