Infant with urinary tract infection

US and VCUG of pediatric everting orthotopic ureterocele — Transverse ultrasound of the bladder (above left) shows an oval lesion in the center of the bladder that has a thick wall and a hypoechoic center. AP image early in the filling phase of a voiding cystourethrogram exam (above right) shows an oval lucent filling defect representing a lesion in the center of the bladder. AP image from later in the filling phase (below left) shows the filling defect / lesion is within the bladder. Lateral image from the voiding phase (below right) shows the lesion has everted out of the bladder. Left sided vesicoureteral reflux was also present.

The diagnosis was everting orthotopic ureterocele.

School ager with right scrotal pain for 1 day

US of torsion of the appendix epididymis — Sagittal US of the scrotum on the day of presentation (above) shows a hypoechoic oval lesion in the epididymis just above the testicle. Sagittal US of the scrotum 2 weeks later (below) shows the previously seen hypoechoic lesion in the epididymis to have evolved into an anechoic cyst.

The diagnosis was torsion of the appendix epididymis.

Newborn with bilateral unpalpable testicles

US of pediatric intraabdominal testicle — Transverse (above left) and sagittal (below left) US of the pelvis show the right testicle to lie lateral to the superior aspect of bladder. Transverse (above right) and sagittal (below right) US of the left inguinal canal shows the left testicle to lie within the left inguinal canal.

The diagnosis was bilateral undescended testicles with the left testicle in the inguinal canal and the right testicle in the abdomen.

Newborn with complex congenital heart disease

US of Tamm Horsfall proteins — Sagittal US of the right kidney (above) and left kidney (below) show multiple round echogenic foci in the renal pyramids bilaterally.

The diagnosis was Tamm Horsfall proteins.

School ager with a urinary tract infection

VCUG of pediatric spinning top urethra — AP image from a voiding cystourethrogram exam during voiding shows a non-obstructive ellipsoid-shaped dilation of the posterior urethra just distal to internal urethral sphincter.

The diagnosis was spinning top urethra.

Newborn with gross hematuria

US of renal vein thrombosis — Sagittal US of the left kidney (above) and right kidney (below) shows an asymmetry in renal length, with the right kidney being more than 1.5 cm longer than the left kidney. Color doppler ultrasound (not provided) showed a non occlusive thrombus in the right renal vein.

The diagnosis was right renal vein thrombosis.

Teenager with right flank pain

CT and US of pediatric cystic nephroma — Axial (above left) and sagittal (above right) CT with contrast of the abdomen show two multiseptated low density lesions in the superior and middle poles of the right kidney. Sagittal US of the right kidney (below) show the two lesions are anechoic and filled with multiple thin septations without any nodularity.

The diagnosis was pediatric cystic nephroma.

School ager with fever and left flank pain

CT of pediatric acute pyelonephritis followed by development of a renal abscess — Coronal CT without contrast of the abdomen (above) shows an enlarged left kidney with associated perinephric fat around its inferior pole. Sagittal (below left) and transverse (below left) ultrasound of the left kidney obtained 1 month later after antibiotic treatment shows a well-circumscribed, round, isoechoic lesion in the inferior pole of the left kidney.

The diagnosis was initially acute pyelonephritis of the inferior pole of the left kidney followed by development of a renal abscess in the inferior pole of the left kidney.

Male teenager with abdominal pain

CT of prostatic utricle cyst — Axial (above) and sagittal (below) CT with contrast of the abdomen show a round, thin-walled, low density structure posterior to the bladder and anterior to the rectum. On a subsequent voiding cytourethrogram exam (not provided) the structure did not fill with contrast.

The diagnosis was prostatic utricle cyst.

Female teenager with enuresis

AXR of ovarian teratoma — AXR AP shows an oval calcification in the right pelvis in the region of the right adnexa.

The diagnosis was right ovarian teratoma.

Newborn with a multicystic dysplastic kidney on prenatal ultrasound

CXR of patient with oligohydramnios — CXR AP shows a bell-shaped chest with extremely low lung volumes.

The diagnosis was oligohydramnios resulting in pulmonary hypoplasia due to multicystic dysplastic kidney.

Teenager with microscopic hematuria

US of nutcracker syndrome — Transverse US of the abdomen (above) shows focal compression of left renal vein between the superior mesenteric artery anteriorly and the aorta posteriorly resulting in stenosis of the proximal left renal vein (markers #2) with associated dilation of the distal left renal vein (markers #1). Sagittal US of the abdomen (below) shows a reduced aortic-superior mesenteric artery angle of less than 45 degrees.

The diagnosis was nutcracker syndrome.

Teenager with flank pain

US of nephrocalcinosis — Sagittal US of the left kidney (above) and right kidney (below) show dense calcification in the medullary pyramids of both kidneys.

