Teenager with sore throat for 1 week who is now having difficulty breathing

CT of pediatric peritonsillar abscess — Axial (left) and coronal (right) CT with contrast of the head and neck show a round mass with a low density center and a thick enhancing rim that is lateral to the left palatine tonsil and which is causing mass effect on the airway.

The diagnosis was left peritonsillar abscess.

Teenager with fever and odynophagia

CT of intratonsillar abscess of right palatine tonsil — Axial (left), coronal (above right) and sagittal (below right) CT with contrast of the head and neck show a low density fluid collection in the right palatine tonsil that is surrounded by a thin enhancing rim of tissue. The airway is widely patent.

The diagnosis was intratonsillar abscess of the right palatine tonsil.

School ager with a ventriculoperitoneal shunt and a new headache

Radiograph of broken ventriculoperitoneal shunt tubing — AP radiograph of the skull (left) shows a break in the VP shunt tubing just above the right orbit. AXR (right) shows the remaining VP shunt tubing coiled in the pelvis.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing.

Infant whose anterior fontanelle appeared to close prematurely

Radiograph and CT of Wormian bone in the anterior fontanelle — AP radiograph of the skull (left) shows a bone in the region of the anterior fontanelle. 3D CT without contrast of the skull (right) shows a Wormian bone in the anterior fontanelle.

The diagnosis was Wormian bones with a Wormian bone in the anterior fontanelle.

Teenager with a VP shunt with a new headache

Radiograph of broken VP shunt tubing — AP radiograph of the neck (above) shows the VP shunt catheter is broken at the level of the mid-neck. Axial CT without contrast of the brain obtained one year ago (below left) shows the tip of the VP shunt in the left lateral ventricle and the ventricular system to be decompressed. Current axial CT without contrast (below right) shows the tip of the VP shunt to be in the left lateral ventricle and interval development of dilation of the ventricular system.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing causing interval development of hydrocephalus.

Teenager with abdominal pain

MRI of schwannoma — AXR AP (above left) shows an incidental semi-circular left paraspinal mass next to the T10-T11 vertebral bodies. Axial T1 MRI without contrast of the thoracic spine (below left) shows an isointense round mass just to the left of the vertebral body. On axial T2 MRI (below center) the mass is hyperintense and on axial T1 MRI with contrast (below right) the mass enhances avidly and homogeneously. There was no spinal extension of the mass. On coronal T1 MRI with contrast (above right) the mass is again seen to be next to the T10-T11 vertebral bodies.

The diagnosis was schwannoma.

Preschooler 1 year after medical and surgical treatment for a posterior fossa tumor

MRI of spinal drop metastases in medulloblastoma — Sagittal (left and middle) T1 MRI with contrast of the spine shows diffuse enhancement along the cerebellar folia and the anterior and posterior aspects of the entire spinal cord. Axial T1 MRI with contrast of the spine (right) shows the enhancement to be somewhat nodular in nature around the spinal cord.

The diagnosis was recurrent medulloblastoma resulting in drop metastases to the spinal cord.

Newborn with respiratory distress

US of intracerebral hemorrhage due to extracorporeal membrane oxygenation — CXR AP (above) shows the tip of the nasogastric tube in the left hemithorax. The punctate radiopaque tip of the arterial ECMO catheter projects near the aortic arch. The punctate radiopaque tip of the venous ECMO catheter projects in the right atrium. The endotracheal tube tip projects between the clavicles and the carina.

Coronal (below left) and sagittal (below right) US of the brain shows a round well-circumscribed echogenic lesion adjacent and inferior to the posterior horn of the right lateral ventricle.

The diagnosis was intracerebral hemorrhage as a complication of extracorporeal membrane oxygenation in a patient with a left-sided congenital diaphragmatic hernia.

Newborn with a seizure

MRI of Lhermitte-Duclos disease — Sagittal (above left), axial (above right) and coronal (below left) T1 MRI without contrast of the brain shows a round lesion centered in the vermis of the cerebellum that is displacing the fourth ventricle to the left. The lesion has hypointense thickened cerebellar folia giving it a striated appearance. The cerebellar folia are hyperintense on the axial T2 MRI (below). The lesion did not enhance.

