School ager with left flank pain and back pain with fever and increased white blood cell count

CT of acute pyelonephritis — Immediate (above) and delayed (below) axial CT with contrast of the abdomen shows multiple low density wedge-shaped lesions in the left kidney and a striated nephrogram on the delayed images.

The diagnosis was acute pyelonephritis.

Teenager who fell off a horse with abdominal pain

CT of bladder trauma / bladder perforation — Axial CT with contrast of the abdomen shows bilateral pubic rami fracture (above) with a Foley catheter in the center of the bladder and contrast extravasating out of the bladder into the perivesical space (below).

The diagnosis was extraperitoneal bladder perforation.

Teenager who crashed their all terrain vehicle with abdominal pain

CT of renal trauma / renal laceration and ureteral trauma / ureteral transection and splenic trauma / splenic laceration — Axial and coronal CT with contrast of the abdomen immediate phase (above) shows low density in the superior and inferior poles of the left kidney and fluid in the left perirenal and pararenal spaces. There is also a large area of low density in the spleen. Delayed phase CT images (below) show extravasation of urine out of the ureter into the left pararenal space.

The diagnosis was left renal laceration with ureteral transection and splenic laceration.

School ager who fell out of a tree with hematuria

CT of renal trauma / renal laceration — Axial CT with contrast of the abdomen shows areas of low density in the anterior and lateral aspects of the left kidney with associated left perirenal and pararenal high density fluid collections.

The diagnosis was left renal laceration with perirenal and pararenal hematomas.

Preschooler who fell 20 feet out a window with abdominal pain

CT of adrenal trauma / adrenal laceration and liver trauma / liver laceration — Axial CT with contrast of the abdomen shows a large amount of fluid in the region of the right adrenal gland and areas of low density in the middle and posterior aspects of the right lobe of the liver.

The diagnosis was right adrenal hemorrhage and liver laceration.

Newborn with an amniotic fluid leak in-utero

CXR of pulmonary hypoplasia due to oligohydramnios — CXR AP shows bilateral poorly developed and poorly expanded lungs.

The diagnosis was oligohydramnios causing pulmonary hypoplasia.

Infant with recurrent pneumonias

CXR and CT of neuroblastoma — CXR shows a posterior mediastinal mass to the left of the spine that is clearly calcified on the coronal and axial CT with contrast of the chest.

The diagnosis was neuroblastoma.

Toddler with weight loss and respiratory distress

CXR and MRI of neuroblastoma — CXR PA and lateral shows a large left posterior mediastinal mass. Coronal and sagittal T1 MRI without contrast (lower left and middle) and coronal T1 MRI with contrast (lower right) of the chest shows an enhancing mass arising from the left adrenal gland extending up into the left thorax.

The diagnosis was neuroblastoma.

School ager with wheezing

CXR and CT of ganglioneuroma — CXR shows a smooth mass in the left superior/posterior mediastinum. Axial CT with contrast of the chest shows a non-calcified solid paraspinal mass.

The diagnosis was ganglioneuroma.

Newborn with midline abdominal mass

CT of neuroblastoma — Axial CT with contrast of the abdomen shows a large midline calcified mass that crosses the midline and encases abdominal vessels.

The diagnosis was neuroblastoma.

Newborn with incidental adrenal mass on cardiac CT

CT of adrenal hemorrhage — Axial, coronal, and sagittal CT with contrast of the abdomen shows a large right solid adrenal mass that decreased in size on serial US exams.

The diagnosis was adrenal hemorrhage.

Newborn with an ovarian cyst on prenatal US

MRI of ovarian torsion — T1 coronal (left) and T1 sagittal (right) and T2 axial (below) MRI images show a heterogeneous intraperitoneal mass that appears to have hemorrhagic and calcified components.

The diagnosis was in-utero right ovarian torsion, presumably secondary to the ovarian cyst.

Infant who had hematuria after placement of an umbilical catheter one month ago

US of renal vein thrombosis — Sagittal US of the IVC (above) shows a calcified thrombus in the IVC which extended to the right kidney (below) and renal veins which was associated with right nephromegaly.

The diagnosis was subacute IVC thrombosis and subacute right renal vein thrombosis.

Newborn with renal cysts on prenatal ultrasound

US of multicystic dysplastic kidney — Sagittal US images of the right kidney show it to be larger than the left kidney and to have multiple cysts of varying sizes that do not communicate.

The diagnosis was multicystic dysplastic kidney.

Newborn with a palpable right sided abdominal mass

US of mesoblastic nephroma — Transverse (above) and sagittal (below) US images shows an enlarged solid reniform shaped mass in the right renal fossa.

The diagnosis was mesoblastic nephroma.

Newborn with echogenic kidneys on prenatal ultrasound

US of autosomal recessive polycystic kidney disease — Transverse and sagittal US images of the right kidney shows it to be enlarged and echogenic. The left kidney was identical in appearance.

The diagnosis was autosomal recessive polycystic kidney disease.

Newborn with prenatal hydronephrosis in the left kidney

IVP of ureteropelvic junction obstruction — 4 hour delayed image from an IVP exam shows an extremely dilated left renal collecting system. The left ureter is not seen.

The diagnosis was left sided ureteropelvic junction obstruction.

Infant with failure to thrive

AXR AP and lateral shows bilateral diffuse calcification in enlarged adrenal glands.

The diagnosis was Wolman disease.

Teen female with hirsuitism and virilization

US of adrenocortical carcinoma. — Transverse and sagittal US of the left kidney shows a large solid left adrenal mass.

The diagnosis was adrenocortical carcinoma.

Toddler who had been abused

CT of adrenal hemorrhage — Axial CT with contrast of the abdomen show a low density fluid collection in the right adrenal gland and a right renal laceration.

The diagnosis was adrenal hemorrhage.

Infant with an abdominal mass

MRI of neuroblastoma — Sagittal T2 MRI shows a huge left adrenal mass that was noted to cross midline and encase the abdominal vasculature.

The diagnosis was neuroblastoma.

Preschooler with increased perspiration

CT of pheochromocytoma — Axial CT without contrast of the abdomen shows a large solid right adrenal mass.

The diagnosis was pheochromocytoma.

Newborn with a left upper quadrant mass

US of adrenal hemorrhge — Sagittal US of the left kidney shows a primarily cystic appearing left adrenal mass. Over months this mass was noted to decrease in size and disappear on serial ultrasound exams.

The diagnosis was adrenal hemorrhage.