Female school ager with acute urinary retention

US of hematocolpos — Sagittal US of the pelvis (above) shows the uterus (upper left) to have a pubertal appearance and to have no fluid within it while the vagina (to the right) is massively distended with heterogeneous appearing fluid. Transverse US of the pelvis better shows the complex nature of the fluid in the vagina.

The diagnosis was hematocolpos.

Male toddler with a left groin mass

US of encysted hydrocele of spermatic cord — Sagittal (above) US of the left groin shows an anechoic fluid collection in the left inguinal canal that does not communicate with the peritoneal cavity above or the scrotum below. Transverse US (below) better shows the septation within the fluid collection.

The diagnosis was an encysted hydrocele of the spermatic cord.

Female infant with a left inguinal bulge

US of canal of Nuck hernia containing uterus and ovary — Transverse US of the left inguinal canal (above) shows a uterus within the inguinal canal while a sagittal US (below) again shows the uterus in the superior inguinal canal and a cystic structure in the inferior inguinal canal.

The diagnosis was hydrocele of the canal of Nuck containing the uterus and the left ovary and thus this is a canal of Nuck hernia.

Teenager with hematuria

The diagnosis was dromedary hump of the left kidney.

Teenager with new hematuria who is being treated with cyclophosphamide for lymphoma

CT of cyclophosphamide induced cystitis — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen shows diffuse thickening of the bladder wall and hyperemia of the bladder mucosa.

The diagnosis was cyclophosphamide induced cystitis.

School ager who wets his pants after voiding

VCUG of Cowper duct perforate syringocele — Lateral images from a voiding cystourethrogram exam during voiding (above) show a long tubular tract filled with contrast inferior to the contrast filled urethra. Lateral image after voiding (below) shows retained contrast pooling in the tubular tract.

The diagnosis was Cowper duct perforate syringocele.

Teenager with bilateral hydronephrosis

IVP of congenital megacalyces — AP excretory phase image from a vintage intravenous pyleogram exam shows bilaterally an overall increased number of calyces in the kidneys. The calyces are enlarged and have a flattened appearance. The renal pelves are normal in size. The kidneys are draining bilaterally without obstruction into the bladder.

The diagnosis was congenital megacalyces.

Teenager with congenital adrenal hyperplasia

US of congenital adrenal hyperplasia with bilateral testicular adrenal rests — Sagittal US of the bilateral testicles shows cerebriform appearing adrenal tissue within each testicle.

The diagnosis was congenital adrenal hyperplasia with bilateral testicular adrenal rests.

Newborn with one perineal opening for their vagina and urethra and rectum

VCUG showing a cloacal malformation — Lateral image from a voiding cystourethrogram exam performed through a suprapubic tube shows a contrast filled bladder (to the left), retrograde filling of the colon (to the right), and incidental vesicoureteral reflux into a non-dilated ureter (in the middle). The patient is also voiding and the contrast filled urethra is seen to join into a common channel with the colon and the contrast flows through the common channel before it exits the body.

The diagnosis was cloacal malformation.

Infant who is post right inguinal hernia repair who has urine leaking out of their wound

VCUG of extraperitoneal bladder leak — AP image from a voiding cystourethrogram shows contrast leaking out of the right side of the bladder into an extraperitoneal location.

The diagnosis was extraperitoneal bladder rupture due to bladder trauma from surgery.

Infant with renal failure

US of autosomal recessive polycystic kidney disease — Sagittal US of the right kidney shows the kidney to be enlarged, diffusely echogenic, and to be composed almost entirely of microcysts. The left kidney (not provided) was identical in appearance. The liver is echogenic in appearance as well.

The diagnosis was autosomal recessive polycystic kidney disease.

School ager who fell and was stepped on by a horse

CT of autosomal dominant polycystic kidney disease — Axial CT with contrast of the abdomen (above left) shows a large laceration in the middle of the right lobe of the liver that is associated with a large amount of hemoperitoneum inferior to the liver (below left). Coronal CT (right) shows multiple large cysts scattered throughout the cortex and medulla in both kidneys.

The diagnosis was autosomal dominant polycystic kidney disease in a patient with a liver laceration.

Teenager with tuberous sclerosis and abdominal pain

CT of angiomyolipomas — Axial CT with contrast of the abdomen shows a small round low density lesion in the posterolateral aspect of the left kidney (above) and a larger round low density lesion in the posterior aspect of the right kidney (below). There is also an intermediate density round lesion in the anteromedial aspect of the left kidney (above).