The diagnosis was Lhermitte-Duclos disease.

School ager with neck pain after motor vehicle accident

CT and MRI of a cervical spine fracture through the left synchondrosis of the C1 vertebral body. — Axial (above left) and coronal (above right) CT without contrast of the cervical spine shows a relative slight diastasis of the left synchrondrosis of the C1 vertebral body when compared to the right synchondrosis. Axial T2 MRI without contrast of the cervical spine shows bright signal in the left synchrondosis (below left) of the C1 vertebral body and anterior to the left synchondrosis (below right).

The diagnosis was fracture of the cervical spine through the left synchondrosis of the C1 vertebral body.

Newborn with a brain cyst on prenatal ultrasound

MRI of intraventricular simple cyst — Axial (above left) and coronal (above right) T2 MRI and sagittal T1 MRI without contrast (below) of the brain show a thin walled round structure without septations in the posterior horn of the right lateral ventricle that follows cerebrospinal fluid signal characteristics on all MRI sequences.

The diagnosis was intraventricular simple cyst.

Newborn who has been abused

Radiograph and CT of Hangman cervical spine fracture — Lateral radiograph of the cervical spine (left) shows a large amount of prevertebral soft tissue swelling. There are fractures through the bilateral pedicles of the C2 vertebral body resulting in anterior translation of the C2 vertebral body on the C3 vertebral body. Sagittal CT without contrast of the cervical spine through the left (above center) and right (above right) pedicles better demonstrates the fractures through them as does the axial CT through the C2 vertebral body (below right).

The diagnosis was Hangman cervical spine fracture due to child abuse.

School ager with acute back pain and gait instability

MRI of myxopapillary ependymoma of the spinal cord — Sagittal T1 MRI without contrast (left), T2 MRI (center), and T1 MRI with contrast (right) of the lumbar spine shows an intradural extramedullary cylindrical solid mass that is arising from the filum terminale and which shows minimal enhancement. On T2 MRI (center) the mass has a triangular area of low signal intensity along its superior border (cap sign).

The diagnosis was a myxopapillary ependymoma of the spinal cord.

Teenager hit by a car while riding their bike

Radiograph and CT of secondary accessory ossification center of vertebral body mimicking cervical spine fracture — Lateral radiograph of the cervical spine (left) shows a small ossific fragment anterior and superior to the C6 vertebral body. There is no prevertebral swelling and the alignment of the cervical spine is normal. Sagittal CT without contrast of the cervical spine (right) shows that the ossific fragment is well corticated.

The diagnosis was a secondary ossification center of the cervical spine mimicking a cervical spine fracture.

School ager with ventriculoperitoneal shunt in clinic for routine followup

AXR of VP shunt migration from abdomen to chest — AXR taken 1 year ago (left) shows the VP shunt to be radiographically intact and its tip is coiled in the pelvis. AXR taken today (right) shows the VP shunt migrated out of the abdomen into the left chest and its tip is in the left costrophrenic angle.

The diagnosis was ventriculoperitoneal shunt malfunction due to shunt tip migration into the chest.

Teenager with a C5-C6 fracture dislocation after a motor vehicle accident

MRA of vertebral artery dissection after trauma — MRA with contrast of the neck in AP (left) and left oblique (middle) and right oblique (right) projections shows the right vertebral artery arises from the right subclavian artery and courses normally to where it enters the basilar artery. The left vertebral artery arises from the left subclavian artery but then is only faintly visualized along its course until it reconstitutes where it enters the basilar artery.

The diagnosis was occlusion of the left vertebral artery from C2 to C7 due to dissection of the left vertebral artery.

