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.

Teenager with a decreased urinary stream

Retrograde urethrogram of pediatric urethral stricture — Lateral image of the urethra from a retrograde urethrogram shows a persistent narrowing at the junction of the posterior urethra and bulbar urethra with the bulbar urethra being dilated.

The diagnosis was urethral stricture.

School ager with nausea and vomiting

US and MAG3 nuclear medicine scan of orthotopic ureterocele — Transverse US of the bladder (above left) shows a round cystic lesion in the base of the bladder. Sagittal US of the bladder (above right) shows to the left of the image an extremely dilated left ureter and to the right of the image again the round cystic lesion in the base of the bladder. Sagittal image of the left renal fossa (below left) shows non-visualization of the left kidney. Nuclear medicine MAG3 scan (below right) shows a normal right kidney, non-visualization of the left kidney, and a round photopenic defect in the bladder.

The diagnosis was left non-functioning kidney with left hydroureter and a left orthotopic ureterocele.

Teenager after motor vehicle accident

CT of renal laceration and suspected ureter transection — Axial CT with contrast of the abdomen (above left) shows an extensive laceration of the left kidney with an associated low density retroperitoneal hematoma surrounding the left kidney. Delayed lower axial image from the same CT exam (below left) shows extravasation of high density IV contrast around the left psoas muscle. 3D CT urogram performed the next day (right) again shows massive extravasation of IV contrast medial to the left kidney with non-visualization of the left ureter suggesting ureteral transection. The right kidney and ureter are normal. However, a retrograde urogram performed the next day showed the left ureter was not transected which allowed placement of a left ureteral stent.

The diagnosis was left kidney laceration and suspected left ureteral transection which was not confirmed on a retrograde pyelogram exam.

Newborn with a mass at the umbilicus

US of umbilical granuloma — Transverse (left) and sagittal (right) US of the umbilicus shows a round hyperechoic lesion with a hypoechoic rim near the umbilical stump.

The diagnosis was umbilical granuloma.

School ager with left scrotal pain

US of torsion of the appendix testis — Sagittal US of the left scrotum at presentation (above) shows a round lesion of heterogenous echogenicity superior to the left testicle. Sagittal US of the left scrotum 2 weeks later (below) shows the lesion has decreased in size and become uniformly echogenic.

The diagnosis was torsion of the appendix testis.

Teenager with left scrotal pain

US of testicular microlithiasis — Sagittal US of the left testicle (above) and right testicle (below) shows numerous microcalcifications in the testicles bilaterally.

The diagnosis was testicular microlithiasis.

Newborn with an abdominal mass

CT of retroperitoneal teratoma — Axial (above), coronal (below left), and sagittal (below right) CT with contrast of the abdomen shows a large left-sided abdominal mass which arises from the retroperitoneum and crosses the midline and which displaces the left kidney inferiorly and posteriorly. The mass is heterogenous in nature and contains fat, is predominantly solid but has some cystic components, and it enhances minimally.

The diagnosis was retroperitoneal teratoma.

Newborn with prenatal hydronephrosis

US of Tamm Horsfall proteins — Sagittal US of the kidneys shows multiple round echogenic foci in the renal pyramids bilaterally.

The diagnosis was Tamm Horsfall proteins.

Teenager with abdominal pain and hematuria

CT of nutcracker syndrome — Axial CT with contrast of the abdomen shows stenosis of the proximal left renal vein with associated dilation of the distal left renal vein due to compression of the left renal vein between the superior mesenteric artery and aorta. There were no gonadal collaterals

The diagnosis was nutcracker syndrome.

Infant with a renal mass on prenatal ultrasound

CT of mesoblastic nephroma, cellular subtype — Coronal CT with contrast of the abdomen (below) shows a solid mass with variable enhancement with cystic components within the right kidney. Axial CT (above) shows the cystic component of the mass extends to the midline. No claw sign is present. The left kidney is normal.

The diagnosis was mesoblastic nephroma, cellular type.

Teenager with a palpable right scrotal lesion

US of epididymal cyst — Sagittal US of the scrotum shows a round lesion in the epididymis that does not have septations but does have complex fluid within it.

The diagnosis was epididymal cyst.

Newborn with an anterior abdominal wall defect

AXR of bladder exstrophy — AP radiograph of the abdomen (left) shows diastasis of the symphysis pubis. Lateral radiograph of the abdomen (right) shows a soft tissue mass protruding anteriorly out of the pelvis.

The diagnosis was bladder exstrophy.

Female teenager with 2 weeks of abdominal pain

CT of ovarian cystadenoma — Coronal (left) and axial (right) CT with contrast of the abdomen show a large multiseptated mass superior to the bladder. The left ovary was normal while the right ovary was not clearly identified.

The diagnosis was ovarian cystadenoma.

Newborn with abdominal muscle hypoplasia and bilateral cryptorchidism

AXR of prune belly syndrome — AXR AP shows bulging flanks bilaterally and low lung volumes bilaterally.

The diagnosis was prune belly syndrome.

Teenager with abdominal pain and hematuria

US and CT of nutcracker syndrome — Transverse US of the abdomen (above) shows just to the left of midline compression of the left renal vein beween the superior mesenteric artery and aorta resulting in dilation of the proximal left renal vein. Axial CT with contrast of the abdomen (below) shows this more clearly.

The diagnosis was nutcracker syndrome.

Female preschooler with pelvic pain

CT of ovarian teratoma causing ovarian torsion. — Axial (above left), sagittal (above right) and coronal (below) CT without contrast of the abdomen show a large thick walled, fluid-filled, unilocular mass just above and to the right of the bladder which contains focal areas of fat density material and calcific density material. There is a small amount of ascites.

The diagnosis was ovarian teratoma causing ovarian torsion.

School ager with neurofibromatosis Type I and hypertension

US and angiogram of bilateral renal artery stenosis due to midaortic syndrome in a patient with Neurofibromatosis Type I — Spectral doppler US of the kidneys (above) shows tardus parvus waveforms in the renal arteries bilaterally. AP image from an abdominal angiogram (below) shows bilateral stenosis of the renal arteries at their origins and progressive narrowing of the mid abdominal aorta centered near the renal artery origins with sparing of the aortic bifurcation.

The diagnosis was bilateral renal artery stenosis due to midaortic syndrome in a patient with Neurofibromatosis Type I.

Preschooler with abdominal pain

CT and ultrasound of a simple renal cyst — Axial (above left) and coronal (above right) CT with contrast of the abdomen show a round low density lesion in the upper pole of the right kidney. Sagittal US of the right kidney (below) shows an anechoic lesion in the upper pole of the right kidney that has a thin wall and no internal septations or calcifications.

The diagnosis was simple renal cyst.

Female preschooler with a urinary tract infection

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

The diagnosis was spinning top urethra.