Teenager with right flank pain

Ultrasound of dromedary hump — US of the left kidney (below) shows a prominent focal bulge on its lateral border that is not present on the lateral border of the right kidney (above).

The diagnosis was dromedary hump of the left kidney.

Newborn with a posterior sacral mass noted on prenatal US

Clinical image of sacrococcygeal teratoma — Clinical image shows a large exophytic soft tissue mass in the region of the sacrum.

The diagnosis was sacrococcygeal teratoma.

Newborn with an anterior abdominal wall defect and a skin covered spinal dysraphism

Clinical image of cloacal exstrophy — Clinical image (left) shows the umbilical stump superiorly and inferior to it is an anterior abdominal wall defect with bladder and cecum herniated through it. Clinical image (right) also shows the skin covered spinal dysraphic defect posteriorly.

The diagnosis was cloacal exstrophy.

Teenager with pelvic fracture from trauma who cannot void

VCUG and RUG of urethral transection — AP (upper left) and oblique (upper right) images from a voiding cystourethrogram with the bladder filled through a suprapubic catheter shows extravasation of contrast into the base of the penis when the patient attempts to void. Oblique image from a retrograde urethrogram (below) shows an inability to fill the urethra completely during retrograde injection.

The diagnosis was urethral transection confirmed at cystoscopy.

Preschooler with febrile seizure and abdominal pain

CT and US of renal abscess — Axial (left upper) and coronal (right upper) CT with contrast of the abdomen shows a round low density lesion in the lower pole of the left kidney. Transverse (lower left) and sagittal (lower right) color doppler US of the the left kidney shows the round lesion in the lower pole to be solid and avascular in nature.

The diagnosis was renal abscess.

Toddler with a left abdominal mass

US and MRI of nephroblastomatosis — The diagnosis was Wilms tumor of the left kidney and nephrogenic rests from nephroblastomatosis in the right kidney.

The diagnosis was Wilms tumor of the left kidney and nephrogenic rests from nephroblastomatosis in the right kidney.

Female infant with a bulge in the left inguinal canal

US of canal of Nuck hydrocele — Sagittal (above) and transvere (below) US images of the left inguinal canal show an oval, anechoic, non-peristalsing lesion in the left inguinal canal.

The diagnosis was canal of Nuck hydrocele.

Teenager with enuresis

US of urethral trauma — Transverse US of the prostatic urethra (upper left) shows a small round echogenic lesion with posterior shadowing in the center of the prostatic urethra which was not seen in the transverse US of the penile urethra (upper right). Sagittal US of the bladder (lower left) shows an echogenic lesion with posterior shadowing in the posterior aspect of the bladder that on transverse US of the bladder (lower right) resolved into two separate echogenic lesions with posterior shadowing.

The diagnosis was urethral trauma due to a metal axle from a toy car the patient had inserted into his urethra years before which had perforated the bladder creating a colovesical fistula and caused development of two bladder stones.

Newborn with prenatal hydronephrosis

US of Tamm Horsfall proteins — Sagittal US of the kidneys shows multiple echogenic lesions in the renal pyramids bilaterally which resolved on a repeat ultrasound performed one month later.

The diagnosis was Tamm Horsfall proteins.

School ager with anti-NMDA encephalitis

US and CT of ovarian teratoma in NMDA encephalitis — Sagittal US of the pelvis (upper left) shows the right ovary to be enlarged and to contain an echogenic lesion within it superiorly. Axial (upper right) and coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows an enlarged right ovary in the midline of the pelvis anterior to the rectum which has multiple low density lesions within it.

The diagnosis was ovarian teratoma.

Infant with a urinary tract infection who was difficult to catheterize

VCUG of prostatic utricle in hypospadias — AP (above) and lateral (below) images from a voiding cystourethrogram shows a large oval structure posterior to the posterior urethra that fills with contrast during voiding and which represents a large prostatic utricle.

The diagnosis was hypospadias.

Newborn with ambiguous genitalia

US of congenital adrenal hyperplasia — Sagittal (above) and transverse (below) US of the kidneys shows enlarged hypoechoic lesions superior to the kidneys which have a triangular shape on sagittal images and a cerebriform shape on transverse images.

The diagnosis was congenital adrenal hyperplasia.

Teenager with urinary tract infection

CT of autosomal dominant polycystic kidney disease — Axial CT with contrast of the abdomen shows multiple variably sized round low density lesions in the bilateral kidneys.

The diagnosis was autosomal dominant polycystic kidney disease.

Teenager with decreased renal function

US of autosomal dominant polycystic kidney disease — Sagittal US of both kidneys shows multiple large round anechoic lesions in the bilateral kidneys.

The diagnosis was autosomal dominant polycystic kidney disease.

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.