Newborn with an anterior abdominal wall defect

Clinical image of bladder exstrophy — Clinical image shows the anterior abdominal wall is not fused inferiorly and that the bladder is not fused anteriorly and is everted and extending through the anterior abdominal wall defect.

The diagnosis was bladder exstrophy.

Infant with drainage of urine through the umbilicus

VCUG of patent urachus and urachal diverticulum — Lateral image from a voiding cystourethrogram performed by catheterizing the site of urine drainage at the patient’s umbilicus shows contrast filling the bladder and urethra as well as a large diverticulum at the dome of the bladder that nearly extends to the patient’s anterior abdominal wall.

The diagnosis was patent urachus and a urachal diverticulum.

Teenager with left scrotal mass

US of varicocele — Sagittal greyscale US of the left scrotum (upper left) shows a serpiginous appearing mass in the superior aspect of the scrotum which during a Valsalva maneuver (upper right) increases in size. Sagittal color US of the left scrotum (lower left) shows the mass to be composed of blood vessels that have increasing venous flow seen through them during a Valsalva maneuver (lower right).

The diagnosis was varicocele.

Teenager with a palpable left scrotal mass

US of embryonal cell testicle tumor — Transverse US of the scrotum (above) shows a focal hypoechoic lesion along the medial border of the left testicle which on the sagittal US of the left testicle (below) appears to have an echogenic posterior aspect, representing calcification.

The diagnosis was embryonal cell testicle tumor.

Male infant with a mass in the right groin

US of spermatic cord hydrocele — Sagittal US of the right inguinal canal and scrotum shows an oval anechoic fluid collection in the inguinal canal that did not communicate with the peritoneum (to the left) and a small amount of anechoic fluid around the right testicle.

The diagnosis was an encysted hydrocele of the spermatic cord and a small hydrocele of the right scrotum.

Infant with a swollen left scrotum

US of bilateral hydroceles — Transverse (above) and sagittal (below) US of the scrotum shows a small amount of anechoic simple fluid around the right testicle and a large amount of anechoic simple fluid around the left testicle.

The diagnosis was bilateral hydroceles, left greater than right.

Infant with bilateral scrotal masses

AXR of bilateral inguinal hernias — AXR AP shows large air-filled loops of bowel within the scrotum bilaterally.

The diagnosis was bilateral inguinal hernias.

Teenager with left cryptorchidism

CT of intraabdominal testicle — Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows an oval isodense soft tissue mass located inferior and lateral to the left kidney.

The diagnosis was left undescended testicle in an infrarenal location.

Infant with bilateral prenatal hydronephrosis

US of ureteropelvic junction obstruction — Sagittal US of the right kidney (upper left) and left kidney (upper right) shows bilateral mild to moderate hydronephrosis. AP image from the excretory phase of an intravenous pyelogram shows bilateral moderately dilated renal collecting systems with normal appearing bilateral ureters.

The diagnosis was bilateral ureteropelvic junction obstruction.

Preschooler with an abdominal mass

MRI of multilocular cystic nephroma — Sagittal US of the left kidney (above) shows a multicystic renal mass involving most of the left kidney. Coronal (lower left) and axial (lower right) T1 MRI with contrast of the abdomen shows the left renal mass to contain multiple thin septations and to have no solid component.

The diagnosis was multilocular cystic nephroma.

Preschooler referred with “stomach cysts”

US of multicystic dysplastic kidney — Sagittal US of the right kidney (above) shows it to contain multiple cysts, of varying size, that do not communicate and there is a paucity of renal parenchyma. Sagittal US of the left kidney (below) shows it to be normal.

The diagnosis was right multicystic dysplastic kidney.

Toddler with presumed urinary tract infection

MRI of Wilms tumor — Sagittal US of the left kidney (upper left) shows a round hyperechoic lesion in the lower pole of the kidney. Axial T2 MRI without contrast of the abdomen (upper right) and coronal T1 MRI without (lower left) and with (lower right) contrast of the abdomen shows a well-circumscribed, solid T1 hypointense and T2 isointense mass in the lower pole of the left kidney that enhances minimally.

The diagnosis was Wilms tumor of the left kidney.

