Preschooler with a cystic structure in the right kidney

CT of simple renal cyst — Coronal (left) and axial (above right) images from a CT with contrast of the abdomen obtained soon after the injection of contrast (nephrographic phase) show a claw sign in the right kidney encasing a large round low density lesion in the lower pole of the right kidney. The Hounsfield unit of the cystic lesion was that of water. Axial delayed image (excretory phase) from the same exam (below right) shows no contrast in the cystic structure.

The diagnosis was a simple renal cyst and not a calyceal diverticulum.

School ager male with excessive post-void dribbling

VCUG of prostatic utricle cyst — Lateral image from early in a VCUG exam (left) shows the catheter in a cystic structure that is posterior to the posterior urethra which has a thin line of contrast in it. Lateral image from later in the study during voiding (right) shows the clear communication between the posterior urethra and the cystic structure posterior to it.

The diagnosis was prostatic utricle cyst.

Teenager with irregular menses

US of polycystic ovarian syndrome — Sagittal US of the pelvis shows a normal uterus (above) and enlarged ovaries bilaterally (below), with each ovary containing a larger number of follicles (>20) than normal.

The diagnosis was polycystic ovarian syndrome.

Female teenager with left lower quadrant pain

CT of paraovarian cyst and ovarian cyst — Coronal (left) and axial (above left) CT with contrast of the abdomen shows a large, simple, fluid-filled structure above the bladder which is arising from the left ovary. Axial CT (below right) obtained more inferiorly shows a second, smaller, fluid-filled structure in the midline between the uterus and rectum which is in close association with the right ovary which is just to the right of the uterus.

The diagnosis was a large left ovarian cyst and a right paraovarian cyst.

Female teenager with right lower quadrant and pelvic pain, normal WBC and a negative pregnancy test

US of hemorrhagic ovarian cyst — Sagittal transabdominal US of the pelvis shows a diffusely hyperechoic mass in the right adnexa that was within the right ovary.

The diagnosis was hemorrhagic ovarian cyst.

Female teenager with pelvic pain, normal WBC and a negative pregnancy test

US of simple ovarian cyst — Transverse transabdominal US of the pelvis (above) shows a round anechoic mass that is inferior to the bladder and to the left of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature.

The diagnosis was a simple ovarian cyst.

Female teenager with right lower quadrant pain, normal WBC and a negative pregnancy test

US of simple ovarian cyst — Transverse transabdominal US of the pelvis (above) shows a round mass of mixed echogenicity that is inferior to the bladder and to the right of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature with several much smaller cysts around it.

The diagnosis was a simple ovarian cyst.

Infant with pus draining from the umbilicus

US of urachal cyst — Sagittal (above) and transverse (below) US of the infraumbilical region in the midline shows a round structure superior and anterior to the bladder that is primarily hypoechoic in appearance with an echogenic center.

The diagnosis was an infected urachal cyst.

School ager in a motor vehicle accident

CT of renal laceration — Axial CT with contrast of the abdomen shows a laceration in the posterior aspect of the left kidney. There is isodense fluid in the left perirenal and pararenal spaces.

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

School ager with right scrotal pain

US of epididimo-orchitis — Sagittal grayscale US (left) shows a morphologically normal appearing right epididymis and testicle while the color doppler US (right) shows increased flow to the right testicle.

The diagnosis was right orchitis.

Teenager post motor vehicle accident

CT of obliterated urachal remnant — Axial CT with contrast of the abdomen shows a small, round, solid structure in the midline anterior to the bladder, which arises from the dome of the bladder and courses superiorly towards the umbilicus.

The diagnosis was an obliterated urachal remnant.

Toddler with a left-sided abdominal mass

US and CT of adrenal neuroblastoma — Sagittal US of the left kidney (above left) shows a large, solid, hyperechoic mass superior to the left kidney. Axial CT with contrast of the abdomen (above right) shows an ill-defined solid mass in the region of the left adrenal gland, which (below right) crosses the midline and encases the mesenteric vasculature. Axial CT without contrast of the brain (below left) shows a lytic lesion in the right mandible.

The diagnosis was neuroblastoma arising from the left adrenal gland with metastases to the skull.

Fetus with cystic abdominal mass on prenatal ultrasound

US of ovarian torsion due to neonatal ovarian cyst — Transverse US of the fetus (above) shows an anechoic mass in the left side of the abdomen anteriorly. Post natal sagittal US images of the mass (below) show the mass to have mixed cystic and solid components.

The diagnosis was ovarian torsion of the left ovary due to a neonatal ovarian cyst.

Newborn with a cystic kidney on prenatal ultrasound

US of multicystic dysplastic kidney — Sagittal US of the right kidney (above) shows it to contain multiple cysts of various sizes that do not communicate. There is also a paucity of renal parenchyma. Sagittal US of the right kidney 1 month later (below) again shows multiple cysts of various sizes that do not communicate and interval decrease in the amount of renal parenchyma present.

The diagnosis was multicystic dysplastic kidney.

