Infant with brachial plexus injury at birth

MRI of avulsion pseudomeningocele — Sagittal (left) and axial (right) T2 MRI without contrast of the cervical spine shows a left sided extradural CSF collection posterior to the spinal cord from C6 to T1.

The diagnosis was avulsion pseudomeningocele with possible avulsion of the C7 nerve root.

School ager with obstructive sleep apnea

MRI of antrochoanal polyp — Axial (left), coronal (middle), and sagittal T1 MRI with contrast of the paranasal sinuses show a left-sided polyp extending from the left maxillary sinus (center), to the nasal cavity (left), to the nasopharynx and ultimately to the oropharynx and abutting the epiglottis (right).

The diagnosis was antrochoanal polyp.

Teenager with neck pain and nausea

MRI of acute disseminated encephalomyelitis / ADEM — Axial FLAIR MRI of the brain (upper and lower left) show multiple high signal intensity lesions primarily in the white matter as well as in the medulla that enhance on T1 MRI with contrast (upper right). Sagittal T2 MRI without contrast of the cervical spine (below right) shows high signal intensity expansile lesions in the spinal cord from C2 to C7 as well as from T2 to T3.

The diagnosis was acute disseminated encephalomyelitis.

Infant with sepsis

MRI of Group B streptococcus meningitis and cerebritis — Axial (left) and coronal (right) T1 MRI with contrast of the brain show diffuse meningeal enhancement along with a large variably enhancing solid right occipital lesion that has surrounding edema.

The diagnosis was meningitis and cerebritis due to Group B streptococcus.

Former premature newborn, now 1 month old with seizures

Head US of E. coli meningitis — Coronal US of the brain (above) shows a dilated ventricular system that contains complex echogenic fluid. Axial CT without contrast of the brain (below) shows a dilated ventricular system that contains complex fluid.

The diagnosis was meningitis due to E. coli resulting in pus in the ventricular system causing communicating hydrocephalus.

Teenager with fever and mental status changes

CT of intraventricular intracranial abscess — Axial CT with contrast of the brain shows ring enhancing lesions in the anterior horn of the left lateral ventricle and faint enhancement of the ependymal lining of the ventricles. There is hydrocephalus present as well as effacement of the basilar cisterns.

The diagnosis was intraventricular intracranial abscess causing communicating hydrocephalus. When a ventriculostomy catheter was placed, pus shot out of it.

Teenager with a seizure

CT of toxoplasmosis encephalitis — Axial CT without contrast of the brain shows bilateral cortical and periventricular coarse calcifications.

The diagnosis was toxoplasmosis encephalitis.

Newborn with a full fontanelle

US of HSV-1 / herpes simplex virus-1 encephaliti — Coronal US of the brain (above) shows a round echogenic lesion in the left fronto-parietal region. Axial CT without contrast of the brain (below) shows the lesion to be high density with surrounding low density edema and felt to represent intraparenchymal hemorrhage.

The diagnosis was herpes simplex virus-1 encephalitis.

Toddler with seizures

MRI of CMV / cytomegalovirus encephalitis — Axial T1 MRI without contrast of the brain (left) shows gyral thickening compatible with pachygyria and ventriculomegaly. Axial T2 MRI (right) shows increased bright signal throughout the white matter, compatible with delayed myelination. There are also several areas of punctate low signal along the periphery of the lateral ventricles posteriorly, compatible with foci of calcification, which were confirmed on GRE images (not provided).

The diagnosis was cytomegalovirus encephalitis, which most likely occurred in the first trimester.

School ager with headache and lethargy with a recent travel history in Africa

MRI of cysticercosis — Axial T2 (above left), FLAIR (above right), T1 (below left) and T1 MRI with contrast (below right) of the brain show a small round lesion in the left frontoparietal region at the grey matter-white matter junction with a large amount of surrounding edema that enhances peripherally.

The diagnosis was cysticercosis.

Teenager who is immune suppressed with headaches

MRI of cryptococcosis — Axial FLAIR (above) MRI without contrast of the brain shows a small round lesion in the left frontal lobe with surrounding edema that demonstrates ring-shaped restricted diffusion on diffusion-weighted imaging (below).

The diagnosis was cryptococcosis.

Preschooler who had their myelomeningocele extending from L4-S5 repaired in utero

3D CT of myelomeningocele — 3D reconstruction of CT without contrast of the lumbar spine shows lack of fusion of the posterior elements of the L4-S5 vertebral bodies.