The diagnosis was angiomyolipomas of the kidneys in a patient with tuberous sclerosis with the left anteromedial lesion having microscopic fat and the left posterolateral and right posterior lesions having macroscopic fat.

Preschooler with Cushing syndrome

CT of adrenocortical carcinoma — Axial (above) and coronal (below) CT without contrast of the abdomen show a large solid nodular mass in the region of the right adrenal gland. The left adrenal gland is normal.

The diagnosis was adrenocortical carcinoma.

Newborn with hydronephrosis on prenatal US

US of uterus under maternal stimulation of estrogen — Transverse (above) and sagittal (below) US of the uterus show the uterus to be enlarged in size and to have a prominent endometrial stripe.

The diagnosis was a normal post natal uterus under maternal stimulation of estrogen.

Teenager with flank pain

CT and VCUG of bilateral orthotopic ureteroceles — Coronal (above left) and axial (below left) CT without contrast of the abdomen show single renal collecting systems bilaterally along with bilateral oval fluid-filled structures superior and posterior to the bladder near the ureterovesical junctions. AP image from a voiding cystourethrogram exam (right) shows two large round filling defects in the bladder.

The diagnosis was bilateral orthotopic ureteroceles.

Toddler with right testicular swelling

US of testicular microlithiasis — Sagittal US of the left testicle (above) shows multiple punctate calcifications throughout the testicle. Sagittal US of the right testicle (below) again shows multiple punctate calcifications throughout the testicle. There is also an anechoic structure superior and inferior to the right testicle.

The diagnosis was bilateral testicular microlithiasis and a right hydrocele.

School ager with incontinence

CT of spinning top urethra — Coronal MIP simulating an intravenous pyelogram (above left), coronal (above right) and axial (below) CT urogram with contrast shows the right kidney to be duplicated. There were normal ureteral insertions bilaterally into the bladder (not pictured). There was an oval structure inferior to the bladder that appeared to be the posterior urethra.

The diagnosis was spinning top urethra in a patient with a right duplicated kidney.

School ager with acute right lower quadrant pain

CT of acute pyelonephritis — Coronal (above) and axial (below) CT with contrast of the abdomen shows three peripheral wedge shaped areas of low density in the middle and lower right kidney.

The diagnosis was acute pyelonephritis of the right kidney.

Teenager with Factor 8 deficiency who took a knee to the left groin and now has back pain

CT of retroperitoneal hematoma of psoas muscle and iliacus muscle — Axial CT with contrast of the abdomen shows asymmetrical enlargement of the left psoas muscle and left iliacus muscle.

The diagnosis was retroperitoneal hematoma in the left psoas and left iliacus muscles.

Teenager with fever and abdominal pain

CT of retroperitoneal fasciitis — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the abdomen shows a large of amount of air in the right posterior pararenal space with associated fat stranding. The appendix was normal in size and there was an appendicolith that was outside of the appendix (not provided).

The diagnosis was right retroperitoneal fasciitis due to perforated appendicitis.

Teenager with an incidental renal cyst containing calcium on US

CT of renal milk of calcium cyst — Coronal (above left), sagittal (above right) and axial (below left) CT without contrast of the abdomen show a round low density lesion in the inferior pole of the right kidney that has a cresenteric calcification next to the wall of its inferior-posterior aspect. Axial CT with contrast of the abdomen (below right) more clearly shows the calcification next to the wall of the inferior-posterior aspect of the low density lesion in the kidney.

The diagnosis was renal milk of calcium cyst.

Female teenager with acute onset of right lower quadrant pain and nausea and vomiting

CT of ovarian cystadenoma — Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the abdomen show a large, well circumscribed, homogenous, non-enhancing, fluid density mass that fills the width of the lower abdomen and pelvis and lies superior and separate from the bladder and uterus. Neither ovary was clearly identified.

The diagnosis was ovarian cystadenoma.

Female teenager with abdominal pain

CT of uterus didelphys or bicornuate uterus — Sequential axial CT with contrast of the abdomen shows a fluid-filled bladder in the anterior aspect of the pelvis that has a soft tissue structure posterior to it, believed to be the uterus, that is composed of what appear to be left and right horns.

The diagnosis was Mullerian duct anomaly in the form of a uterus didelphys or a bicornuate uterus.

Female teenager with right lower quadrant pain

MRI of unicornuate uterus — Sequential coronal T2 MRI without contrast images of the pelvis show the uterus to consist of a single fluid filled dilated right horn (above) which empties into the vagina (below).

The diagnosis was Mullerian duct anomaly in the form of right unicornuate uterus.