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.

Newborn who experienced oligohydramnios in utero

CXR and US of autosomal recessive polycystic kidney disease causing oligohydramnios and pulmonary hypoplasia — CXR AP (above) shows a small bell-shaped thorax with poorly expanded lungs despite being on a ventilator. Transverse US of the left kidney (below left) and right kidney (below right) shows the kidneys bilaterally to be enlarged and to be composed of innumerable microcysts giving the kidneys overall an echogenic appearance.

The diagnosis was autosomal recessive polycystic kidney disease resulting in oligohydramnios resulting in pulmonary hypoplasia.

Teenager with tuberous sclerosis

MRI of renal angiomyolipomas in a patient with tuberous sclerosis. — Axial T1 MRI without contrast of the abdomen shows two oval hyperintense lesions in the right kidney that have similar signal intensity to the subcutaneous fat. No renal cysts were seen.

The diagnosis was renal angiomyolipomas in a patient with tuberous sclerosis.

Teenager with scrotal pain

US of varicocele — Transverse US of the left scrotum (above) shows a collection of enlarged serpiginous appearing veins superior to the testicle which are greater than 3 millimeters in diameter and which on transverse US of the left scrotum during a Valsalva maneuver (below) increase in diameter.

The diagnosis was varicocele.

School ager who sat on a rebar construction rod

CT of pediatric vaginal trauma and extraperitoneal bladder rupture — Immediate contiguous (above) sagittal CT with contrast of the pelvis shows on the immediate image fluid and air anterior to the bladder (above left) and air anteriorly in the fluid-filled vagina and active bleeding in the rectum posteriorly (above right). The delayed image (below) shows extravasated intravenous contrast anterior to the contrast filled bladder.

The diagnosis was vaginal trauma in the form of laceration of the rectum and vagina and extraperitoneal bladder rupture.