Teenager playing ice hockey who was hit hard by another player into the boards

CT of perirenal hematoma in a patient with a ureteropelvic junction obstruction — Axial CT without contrast of the abdomen (above) shows the unenhanced right kidney to have a low density dilated central collecting system and to be surrounded by a high density cresenteric fluid collection in the right perirenal space. Axial CT with contrast (below) better shows the low density dilated central collecting system and a decreased amount of enhancement in the right kidney when compared to the normal left kidney. The amount of enhancement in the right kidney is the same density as the right perirenal fluid collection.

The diagnosis was a right perirenal hematoma in a patient with right ureteropelvic junction obstruction.

Female school ager with abdominal distension

US and MRI of ovarian endodermal sinus tumor — AXR (above left) shows displacement of the bowel loops to the left upper quadrant. Sagittal US of the abdomen (above right) shows a large solid heterogenous intraperitoneal mass in the lower right abdomen whose organ of origin was uncertain. There was a large amount of ascites. Coronal (below left) and sagittal (below right) T1 MRI with contrast of the abdomen shows a large right-sided mass that was oval in shape with smooth contour with multiple cystic lobulations with enhancing septae within it superiorly with it being more solid inferiorly and which appeared to be adherent to the right ovary.

The diagnosis was ovarian endodermal sinus tumor.

Male toddler with a swollen right scrotum after having been taken cross country skiing in their parents baby backpack

US of testicular hematocele — Transverse US of the scrotum (above) shows the right scrotum to be larger in size than the left scrotum. Transverse (below left) and sagittal (below right) US of the right scrotum shows the right testicle to be intact, however it is surrounded by a complex septated fluid collection.

The diagnosis was testicular hematocele.

Teenager kicked in the left scrotum

US of testicular hematocele — Sagittal US of the left testicle (above) shows the left testicle to be intact, however the transverse US (below) shows the left testicle surrounded by an echogenic fluid collection.

The diagnosis was testicular hematocele.

Teenager with right flank pain when drinking large amounts of soda pop

IVP of retrocaval ureter — AP image from the excretory phase of a vintage intravenous pyelogram (left) shows a normal left renal collecting system and left ureter and an extremely dilated right renal collecting system. Magnified views of the right ureteropelvic junction (right above and right below) show a sharp kink at the right ureteropelvic junction.

The diagnosis was retrocaval ureter causing right ureteropelvic junction obstruction.

Female infant with a purple mass protruding from her vagina

US and IVP of prolapsed ectopic ureterocele — Sagittal US of the vaginal mass (above left) shows it to be cystic in nature. Sagittal US of the right kidney (middle left) shows moderate hydronephrosis of the upper and lower poles of a duplicated renal collecting system. Sagittal US of the left kidney (below left) shows marked hydronephrosis of the upper pole and moderate hydronephrosis of the lower pole of a duplicated renal collecting system. Excretory phase of a vintage intravenous pyelogram (right) shows on the right a moderately hydronephrotic duplicated renal collecting system and on the left an obstructed nonopacified nonfunctional upper pole collecting system which displaces the opacified functional moderately hydronephrotic lower pole collecting system inferolaterally (drooping lily sign).

The diagnosis was prolapsed ectopic ureterocele from the upper pole of the left kidney in a patient with bilateral duplicated kidneys.

Female teenager with hirsuitism and virilization

CT of adrenocortical carcinoma — Axial CT with contrast of the abdomen shows a large solid mass mass in the left adrenal gland that has heterogenous enhancement.

The diagnosis was adrenocortical carcinoma.

Preschooler with a palpable midline abdominal mass

AXR and US and CT of rhabdomyosarcoma of the bladder — AXR (above left) shows a soft tissue mass in the mid abdomen displacing the bowel loops superiorly. Transverse and sagittal US of the mass (below left) show a solid, homogenous, lobulated mass. Axial CT with contrast of the abdomen (below right) shows a large heterogeneous mass in the mid to left abdomen with a low density center and swirling enhancement. There was a suggestion of direct tumor invasion into the right rectus muscle anteriorly (above right) and the bladder inferiorly.

The diagnosis was rhabdomyosarcoma arising from the dome of the bladder.

Toddler with urinary tract infection

IVP of bilateral duplicated kidneys and ectopic ureteroceles — Post void excretory phase image from an intravenous pyelogram exam shows bilateral duplication of the kidneys. Within the collapsed bladder are two round filling defects.

The diagnosis was bilateral duplicated kidneys with bilateral ectopic ureteroceles.

Toddler with moderate to marked right hydronephrosis on ultrasound

IVP of ureteropelvic junction obstruction due to a crossing vessel — AP image from the excretory phase of an intravenous pyelogram (above) shows a normal left renal collecting system and a markedly dilated right renal collecting system. No contrast was seen in the right ureter. AP image from a retrograde pyelogram (below) shows a markedly dilated right renal collecting system and a narrowing and tortuosity to the proximal right ureter.

The diagnosis was right ureteropelvic junction obstruction due to a crossing vessel.

Preschooler male with acute urinary retention

US and CT of rhabdomyosarcoma of the prostate. — Sagittal US of the pelvis (above) shows an anechoic distended bladder superiorly and an echogenic mass posterior and inferior to the bladder. Axial CT with contrast of the pelvis (below) shows a round heterogenous necrotic mass in the center of the pelvis that is displacing the bladder superior and anteriorly.

The diagnosis was rhabdomyosarcoma of the prostate.