The diagnosis was bilateral nephrocalcinosis.

Teenager with left scrotal pain

US of scrotolith — Transverse (above) and sagittal (below) US of the left scrotum show an oval hyperechoic lesion that is in the scrotum but that is extratesticular in location and which has posterior acoustical shadowing.

The diagnosis was scrotolith.

Teenager with right lower quadrant pain

MRI of Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx — Contiguous axial (above) and coronal (below) T2 MRI of the pelvis show a bicornuate unicollis uterus with the left horn intact and with the right horn atretic and dilated and associated with a right hydrohematosalpinx.

The diagnosis was Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx.

Infant with suspected vascular ring on an upper GI exam

CT of intrathoracic kidney — Coronal CT with contrast of the chest (above left) shows the left kidney in the lower left thorax with its vascular pedicle coursing away from it inferiorly. Sagittal CT (above right) shows the kidney had ascended into the chest through the foramen of Bochdalek. Axial CT (below) again shows the kidney in the left hemithorax.

The diagnosis was intrathoracic kidney.

Infant with prenatal hydronephrosis

US and MAG3 scan of horseshoe kidney — Transverse midline US of the lower abdomen (above) shows renal parenchymal tissue in the midline just anterior to the spine representing the fused lower poles of both kidneys. MAG3 scan (below) shows radiotracer uptake in the bilateral kidneys as well as in their fused lower poles.

The diagnosis was horseshoe kidney.

Teenager with pelvic pain

CT of hematometrocolpos due to vaginal atresia — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the pelvis show a distended fluid-filled bladder anterior to an extremely distended fluid-filled uterus and vagina. The fluid in the uterus and vagina was of higher density than the fluid in the bladder.

The diagnosis was hematometrocolpos due to vaginal atresia.

Infant with an enlarged left scrotum

US of encysted hydrocele of the spermatic cord — Sagittal US of the left scrotum shows a large anechoic mass in the left inguinal canal and upper scrotum that is superior to the left epididymis and testicle which are located on the right most aspect of the image. The mass did not communicate with the peritoneal cavity.

The diagnosis was an encysted hydrocele of the spermatic cord.

Teenager with a palpable mass superior to the left testicle

US of epididymal cyst — Sagittal US of the left scrotum (above) shows normal appearance of the left testicle. Sagittal US of the left scrotum (below) shows an anechoic oval lesion in the head of the left epididymis.

The diagnosis was epididymal cyst.

School ager with hematuria who has lymphoma and is being treated with cyclophosphamide

CT of cyclophosphamide induced cystitis with a large blood clot in the bladder — Axial CT with contrast of the pelvis (above) shows mild thickening of the wall of the bladder which has a large oval mass within it that has a whorled appearance. Transverse US of the bladder (below) shows a large round echogenic lesion with a whorled appearance located posteriorly in the bladder.

The diagnosis was cyclophosphamide induced cystitis with a large blood clot in the bladder.

School ager with difficulty voiding

Retrograde urethrogram of Cowper duct syringocele and stricture of the membranous urethra — Lateral image from a retrograde urethrogram exam shows a short tubular tract filled with contrast inferior to the contrast filled urethra. There is also a persistent long narrowing in the membranous urethra.

The diagnosis was Cowper duct syringocele in a patient with a stricture of the membranous urethra.

Toddler with a urinary tract infection

US of congenital megaureter — Sagittal US of the left kidney (above) and left ureteropelvic junction (below) show moderate hydroureteronephrosis. There was moderate hydroureter all the way to the ureterovesical junction. A subsequent voiding cystourethrogram showed no evidence of vesicoureteral reflux.

The diagnosis was congenital megaureter.

Newborn with one perineal opening for the vagina and urethra and rectum

Fluoroscopic exam of cloacal malformation — AP (above left) and lateral (above right) images during injection of water soluble contrast into the vagina shows a dilated vagina and a duplicated uterus. Lateral image during antegrade injection of water soluble contrast into the patient’s distal mucous fistula (below left) shows a connection between the posteriorly located distal rectum and the posterior aspect of the vagina. Lateral image obtained during filling of the anteriorly located bladder with water soluble contrast through a suprapubic catheter (below right) shows the proximal urethra just inferior to the bladder to be dilated.

The diagnosis was cloacal malformation.

Infant with a urinary tract infection who is post repair of an inferior abdominal wall defect at birth

VCUG of grade V vesicoureteral reflux in a patient with bladder exstrophy — AP image from a voiding cystourethrogram shows reflux of contrast into extremely dilated renal collecting systems and ureters bilaterally. There is also diastasis of the symphysis pubis.

The diagnosis was bilateral Grade V vesicoureteral reflux in a patient with bladder exstrophy.