Preschooler with fever and right facial tenderness

CT of mastoiditis with dural venous sinus thrombosis — Axial CT with contrast of the brain with bone windows (left) shows complete opacification of the mastoid air cells bilaterally. MRV with contrast of the brain (right) shows a lack of venous flow in the right sigmoid sinus.

The diagnosis was acute mastoiditis with thrombosis of the right sigmoid sinus.

Preschooler with chickenpox and a left earache

CT of acute mastoiditis — Axial CT with contrast of the brain with bone windows (left) shows partial opacification of the left mastoid air cells and a lower image with soft tissue windows (right) shows inflammation in the left neck soft tissues at the level of the left mastoid air cells.

The diagnosis was acute mastoiditis.

Toddler with left earache

CT of mastoiditis with Bezold abscess — Axial CT with contrast of the brain with bone windows (left) shows opacification of the left mastoid air cells and the same image with soft tissue windows (right) shows a low density rim enhancing fluid collection at the level of the left mastoid air cells deep to the sternocleidomastoid and trapezius muscles.

The diagnosis was acute mastoiditis with a Bezold abscess.

Infant with left otitis media and left neck swelling

CT of coalescent mastoiditis — Axial and coronal CT with contrast of the neck with soft tissue windows (above) show extensive left cervical adenopathy and inflammation. Axial CT with contrast of the neck with bone windows (below) show bilateral complete opacification of the mastoid air cells and subtle erosive changes in the anterior aspect of the left temporal bone. There were no intracranial findings.

The diagnosis was left coalescent mastoiditis.

School ager with pus draining from the right ear

CT of coalescent mastoiditis with intracranial abscess — Axial CT with contrast of the brain with bone windows (left) shows opacification and destruction of the right mastoid air cells while axial CT with contrast of the brain with soft tissue windows (right) shows a large low density ring enhancing lesion in the right cerebral hemisphere that is causing midline shift to the left.

The diagnosis was right coalescent mastoiditis with an intracranial abscess.

Teenager with left orbital and forehead swelling

CT of Pott puffy tumor and subdural empyema — Sagittal CT with contrast of the brain shows frontal and left maxillary sinusitis and extensive soft tissue swelling anterior to the forehead (upper left) and destruction of the anterior left frontal bone in the frontal sinus and extensive soft tissue swelling anterior to the left orbit (upper right). Coronal (lower left) and sagittal (lower right) T1 MRI with contrast of the brain shows diffuse meningeal enhancement, subdural empyemas along the falx and both cerebral convexities, and multiple large non-enhancing subgaleal fluid collections in the left scalp.

The diagnosis was meningitis, subdural empyema, and Pott puffy tumor as complications of sinusitis.

School ager with left eye swelling

CT of subperiosteal abscess — Axial CT with contrast of the orbits shows opacification of the left ethmoid sinus and bilateral sphenoid sinuses along with pre and post-septal inflammation of the left orbit. A lenticular fluid collection with rim enhancement is present along the medial wall of the left orbit.

The diagnosis was orbital cellulitis with a subperiosteal abscess.

Preschooler with right eye swelling

CT of orbital cellulitis — Axial CT with contrast of the orbits shows opacification of the bilateral ethmoid and maxillary sinuses along with pre and post-septal inflammation of the right orbit. No subperiosteal abscess was seen.

The diagnosis was orbital cellulitis.

School ager who does not take care of their teeth and had a seizure

MRI of intracranial abscess due to sinusitis — Axial T2 MRI of the brain (above left) shows a mass in the right front lobe with surrounding vasogenic edema. Axial (above right) and coronal (below right) T1 MRI with contrast shows the mass to have thin rim enhancement and the coronal image also shows left maxillary sinusitis. The mass is shown to demonstrate diffusion restriction on diffusion-weighted imaging (below left).

The diagnosis was intracranial abscess as a complication of sinusitis.

Infant with hydrocephalus on prenatal ultrasound

CT of right open lip schizencephaly — Axial CT without contrast of the brain shows a cerebrospinal fluid tract communicating between the right occipital cortex and the posterior horn of the right lateral ventricle that was felt to be lined by gray matter on both sides.

The diagnosis was right open lip schizencephaly.

School ager with seizures

MRI of perisylvian polymicrogyria and open lip schizencephaly — Coronal and axial T1 (above) and axial T2 (below) MRI without contrast of the brain shows small haphazard appearing gyri and too few sulci present bilaterally, left greater than right, primarily in the sylvian fissures. There is also a cleft of gray matter with cerebrospinal fluid within extending from the cortex to the posterior aspect of the left lateral ventricle.

