Infant who is status post cardiac arrest

CT of hypoxic ischemic encephalopathy and interhemispheric subdural hematoma in child abuse
Axial CT without contrast of the brain shows decreased density of the cerebrum when compared to the density of the cerebellum. There is also loss of gray matter-white matter differentiation and effacement of the cerebral sulci and the basal cisterns. There is linear increased density present along the entire falx.

The diagnosis was hypoxic ischemic encephalopathy and interhemispheric subdural hematoma in a child abuse patient.

Toddler with left hearing loss

CT of acoustic neuroma
Axial CT without contrast of the temporal bones shows the left internal auditory canal (right) is smoothly expanded and much larger than the right internal auditory canal (left). This enlargement of the left internal auditory canal corresponded to the location of an enhancing mass within it on an MRI of the brain performed with contrast from an outside institution.

The diagnosis was left acoustic neuroma.

Teenager with new onset seizure

CT and MRI of glioblastoma
Axial CT without contrast of the brain (above left) shows a hypodense, ill-defined, infiltrative mass centered in the left basal ganglia that contains coarse calcifications. Axial T2 (above right), T1 without contrast (below left) and T1 MRI with contrast (below right) of the brain show the mass to be heterogenous in nature and to have some heterogenous areas of enhancement.

The diagnosis was glioblastoma.

Teenager with back pain and lumbar scoliosis for 1 year

MRI of ganglioglioma of the spinal cord
Sagittal T1 (above left) and T2 (above middle) MRI of the spine show an intramedullary tumor of the spinal cord extending from T10 to T12 that on sagittal T1 MRI with contrast (above right) shows heterogenous enhancement. Axial T2 MRI (below) better demonstrates the cord expansion caused by the tumor.

The diagnosis was ganglioglioma of the spinal cord in a patient with painful scoliosis.

School ager with vertigo

MRA of Moya Moya disease
AP view of a 3D MR angiogram with contrast of the brain shows marked narrowing of the bilateral supraclinoid internal carotid arteries and nonvisualization of the A1 and M1 segments of the anterior and middle cerebral arteries with multiple lenticulostriate collateral vessels arising from the terminal portions of the supraclinoid internal carotid arteries which are reconstituting the A2 and M2 segments.

The diagnosis was Moya Moya disease.

Preschooler with new onset diabetes insipidus

MRI of Langerhans cell histiocytosis of the pituitary
Sagittal T1 MRI without contrast (above left) of the brain shows absence of the posterior pituitary bright spot. Sagittal (above right) and coronal T1 with contrast (below left) show a thick and enhancing pituitary stalk. Axial T1 with contrast (below right) again shows the thick enhancing pituitary stalk and enhancing lesions in both sphenoid wings and in the left orbit.

The diagnosis was Langerhans cell histiocytosis of the pituitary and Langerhans cell histiocytosis of the orbit.

Toddler with left orbital swelling

CT and MRI of Langerhans cell histiocytosis of the orbit
Coronal CT with contrast of the orbits in bone (above left) and soft tissue (above right) windows show bony destruction in the superolateral aspect of the orbit caused by a soft tissue mass. Coronal T1 MRI without (below left) and with contrast (below right) of the orbits better show the soft tissue mass superolateral to the left orbit which enhances avidly.

The diagnosis was Langerhans cell histiocytosis of the orbit.

Teenager with first time seizure

MRI of dysembryoplastic neuroepithelial tumor / DNET
Axial T1 without contrast (above left), T2 (above right) and T1 with contrast (below left) MRI of the brain show a round heterogenous lesion in the medial aspect of the left temporal lobe that appears to extend into the cortex, has a small amount of surrounding edema, and does not enhance. On gradient echo (below right) there is some hemosiderin staining in the lesion but no hemosiderin ring around it.

The diagnosis was dysembryoplastic neuroepithelial tumor.

Teenager with left leukocoria

CT of Coat disease
Axial CT without contrast of the orbits (above left) shows increased density in the left vitreous humor when compared to the right. Axial FLAIR MRI of the orbits (above right) shows the vitreous humor to have high signal intensity which is isointense on T1 MRI without contrast (below left) which was felt to be consistent with proteinaceous material or hemorrhage. Axial T1 with contrast (below right) shows wispy enhancement lateral to the left globe due to retinal detachment.

The diagnosis was Coat disease.