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.

Teenager with pelvic pain

US of intrauterine pregnancy of 8 weeks gestational age — Sagittal US of the uterus shows a yolk sac (to the left) and a fetus (to the right) within a gestational sac in the uterus.

The diagnosis was intrauterine pregnancy of approximately 8 weeks gestational age.

Teenager with pelvic pain

US of 20 weeks gestational age intrauterine pregnancy — Sagittal US of the uterus shows a fetus within a fluid-filled uterus.

The diagnosis was intrauterine pregnancy of approximately 20 weeks gestational age.

Premature newborn with candidemia

US of fungal ball of urinary tract — Sagittal (above) and transverse (below) US of the right kidney shows a round echogenic lesion in the renal pelvis of the right upper pole which is outlined by fluid in the collecting system.

The diagnosis was a fungal ball of the urinary tract.

Teenager with a palpable mass in the right scrotum

US of epididymal cyst — Sagittal US (above) and transverse US (below) of the right scrotum shows a round, anechoic, simple lesion in the right epididymis. The right testicle is normal in appearance.

The diagnosis was epididymal cyst.

Teenager with syncope and vaginal bleeding who has a positive betaHCG test and who denies sexual activity

CT of ruptured ectopic pregnancy — Sagittal CT with contrast of the abdomen (above left) shows in the pelvis from anterior to posterior – a fluid filled bladder, an enhancing uterus, and a solid appearing homogenous mass compressing the rectum behind it. Coronal CT (above right) shows a large amount of free fluid in the pelvis tracking up around the liver. Axial CT (below) again shows the mass anterior to the rectum. The mass was felt to be arising from the left adnexa.

The diagnosis was ruptured ectopic pregnancy.

Preschooler with left upper quadrant pain

CT of clear cell sarcoma of the kidney — Axial CT with contrast of the abdomen (above) shows a round, heterogenously enhancing, well-defined lesion arising from the medulla of the left kidney that demonstrates a claw sign. There is also a round focus of high density in the center of the mass anteriorly. Coronal CT (below) shows fluid in the left perirenal and pararenal spaces.

The diagnosis was clear cell sarcoma of the kidney with active hemorrhage into the tumor.

Newborn female with a multicystic dysplastic kidney being investigated for vesicoureteral reflux

VCUG showing a vaginogram — Scout image from a voiding cystourethogram exam (above) shows a urinary catheter looped within the pelvis. AP image (below left) obtained after the introduction of contrast through the catheter shows filling of a structure that does not conform to the expected contour of the bladder and whose inferior aspect lies very low in the pelvis. Lateral image (below right) shows a filling defect on the superior aspect of the structure which represents the cervix projecting into a contrast-filled vagina.

The diagnosis was inadvertent performance of a vaginogram in a patient with possible vesicoureteral reflux.

School ager with fever and abdominal pain

CT of acute pyelonephritis and chronic pyelonephritis in the same kidney — Axial CT with contrast of the abdomen (above) shows the left kidney to have a striated nephrogram appearance with multiple wedge-shaped areas of low density in the left kidney. Coronal CT (below) shows the low density areas are in the upper pole of the left kidney. The lower pole of the left kidney is shrunken and scarred.

The diagnosis was acute pyelonephritis in the upper pole of the left kidney and evidence of chronic pyelonephritis in the lower pole of the left kidney.

School ager with left flank pain who underwent a Deflux injection at the left ureterovesical junction 3 days ago and now has decreased urine output

US of acute ureteral obstruction after Deflux injection — Sagittal US of the right kidney (above left) was normal. Sagittal US of the left kidney (above right) showed new moderate hydronephrosis. Transverse US of the bladder (below left) showed a normal right ureteral jet. Transverse US of the bladder (below right) shows an oval echogenic structure near the left ureterovesical junction at the base of the bladder and a left ureteral jet which is markedly less than its counterpart on the right.

The diagnosis was left acute ureteral obstruction after Deflux injection for left vesicoureteral reflux.

Teenager with spinal dysraphism

US of bladder stone in neurogenic bladder — Transverse (above) and sagittal (below) US of the bladder shows a round echogenic mass in the base of the bladder that has posterior shadowing. The bladder wall is mildly thickened.

The diagnosis was bladder stone in a patient with neurogenic bladder.

Infant with a urinary tract infection

US and VCUG of ectopic ureterocele — Sagittal US of the right kidney (above left) was unremarkable. Sagittal US of the left kidney (above right) shows a duplicated kidney with hydronephrosis of the upper pole. Sagittal US of the bladder (below left) shows a round thick walled lesion at the base of the bladder. AP image from a voiding cystourethrogram exam (below right) shows a round filling defect on the left side of the bladder.

The diagnosis was left duplicated kidney with a left ectopic ureterocele causing hydronephrosis of the upper pole.

Newborn with hydronephrosis on prenatal US

VCUG of bilateral vesicoureteral reflux — AP image from a voiding cystourethrogram exam shows bilateral vesicoureteral reflux up to the level of the single bilateral renal collecting systems, which are moderately dilated. There were normal ureteral insertions present bilaterally.

The diagnosis was bilateral vesicoureteral reflux grade III.

Newborn with left hydronephrosis on prenatal US

US of ureteropelvic junction obstruction — Sagittal US of the right kidney (above) shows a single renal collecting system with no evidence of hydronephrosis. Sagittal US of the left kidney (below) show a single renal collecting system that has a moderate amount of hydronephrosis. The left renal pelvis is also moderately dilated. There was no left hydroureter.

The diagnosis was left ureteropelvic junction obstruction.

School ager with periumbilical pain

CT of obliterated urachal remnant — Axial (above) and sagittal (below) CT with contrast of the pelvis shows a small oval solid soft tissue mass in the midline of the anterior wall / dome of the bladder.

The diagnosis was an obliterated urachal remnant.

Teenager with left flank pain

CT of renal stone at ureteropelvic junction — Axial CT without contrast of the abdomen (above left) shows a hydronephrotic left kidney with a small amount of perinephric fat stranding. There is a high density calcification associated with the inferior aspect of the left kidney (below left) that on the sagittal image (right) is seen to be at the left of the ureteropelvic junction.

The diagnosis was a renal stone at the left ureteropelvic junction.

Newborn with an abdominal cyst on prenatal US

US of neonatal ovarian cyst and a uterus under maternal stimulation of estrogen — Transverse US of the pelvis shows the fluid-filled bladder on the anterior right side of the image with a uterus with a thickened myometrium and prominent central endometrial stripe located just posterior to it. A large anechoic structure without septations is seen in the left side of the image and was felt to be associated with the right ovary.

The diagnosis was a right neonatal ovarian cyst and a uterus under maternal stimulation of estrogen.

Preschooler with chronic kidney disease

US of nephrocalcinosis — Sagittal US of the kidneys shows diffusely increased echogenicity throughout the medullary pyramids bilaterally.

The diagnosis was nephrocalcinosis.

Newborn with renal cysts on prenatal US

US of multicystic dysplastic kidney — Sagittal (above left) and transverse (above right) US of the right kidney shows an absence of renal parenchyma and multiple cysts of various sizes that do not communicate. Sagittal US of the left kidney (below) is normal.

The diagnosis was right multicystic dysplastic kidney.