School ager with left testicular pain and swelling

US of epididimo-orchitis — Sagittal (above left) and transverse (below left) color doppler US of the left testicle shows hypervascularity of the left epididymis and testicle when compared to the right testicle (above right).

The diagnosis was left epididimo-orchitis.

Newborn with oligohydramnios and hydroureteronephrosis on prenatal US

US of cystic renal dysplasia — Sagittal US of the kidneys (above) show small echogenic kidneys bilaterally with some cysts but no hydronephrosis. AP image from a VCUG (below left) shows bilateral grade 4 vesicoureteral reflux with intrarenal reflux and the bladder is trabeculated. Lateral image from the VCUG (below right) shows a urachal diverticulum arising from the dome of the bladder anteriorly. The urethra was normal.

The diagnosis was vesicoureteral reflux causing cystic renal dysplasia and an incidental urachal remnant.

Newborn with anterior abdominal wall defect

AXR of cloacal exstrophy — AXR shows diastasis of the symphysis pubis, multiple loops of bowel outside the contour of the abdomen inferiorly, and multiple segmentation anomalies in the lower lumbar spine and sacrum.

The diagnosis was cloacal exstrophy in a patient with Omphalocele-Exstrophy of cloaca-Imperforate anus–Spinal defects (OEIS) syndrome.

School ager with abdominal pain and fever

CT of adrenal hemorrhage — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen show a right adrenal mass of intermediate density. On follow-up ultrasound exams, the mass was seen to resolve over several months.

The diagnosis was adrenal hemorrhage.

Infant with prenatal diagnosis of left multicystic dysplastic kidney

US of kidney agenesis and seminal vesicle cyst / Zinner syndrome — Sagittal US of the left renal fossa (above) demonstrated that no left kidney was present in the left renal fossa or pelvis. Transverse ultrasound of the bladder (below) demonstrated a cystic structure adjacent to the left side of the bladder.

The diagnosis was left kidney agenesis and a left seminal vesicle cyst, which is Zinner syndrome.

Infant with complications from an umbilical venous catheter placed 6 months ago

US of renal vein thrombosis — Sagittal US of the kidneys shows a small shrunken left kidney and an enlarged right kidney due to compensatory hypertrophy.

The diagnosis was left renal atrophy secondary to remote left renal vein thrombosis.

School ager with hypertension and neurofibromatosis Type 1

CT angiogram and spectral doppler US of bilateral renal artery stenosis in a patient with neurofibromatosis Type 1 — 3D reconstruction of a CT angiogram with contrast of the chest and abdomen (left) shows diffuse moderate narrowing of the mid aorta and marked narrowing of the origins of the renal arteries bilaterally. Spectral doppler US of the renal arteries (right) shows parvus tardis waveforms within them bilaterally.

The diagnosis was bilateral renal artery stenosis in a patient with neurofibromatosis Type 1.

Newborn with a left abdominal mass and palpable subcutaneous nodules on the right chest wall, left thigh, and right buttock

CT of neuroblastoma Stage 4S — Coronal (above left), sagittal (above right) and axial (below left) CT with contrast of the abdomen show a large left-sided suprarenal mass which is calcified and displaces the right kidney inferiorly and posterior. Axial CT of the pelvis (below right) shows the small right gluteal subcutaneous soft tissue nodule.

The diagnosis was neuroblastoma Stage 4S.

Teenager with hyperprolactinemia

MRI of pituitary microadenoma — Sagittal (above) and coronal (below) T1 MRI with contrast of the sella shows a small mass in the midline of the sella that enhances less than the surrounding pituitary gland.

The diagnosis was pituitary microadenoma.

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.