The diagnosis was myelomeningocele.

Newborn with an occipital protuberance

MRI of cervical meningocele — Axial (above left) and sagittal (below left) T1 and axial (above right) and sagittal (below right) T2 MRI without contrast of the cervical spine show a midline occipital mass which is not covered with subcutaneous fat that contains fluid centrally and which communicates via a thin tract to a protruding CSF space just below and contiguous to the cisterna magna through a discontinuity in the subcutaneous fat.

The diagnosis was a cervical meningocele.

Newborn with a skin covered bump on the back

MRI of lipomyelomeningocele — Sagittal T1 (left), T2 (middle) and T1 with contrast (right) MRI of the lumbar spine show a low-lying conus medullaris at the level of S2, which ends in a lipomatous mass that via a defect in the bone is contiguous with the subcutaneous fat posteriorly.

The diagnosis was lipomyelomeningocele.

Newborn with a bump on the left posterior skull

CT of parietal encephalocele — Axial CT without contrast of the brain shows in the left parietal region a low density cystic lesion that has a small amount of brain tissue within it laterally.

The diagnosis was parietal encephalocele.

School ager with skin stigmata along the spine

CT of diastematomyelia — AP radiograph of the spine (left) suggests a linear piece of bone in the center of the spinal canal at the L2-L3 level. Axial CT without contrast of the spine at the L2-L3 level (right) shows the spinal cord and thecal sac are bisected by a boney bridge in the center of the spinal canal. There is also evidence of vertical fusion of the spinal lamina.

The diagnosis was diastematomyelia.

Preschooler with 2 weeks of right eye swelling

MRI of rhabdomyosarcoma — Axial T1 MRI without (above left) and with contrast (above right) of the orbits show a solid homogenously enhancing mass arising superior and medially to the right orbit which shows restricted diffusion on diffusion weighted imaging (below right).

The diagnosis was rhabdomyosarcoma.

Infant with bilateral leukocoria

MRI of bilateral retinoblastoma — Axial T1 MRI with contrast of the orbits shows solid enhancing masses arising from the posterior aspect of the globes bilaterally. There was no extension into the optic nerves.

The diagnosis was bilateral retinoblastoma.

Preschooler with proptosis of the right orbit

MRI of retinoblastoma — Axial T1 without contrast (above left), coronal T2 (above right), axial T1 (below left) and coronal T1 (below right) MRI with contrast of the orbits show a large heterogenous solid mass arising from the posterior aspect of the right globe that enhances with contrast. There was no extension to the right optic nerve.

The diagnosis was retinoblastoma.

Toddler with small orbits

Axial (above) and coronal (below) CT with contrast of the orbits show bilaterally small orbits containing small optic nerves and small extraocular muscles. There is also bilaterally calcification in the center of the vitreous of the globes and colobomatous cysts inferolaterally within the orbits.

The diagnosis was microphthalmia and coloboma.

Toddler with an orbital mass

CT of orbital dermoid — Coronal (above) and axial (below) CT with contrast of the orbits show a right superolateral rounded low density mass that is not causing any bone erosion.

The diagnosis was orbital dermoid.

Toddler with an orbital mass

CT of orbital dermoid — Axial CT without contrast of the orbits in soft tissue (above) and bone windows (below) show a left superomedial rounded low density mass that is not causing any bone erosion.

The diagnosis was orbital dermoid.

Infant with an orbital mass

CT of dacrocystocele — Axial (above) and coronal (below) CT without contrast of the orbits show a left inferomedial low density bilobed mass extending from the left medial canthus through the lacrimal duct into the left inferior nasal cavity.

The diagnosis was dacrocystocele.

Toddler with left arm weakness

CT and MRI of supratentorial primitive neuroectodermal tumor — Axial CT without contrast of the brain (above left) shows an ill-defined large heterogenous right periventricular mass causing midline shift to the left. Axial T2 (above right) and T1 MRI without contrast (below left) of the brain show the mass to be fairly well circumscribed, primarily solid with some cystic components, and to show heterogenous enhancement on axial T1 MRI with contrast (below right).

The diagnosis was primitive neuroectodermal tumor.

Teenager with seizures

MRI of mesial temporal sclerosis — Coronal T2 (above) and FLAIR (below) MRI of the brain shows atrophy and sclerosis represented by bright T2 signal of the left hippocampus which also showed low metabolism on PET imaging.

The diagnosis was mesial temporal sclerosis.