Toddler with a fever

US of acute pyelonephritis / acute lobar nephronia — Sagittal US of the right kidney (above) shows an ill-defined hypoechoic mass in the right upper pole that is obscuring the normal outline of the echogenic fat in the renal hilum. The mass was hypoperfused on color and power doppler US. AP image from a voiding cystourethrogram (below) shows bilateral vesicoureteral reflux, grade II on the left and grade III on the right

The diagnosis was acute pyelonephritis in a patient with vesicoureteral reflux.

School ager with bilateral abdominal masses

CT of Burkitt lymphoma of kidney — Coronal T1 MRI without contrast of the abdomen (upper left) shows bilateral enlarged kidneys which after the administration of contrast (upper right) is seen to be due to multiple non-enhancing renal masses. Transverse US of the liver (below) shows a round hypoechoic mass in the liver, superior and to the left of the gall bladder.

The diagnosis was Burkitt lymphoma with renal and liver involvement.

School ager with right flank pain

Axial (left) and coronal (right) CT without contrast of the abdomen and pelvis shows mild enlargement of the right kidney and a round calcified lesion at the right ureterovesical junction.

Toddler with urinary tract infection

Excretory phase image from an intravenous pyelogram shows marked dilation of the left renal collecting system and marked dilation of the left ureter throughout its course when compared to the right ureter. No vesicoureteral reflux was seen on a voiding cystourethrogram.

The diagnosis was left congenital megaureter.

Toddler with hypercalcemia

Sagittal US of the left and right kidneys shows echogenic medullary pyramids bilaterally and mild right hydronephrosis.

The diagnosis was nephrocalcinosis and a mild left ureteropelvic junction obstruction.

Newborn with abnormal prenatal ultrasound

Sagittal US of the right kidney shows a lobulated renal contour along the anterior aspect of the right kidney. The left kidney was absent.

The diagnosis was renal fetal lobulations in a patient with a solitary right kidney.

Female infant with a single perineal opening

Lateral view (left) from a colostogram (lower left contrast collection) shows a rectovesical fistula with contrast filling the patient’s bladder (upper left contrast collection). Oblique view from later in the study (right) shows a filled bladder with a competent bladder neck, a long urethra-urogenital sinus and possibly a rudimentary vagina.

The diagnosis was cloacal malformation.

Teenager with an abdominal mass

Axial CT without contrast of the abdomen shows the right kidney to be normal in size and to contain multiple small low density lesions that when measured demonstrate negative Hounsfield units. The left kidney, which is massively enlarged, also contains multiple small low density lesions as well as one extremely large low density lesion in its anterior aspect.

The diagnosis was angiomyolipoma of the kidneys in a patient with tuberous sclerosis.

Toddler with constipation and urinary retention

BE of presacral neuroblastoma — Lateral image from a barium enema performed after an intravenous pyelogram (below) shows anterior displacement and compression of the bladder (to the left of the image) and rectum (in the middle of the image) by a presacral mass. The scout image (above) showed the mass was not calcified.

The diagnosis was presacral neuroblastoma.

Preschooler with abdominal pain

CT of infected urachal cyst — Axial (left) and sagittal (right) images from a CT with contrast of the abdomen shows a midline cystic lesion with a thick enhancing wall and surrounding inflammatory change just inferior to the umbilicus that appears to course to the dome of the bladder on the sagittal image.

The diagnosis was an infected urachal cyst.

Female school ager with left lower quadrant abdominal pain and an abdominal mass

US and CT of ovarian dysgerminoma with torsion — Transverse and sagittal US of the pelvis (above) shows an echogenic and inhomgenous solid mass superior to the bladder. Neither ovary could be visualized. Axial CT with contrast of the abdomen shows a solid non-enhancing midline mass. The mass was found to be tossed in the operating room.

The diagnosis was an ovarian dysgerminoma which was found to be torsed in the operating room.

Female school ager with abdominal pain

CT of ovarian cystadenoma — Axial, coronal and sagittal images from a CT with contrast of the abdomen shows a large cystic mass with thin separations on the right side of the abdomen above the bladder. The uterus and left ovary were unremarkable.

The diagnosis was ovarian cystadenoma

Female infant with pelvic mass

US of hematocolpos — Transverse (above) and sagittal (below) US of the pelvis shows a large cystic structure filled with complex fluid posterior to the bladder which is visible on the right side of the sagittal image. The uterus was identified and was unremarkable and therefore the cystic structure was felt to represent a distended vagina.

The diagnosis was hydrocolpos.