School ager with a ventriculoperitoneal shunt and new neck pain

Radiograph of breakage of VP shunt tubing in the neck — Lateral radiograph of the skull taken 7 years ago (above) shows the VP shunt to be intact inferior to the lucent shunt reservoir. Current lateral radiograph of the skull (below) shows a discontinuity in the ventriculoperitoneal shunt inferior to the lucent shunt reservoir due to a breakage of the shunt tubing.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of a breakage of the tubing in the neck.

Teenager whose ventriculoperitoneal shunt was revised 1 month ago who now has a new headache and redness along the anterior abdominal wall.

CT of a CSFoma / cerebrospinal fluid pseudocyst in the anterior abdominal wall — Axial (above) and coronal (below) CT with contrast of the abdomen shows a round low density fluid collection in the subcutaneous tissues of the right anterior abdominal wall with inflammatory changes noted around the fluid collection. In the center of the fluid collection is a coiled ventriculoperitoneal shunt.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of a CSFoma in the anterior abdominal wall due to VP shunt tip migration out of the abdomen.

School ager with a ventriculoperitoneal shunt with vomiting, diplopia, abdominal pain and newly dilated lateral ventricles

CT of CSFoma / cerebrospinal fluid pseudocyst — Axial CT with contrast of the abdomen (above) shows the VP shunt anteriorly in the abdomen coursing through a multiloculated fluid collection on the left side of the abdomen. Coronal CT (below left) shows multiple dilated loops of proximal small bowel while the sagittal CT (below right) shows the fluid collection to have at least 3 locules.

The diagnosis was a ventriculoperitoneal shunt malfunction in the form of a CSFoma.

School ager with a ventriculoperitoneal shunt who has had abdominal pain for a week and a headache for a day

CT of CSFoma / Cerebrospinal fluid pseudocyst — Axial CT without contrast of the abdomen shows a VP shunt in the anterior right abdomen that is coursing between two low density fluid collections and whose tip is in the fluid collection nearest to the midline.

The diagnosis was a ventriculoperitoneal shunt malfunction in the form of a CSFoma.

Premature newborn with apnea and bradycardia

US and MRI of choroid plexus hemorrhage — Coronal (above left) and sagittal (above right) US of the brain show the right lateral ventricle to be filled with echogenic material and to be dilated. Axial GRE MRI without contrast of the brain obtained 1 month later (below) shows dark signal representing hemosiderin in the choroid plexus of the right lateral venticle. There is no hemosiderin in the right germinal matrix.

The diagnosis was right choroid plexus hemorrhage.

Infant with a ventriculoperitoneal shunt who has projectile vomiting

CT of overshunting of the ventricular system — Axial CT without contrast of the brain show a ventriculoperitoneal shunt entering from a right parietal approach whose tip projects over the anterior horn of the right lateral ventricle. The ventricular system is completely collapsed and cannot be seen.

School ager with parasomnias and gait disturbance

MRI of diffuse midline glioma — Axial FLAIR MRI without contrast of the brain (above left) shows the pons to be enlarged and to have increased signal intensity throughout. There is also increased signal intensity in the medial aspect of the left temporal lobe. Going upwards in the brain (above right and below) the increased signal intensity is seen in the midbrain and in the left basal ganglia and thalamus.

The diagnosis was diffuse midline glioma.

Teenager with a malignant bone tumor who has headaches and vomiting

CT of brain metastasis from osteosarcoma — Axial CT without contrast of the brain shows a large dense lesion in the posterior aspect of the right cerebral hemisphere which has high density calcification along its most posterior aspect. The lesion is surrounded by low density vasogenic edema.

The diagnosis was brain metastasis in a patient with osteosarcoma.

Toddler with lethargy

MRI of atypical teratoid rhabdoid tumor — Sagittal T1 MRI without contrast of the brain (above left) shows a large, isointense, heterogenous but primarily solid mass arising in the region of the pineal gland. On axial T2 MRI without contrast (above right) the mass is also isointense but has some cysts within it. Axial DWI MRI (below left) shows diffusion restriction in the mass while axial T1 MRI with contrast (below right) shows heterogenous enhancement of the mass.

The diagnosis was atypical teratoid rhabdoid tumor.