Premature newborn with a large sacral mass

Radiograph of sacrococcygeal teratoma — AXR shows a large soft tissue mass arising in the region of the sacrum.

The diagnosis was sacrococcygeal teratoma.

Toddler with a right-sided abdominal mass

MRI of Wilms tumor — AXR (above left) shows displacement of the bowel out of the right side of the abdomen. Sagittal US of the right kidney (above right) shows a large right renal mass that spares the upper pole of the right kidney. Coronal T1 MRI with contrast of the abdomen (below left) shows a large mass that is heterogenous in appearance that arises from the lower pole of the right kidney and that is demonstrating a claw sign superiorly. Axial T2 MRI (below right) again shows the heterogenous nature of the mass due to hemorrhage and necrosis.

The diagnosis was Wilms tumor.

Teenager after a motor vehicle accident

CT of ovarian cyst — Axial CT with contrast of the pelvis shows a distended contrast-filled bladder in the center of the image and contrast in the distal left ureter adjacent to the normal left ovary and contrast in the distal right ureter adjacent to the right ovary which contains a round low density lesion in its center. There is also a small amount of physiologic free fluid in the pelvis

The diagnosis was right ovarian cyst.

Preschooler with right scrotal pain

Color doppler US of epididymitis — Sagittal color doppler US of the right scrotum shows increased flow to the right epididimis compared to the flow in the right testicle, which was shown to be present on spectral doppler US.

The diagnosis was right epididymitis.

Infant with urinary tract infection

VCUG of an everting ectopic ureterocele — Sagittal US of the right (above left) and left (above right) kidneys shows parenchymal bars of tissue between the upper and lower poles of each kidney. Transverse US of the bladder (middle left) shows a round cystic structure on the right side of the bladder. Sagittal US of the bladder (middle right) shows the right ureter in continuity with the cystic structure within the bladder. AP image of the bladder (below left) obtained at the start of filling the bladder during a voiding cystourethrogram (VCUG) shows a round filling defect in the right base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows the previously seen filling defect in the base of the bladder has everted out of the bladder and now appears as a contrast filled structure to the right of the bladder.

The diagnosis was bilaterally duplicated kidneys with a right everting ectopic ureterocele.

Newborn with a cystic mass in the left kidney on prenatal US

US of duplicated kidney with multicystic dysplastic kidney in the lower pole — Sagittal US of the left kidney shows a normal appearing upper pole. The lower pole has two large cysts, of different sizes, that do not communicate.

The diagnosis was duplicated kidney with a multicystic dysplastic kidney in the lower pole of the left kidney.

Infant with a diaper that is never dry

VCUG of ectopic ureter inserting into the urethra — Sagittal US of the right kidney (above left) is normal while sagittal US of the left kidney (above right) shows a parenchymal bar between the upper and lower pole collecting systems. AP image of the bladder (below left) obtained during filling of the bladder during a voiding cystourethrogram (VCUG) shows right-sided vesicoureteral reflux into a dilated collecting system with the right ureter inserting normally into the base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows new left-sided grade I vesicoureteral reflux with the left ureter inserting into the urethra.

The diagnosis was a left duplicated kidney with an ectopic insertion of the left ureter into the urethra and right Grade III vesicoureteral reflux.

Infant with a urinary tract infection

US and VCUG of duplicated kidney with everting ectopic ureterocele — Sagittal US of the upper pole of the left kidney (above left) shows a duplicated kidney with hydronephrosis of the upper pole collecting system. Sagittal US of the bladder (above right) shows a large cystic structure at the base of the bladder. AP image of the bladder (below left) obtained at the start of filling of the bladder during a voiding cystourethrogram (VCUG) shows a large filling defect in the base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows the previously seen filling defect in the base of the bladder has everted out of the bladder and now appears as a contrast filled structure to the left of the bladder.

The diagnosis was a left duplicated kidney with an everting left ectopic ureterocele.

Newborn with bilateral adrenal masses on prenatal ultrasound which were decreasing in size over time

US of bilateral adrenal hemorrhage — AXR (above) shows faint linear calcification in the adrenal glands bilaterally. Sagittal US of the left adrenal gland (below left) and right adrenal gland (below right) show the adrenal glands to be slightly enlarged and to have central echogenic foci within them.

The diagnosis was resolving bilateral adrenal hemorrhage.

Toddler with opsoclonus and myoclonus

CT and MRI of presacral neuroblastoma — Axial CT with contrast of the pelvis (above) shows (from top to bottom in the midline) contrast in the base of the bladder, contrast in the rectum which is deviated to the right, and a solid soft tissue mass anterior to the sacrum. Axial (below left) and sagittal (below right) T2 MRI without contrast of the pelvis shows the presacral mass to have high signal intensity.

The diagnosis was presacral neuroblastoma.

Toddler with abdominal pain and distension, hematuria and lethargy for 2 months

CT of Wilms tumor with lung metastases, liver metastases, and IVC invasion — Axial (above right), coronal (below middle) and sagittal (below right) CT with contrast of the abdomen shows a large heterogenous non-calcified mass that fills the entire left side of the abdomen. The inferior vena cava (to the right of the aorta) was distended with tumor thrombus. Multiple liver (above left) and lung (below left) lesions are also seen.

The diagnosis was Wilms tumor with liver metastases and lung metastases and invasion of the inferior vena cava.

