School ager with acute right flank pain

CT of ureteral stone — Axial (left) and coronal (right) CT without contrast of the abdomen shows a dense calcification at the right ureteovesical junction. There is mild associated enlargement of the right kidney with mild inflammatory fat stranding around the right kidney.

The diagnosis was right ureteral stone at the level of the ureterovesical junction.

Infant with a right orbital mass

CT of neuroblastoma with orbital metastasis — Axial CT without contrast of the abdomen (above) shows a large mass that has faint calcifications within it that fills the entire left upper quadrant of the abdomen. Axial CT without (lower left) and with (lower right) contrast of the orbit shows a round soft tissue mass around the right pterygoid plate that enhances strongly with contrast.

The diagnosis was neuroblastoma of the right adrenal gland with metastasis to the right orbit.

School ager with spinal dysraphism and a neurogenic bladder

AXR and US of bladder stone — AXR AP (above) shows two irregularly-shaped calcified objects projecting over the pelvis. Spinal dysraphism is noted in the sacrum. There is a cecostomy tube in the right lower quadrant. Sagittal US of the bladder (below) shows an echogenic mass within the inferior aspect of the bladder (to the right of the image) that has posterior shadowing.

The diagnosis was two bladder stones in a patient with neurogenic bladder.

Infant with constipation

AXR of adrenal hemorrhage — AXR shows large triangle-shaped calcifications projecting over the right adrenal gland at the level of T10 and the left adrenal gland at the level of T11. These were noted to resolve over several months.

The diagnosis was bilateral adrenal hemorrhage.

School ager with congenital heart disease

CXR and CT of intrathoracic kidney — CXR PA and lateral (above) shows a soft tissue mass in the posterior costophrenic sulcus. Axial CT with contrast of the chest shows the right kidney in the right hemithorax.

The diagnosis was intrathoracic kidney.

Newborn with prenatal ultrasound that showed marked bilateral hydroureteronephrosis

Clinical image of prune belly syndrome / Eagle Barrett syndrome — Clinical image shows a small thorax, a bulging abdomen due to hypoplastic abdominal wall musculature, and bilateral undescended testicles.

The diagnosis was Prune Belly Syndrome.

Newborn with a defect of the lower abdominal wall

AXR of cloacal exstrophy — AXR AP shows diastasis of the symphysis pubis and multiple spinal segmentation defects while the AXR lateral shows a small amount of bowel herniated anterior to the abdomen and inferior to the umbilicus along with a large skin covered spinal dysraphism posteriorly and a radioopaque marker being held in place over where the anus should be.

The diagnosis was cloacal exstrophy with bladder exstrophy, anorectal malformation and spinal segmentation anomalies.

Newborn with a defect of the lower abdominal wall

AXR of bladder exstrophy — AXR shows diastasis of the symphisis pubis.

The diagnosis was bladder exstrophy.

Newborn with a solid renal mass on prenatal ultrasound.

Surgical image of mesoblastic nephroma — Surgical image shows an extremely large right renal tumor displacing the cecum into the left lower quadrant.

The diagnosis was mesoblastic nephroma.

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. In the operating room this mass was found to be torsed.

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.