Toddler with hypertension, flushing, and an elevated vanillylmandelic acid level

CT of pheochromocytoma — Axial CT with contrast of the abdomen shows a small, oval, homogeneously mildly enhancing solid lesion in the left adrenal gland just anterior to the left kidney.

The diagnosis was pheochromocytoma arising from the left adrenal gland.

Preschooler with an abdominal mass

CT of Wilms tumor — Axial CT with contrast of the abdomen (above) shows a large non-calcified and non-enhancing mass crossing the midline with multiple retrocrural lymph nodes present. Axial CT (below) shows the mass is arising from the upper pole of the right kidney. The right renal vein and inferior vena cava are not clearly seen.

The diagnosis was Wilms tumor of the right kidney with probable tumor invasion of the right renal vein and inferior vena cava.

Toddler with an abdominal mass

CT of neuroblastoma from right adrenal gland — Axial CT with contrast of the abdomen shows a large non-calcified low density abdominal mass arising from the right adrenal gland which crosses the midline (above) and displaces the right kidney laterally (middle) and inferiorly (below).

The diagnosis was neuroblastoma arising from the right adrenal gland.

School ager with a right abdominal mass

CT of Wilms tumor — Axial CT without contrast of the abdomen (above) show a large right renal mass with some coarse calcifications within it. Axial CT with contrast (middle and below) shows a low density mass to be arising from the hilum of the right kidney and to be approaching the midline. The inferior vena cava appears to be clear of tumor as does the left kidney.

The diagnosis was Wilms tumor.

Newborn male who has not had a wet diaper after birth

VCUG of urine ascities — AXR scout image (left) shows centralization of mildly distended bowel loops. AP image obtained at the end of a voiding cystourethrogram (right) shows left Grade V vesicoureteral reflux. The overall density of the abdomen is increased in the interval due to contrast extravasation out of the renal collecting system and extravasated contrast is outline loops of bowel and can be seen tracking up the right lateral aspect of the abdomen.

The diagnosis was urine ascites due to posterior urethral valves causing high grade vesicoureteral reflux and subsequent rupture of the renal collecting system.

Newborn with a swollen right scrotum

US of testicular torsion and hematocele — Transverse US of the right scrotum (above) shows a heterogenous appearing testicle surrounded by a complex fluid collection. Spectral doppler US of the right testicle (below) shows no arterial flow in the right testicle.

The diagnosis was testicle torsion surrounded by a hematocele.

Toddler with respiratory distress and sepsis

MRI of duplicated kidney with ectopic ureterocele — Axial T2 MRI without contrast of the upper abdomen (above right) shows a normal right kidney and the upper pole of the left kidney has a thin rim of parenchyma around an extremely large cyst. Axial T2 MRI of the lower abdomen (below left) shows the hydronephrotic lower pole of the left kidney which is rotated on its axis and a dilated hydroureter medial to it while the cystic structure posterior to the left kidney is the continuation of the left kidney upper pole cystic structure. Axial T2 MRI of the pelvis (below right) shows an oval cystic structure with a thin wall located posteriorly within the bladder. Coronal T2 MRI (above left) again shows the full extent of the dilated cystic structure in the upper pole of the left kidney, the midline hydroureter, and the cystic structure within the bladder.

The diagnosis was left duplicated kidney with an extremely obstructed upper pole and an ectopic ureterocele.

Preschooler with diarrhea

Small bowel follow through of giardiasis — AP image from late in a vintage small bowel follow through exam shows thickening of the mucosal folds in the duodenum and jejunum. There is also luminal narrowing and dilution of the barium and segmentation of the barium column in the jejunum. The ileum appears normal.

The diagnosis was giardiasis.

Newborn with a hard swollen right scrotum

US of testicle torsion — Transverse grayscale US of the testicles (above) shows the right testicle to be larger and more heterogenous in echotexture than the normal left testicle. Transverse color doppler US of the testicles (below) shows no flow in the right testicle and normal flow in the left testicle, findings which were confirmed on spectral doppler US (not provided).

The diagnosis was right testicle torsion.

Young adult with newly rising ammonia levels after bone marrow transplant

US of sinusoidal obstruction syndrome — Spectral doppler US of the left, middle and right hepatic veins from 2 days ago (left) shows them to be of normal caliber and to have normal appearing phasicity. Spectral doppler US of the left, middle, and right hepatic veins today (right) shows the hepatic veins to be compressed and difficult to see and to have spectral broadening and loss of phasicity. The flow velocity in the main portal vein had decreased by 50% between the two exams.

The diagnosis was sinusoidal obstruction syndrome.

Newborn with an abdominal mass

US of retroperitoneal teratoma — AXR (left) shows faint calcifications in the middle aspect of the right abdomen. Transverse US (above right) and sagittal US (below right) of the right lower quadrant shows a large primarily cystic mass with some solid components that is medial to and inferior to the right kidney.