Preschooler with abdominal pain

CT of cystic Wilms tumor — Axial (left) CT with contrast of the abdomen shows a large cystic mass with septations in the left side of the abdomen. Coronal immediate image (above right) shows a claw sign proving the left kidney is the organ of origin of the mass. Coronal delayed image (below right) shows the mass has a mural nodule superiorly within it.

The diagnosis was cystic Wilms tumor.

Preschooler with gross hematuria

CT of bilateral Wilms tumor — Axial (left) and coronal (right) CT with contrast of the abdomen shows a large rounded solid heterogenous mass arising from the upper pole of the right kidney and a large rounded solid heterogenous mass arising from the center of the left kidney.

The diagnosis was bilateral Wilms tumor.

School ager with a cough for 1 month

CXR and CT of thoracic ganglioneuroma — CXR PA and lateral (above) show a large mass in the posterior mediastinum which is deforming the right 6th through 12th ribs. Axial CT without contrast of the chest (below) shows the mass to extend across the midline and to have small areas of calcification within it. At the level of the diaphragm there was extension of tumor into the spinal canal.

The diagnosis was thoracic ganglioneuroma.

Newborn with posterior mediastinal mass on prenatal US

CXR and CT and MRI of thoracic ganglioneuroblastoma — CXR AP (above left) shows a soft tissue mass in the left superior chest causing spreading and erosion of the left first and second rib, and increased distance between the left C7 and T1 transverse processes. Axial CT without contrast of the chest (above right) shows the mass to be densely calcified, in the posterior mediastinum, and displacing and compressing the trachea. Coronal (below left) and sagittal (below right) T1 MRI without contrast of the chest show a posterior mediastinal mass from C7 to T3 that has intraspinal extension.

The diagnosis was thoracic ganglioneuroblastoma.

Infant with febrile urinary tract infection

US and VCUG of vesicoureteral reflux and neurogenic bladder — Sagittal US of the right kidney (above) shows moderate hydronephrosis. AP image from a voiding cystourethrogram (below) shows right-sided vesicoureteral reflux into a dilated collecting system and a trabeculated bladder. The urethra was normal in appearance.

The diagnosis was right Grade III vesicoureteral reflux and a neurogenic bladder.

School ager with left flank pain

US of congenital megaureter — Sagittal US of the left kidney (above) and left ureterovesical junction (below) show moderate hydroureteronephrosis. There was no evidence of a urinary tract stone. A subsequent voiding cystourethrogram showed no evidence of vesicoureteral reflux.

The diagnosis was congenital megaureter.

School ager with right flank pain and hematuria after falling off a table

CT of hemorrhage into ureteropelvic junction obstruction after trauma — Coronal (above left) and sagittal (above right) CT with contrast of the abdomen show an extremely dilated right renal collecting system surrounded by an extremely thin rim of renal cortex. The axial image (below) shows high density material within the medial aspect of the renal collecting system.

The diagnosis was hemorrhage into a severe right ureteropelvic junction obstruction in a patient with renal trauma.

Infant with right hydronephrosis on prenatal US

VCUG of ectopic ureterocele — AP images from a voiding cystourethrogram (above) show a lucent filling defect in the base of the bladder. Oblique image (below) shows reflux into an extremely dilated right renal collecting system. The right ureter inserts into a dilated structure that is inside and outside of the bladder.

The diagnosis was a right ectopic ureterocele causing vesicoureteral reflux Grade V in a patient with a right duplicated kidney.

Infant with umbilical discharge

US of urachal sinus — Sagittal US of the lower abdomen just inferior to the umbilicus (above) shows a hypoechoic, blind-ending tubular structure that originates from the bladder and which extends inferiorly. Lateral image from a voiding cystourethrogram (below) shows no communication between the bladder and the umbilicus.

The diagnosis was urachal sinus.

Newborn whose right testicle is harder and smaller than the left testicle

US of prenatal testicle torsion — Sagittal US of the left scrotum (above) shows a normal appearing left testicle. Transverse US of the right scrotum (below) shows a small round echogenic lesion with extensive posterior shadowing that was felt to represent the remnant of an infarcted and calcified testicle.

The diagnosis was right prenatal testicle torsion.

Newborn with an enlarged and firm left testis

US of testicle torsion — Sagittal color doppler US of the right testicle (left) shows a normal appearing testicle and epididymis. Sagittal color doppler US of the left testicle (right) shows the testicle to be enlarged and heterogenous. There was no flow in the left testicle on spectral doppler.

The diagnosis was left testicle torsion.

School ager with meatal stenosis and abdominal pain and fever

CT of acute pyelonephritis and chronic pyelonephritis — Coronal (above) and axial (below) CT with contrast of the abdomen shows multiple peripheral wedge-shaped areas of low density in the upper and middle left kidney. The right kidney is noted to be significantly smaller in size than the left kidney.

The diagnosis was acute pyelonephritis of the left kidney and chronic pyelonephritis of the right kidney.

Infant with a urinary tract infection

VCUG of posterior urethral valves — Oblique image from a voiding cystourethrogram (left) shows left vesicoureteral reflux up into a non-dilated left renal collecting system (Grade 2 vesicoureteral reflux). The posterior urethra appears dilated. Magnified lateral image of the urethra (right) shows the dilation of the posterior urethra is due to a fixed narrowing in the posterior urethra.

The diagnosis was left grade II vesicoureteral reflux in a patient with posterior urethral valves.

Teenager with right groin pain

CT of paraganglioma — Axial CT with contrast of the abdomen shows a solid, enhancing, round, heterogenous mass anterior to and between the aorta and inferior vena cava.

The diagnosis was paraganglioma.