The diagnosis was retroperitoneal teratoma.

School ager with a solitary right kidney

US of hypertrophied column of Bertin — Sagittal US of the right kidney (right) shows a suspicious appearing round mass-like lesion in the middle pole of the kidney which upon further scanning (left) was seen to be in continuity with the cortex of the kidney and to have the same echogenicity of the cortex of the remainder of the kidney.

The diagnosis was hypertrophied column of Bertin.

Female teenager with acute right lower quadrant pain

US of ovarian torsion — Sagittal grayscale US of the right ovary (above) shows the right ovary to be enlarged and to contain a large central hypoechoic cyst. The right ovary was 4 times larger in size than the normal left ovary. Sagittal spectral doppler US of the right ovary (below) shows arterial flow to be present in the right ovary, but the amount of arterial flow was decreased when compared to the arterial flow to the left ovary.

The diagnosis was ovarian torsion around an ovarian cyst.

Teenager with straining with urination

Retrograde urethrogram of bulbar urethral stricture — Oblique image from a retrograde urethrogram shows a fixed, marked narrowing in the bulbar urethra.

The diagnosis was bulbar urethral stricture.

Teenager in an MVA with pelvic pain and vaginal bleeding

CT of vaginal laceration and VCUG of urethral laceration — Axial CT with contrast of the lower pelvis (above left) shows a contrast-fluid level in the bladder in the anterior part of the pelvis along with a fluid-filled vagina in the middle of the pelvis that lies anterior to the rectum. There is also free fluid noted around the bladder. At a lower level in the CT (below left) the left wall of the vagina is seen to be completely disrupted and discontinuous. AP image from the voiding phase of a voiding cystourethrogram exam obtained a month later (right) shows contrast leaking out of the left side of the urethra.

The diagnosis was vaginal laceration with associated urethral laceration.

Teenager with flank pain

IVP of congenital megacalyces — Excretory phase image from a vintage intravenous pyelogram exam shows bilaterally enlarged and flattened calyces which also appear to be increased in number. The renal pelvises bilaterally are normal in appearance.

The diagnosis was congenital megacalyces.

Newborn with oligohydramnios on prenatal US and bilateral large abdominal masses and Potter’s facies on physical exam

AXR of urethral atresia — Postmortem CXR and AXR shows an extremely distended abdomen due to bilateral abdominal masses resulting in a small thorax. An umbilical catheter fragment is also present.

The diagnosis was urethral atresia causing bladder outlet obstruction resulting in bilateral hydroureteronephrosis and subsequent cystic renal dysplasia.

Male preschooler with a urinary tract infection

VCUG of Cowper duct imperforate syringocele — Lateral image of the urethra from the voiding phase of a VCUG exam shows a filling defect (arrow) in the posterior urethra.

The diagnosis was a Cowper duct imperforate syringocele.

School ager with chronic left flank pain

IVP and retrograde ureteroscopy of ureteral valve — Sagittal US of the left kidney (above) shows a moderate amount of hydronephrosis. Image from the excretory phase of an intravenous pyelogram exam (below left) shows a normal right renal collecting system and a markedly dilated left renal collecting system and proximal left ureter. Image from a retrograde ureteroscopy exam (below right) shows normal caliber of the distal and middle left ureter with a sharp area of narrowing in the proximal left ureter with a markedly dilated proximal left ureter above it.

The diagnosis was a left ureteral valve.

Infant with an umbilical mass

US of umbilical granuloma — Transverse (above) and sagittal (below) US of the umbilicus shows an oval mass which is primarily echogenic in appearance with a hypoechoic rim, which is situated close to the umbilical stump.

The diagnosis was umbilical granuloma.

Teenager with a painless right testicular mass

US of testicular epidermoid cyst — Transverse (above) and sagittal (below) color doppler US of the right testicle shows an intratesticular, round, well-marginated, hypovascular lesion which has a hyperechoic center and a hypoechoic perhiphery (target sign) and overall a whorled appearance.

The diagnosis was testicular epidermoid cyst.

Teenager with right scrotal fullness

US of scrotolith — Sagittal US of the right scrotum shows a round echogenic extratesticular lesion that does not have posterior shadowing in the superior and posterior scrotum.

Preschooler with painless right scrotal mass for 1 month

US of paratesticular rhabdomyosarcoma — Sagittal color doppler US of the left scrotum (left) shows the left testicle to be unremarkable. Sagittal (above right) and transverse (below right) color doppler US of the right scrotum shows it to be filled with a large fairly homogeneous and hypervascular mass. A discrete right testicle could not be identified on ultrasound. In the operating room, a normal right testicle was seen medial to and adherent to and almost completely encased by this large mass.

The diagnosis was paratesticular rhabdomyosarcoma.

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.