The diagnosis was bilateral perisylvian polymicrogyria in a patient with left open lip schizencephaly.

Newborn with macrocephaly

MRI of perisylvian polymicrogyria — Axial T2 (above) and coronal T1 (below) MRI without contrast of the brain shows small haphazard appearing gyri and too few sulci present bilaterally, primarily in the sylvian fissures.

The diagnosis was bilateral perisylvian polymicrogyria.

Newborn with hydrocephalus on prenatal ultrasound

MRI of lissencephaly type I classic — Axial T1 (left) and axial T2 (right) MRI without contrast of the brain shows a decreased number of gyri and sulci resulting in a nearly smooth brain. There is ventriculomegaly. Overall the brain has an hourglass or figure of 8 appearance.

The diagnosis was lissencephaly type I classic.

Infant with meningomyelocele who has had a VP shunt placed

MRI of heterotopia — Axial (left) and coronal (right) T2 MRI without contrast of the brain shows multiple subependymal nodules along the lateral wall of the left lateral ventricle that have signal characteristics similar to those of gray matter. Similar lesions were found in the right lateral ventricle on images that did not contain artifact from the right parietal VP shunt.

The diagnosis was heterotopia.

Toddler with seizures

MRI of tuberous sclerosis — Axial T2 MRI without contrast of the brain (left) shows three rounded low intensity subependymal lesions along the lateral aspect of the left lateral ventricle. Axial FLAIR MRI image without contrast of the brain (right) shows multiple bilateral poorly defined hyperintense areas located just beneath the cortex of the brain.

The diagnosis was multiple subependymal nodules and subcortical tubers in tuberous sclerosis.

School ager with seizures

MRI of tuberous sclerosis — Coronal FLAIR MRI images without contrast of the frontal (above left), middle (above right) and posterior (below) aspects of the brain shows multiple bilateral poorly defined hyperintense areas located just beneath the cortex of the brain.

The diagnosis was multiple subcortical tubers in tuberous sclerosis.

School ager with seizures

CT of Sturge-Weber syndrome — Axial CT with contrast of the brain shows diffuse leptomeningeal enhancement involving the right temporal and parietal and occipital lobes, an enlarged enhancing right choroid plexus, an enlarged medullary vein draining into the deep venous system, and some mild atrophy of the right cerebral hemisphere.

The diagnosis was Sturge-Weber syndrome.

Preschooler with seizures

MRI of optic pathway gliomas in neurofibromatosis type I — Axial (left) and coronal T1 MRI with contrast of the orbits shows marked thickening of the optic nerves bilaterally.

The diagnosis was bilateral optic pathway gliomas in a patient with neurofibromatosis type I.

Preschooler with cafe au lait spots

MRA of Moya Moya syndrome in neurofibromatosis type I — AP view of a 3D maximum intensity projection of an MRA of the neck with contrast (above) and AP (below left) and inferior (below right) views of a 3D maximum intensity projection of an MRA of the brain without contrast shows diffuse hypoplasia of the left internal carotid artery. There is stenosis and occlusion of the cavernous and supraclinoid segments of the left internal carotid artery and then there is a thin left M1 segment without evidence of collaterals in the basal ganglia. Additionally, aneurysms are noted in the left A1 and A2 segments.

The diagnosis was Moya Moya syndrome in a patient with neurofibromatosis type I.

Newborn who was dropped on the floor in the delivery room

CT of skull molding — Axial (left) and coronal (right) CT without contrast of the brain show the occiptal bone of the skull to be pushed underneath the parietal bones of the scalp. No skull fractures are seen.

The diagnosis was skull molding.

Infant who had a forceps delivery 3 months ago

Radiograph of calcified cephalohematoma — AP radiograph of the skull shows bilateral calcified cresenteric areas in the subcutaneous tissues on the top of the skull that do not cross suture lines.

The diagnosis was bilateral calcified cephalohematomas.

Newborn with failure to progress during delivery due to dystocia who is now apneic

CT of caput succedaneum — Axial CT without contrast of the brain shows a cresenteric high-density fluid collection in the subcutaneous tissues of the right scalp that crosses suture lines and a cresenteric low-density fluid collection in the subcutaneous tissues of the left scalp that crosses suture lines. Intracranially, there is diffuse loss of gray matter-white matter differentiation secondary to diffuse cerebral edema.

The diagnosis was a left caput succedaneum and a right subgaleal hematoma in a patient with hypoxic ischemic encephalopathy.

Newborn who experienced prolonged labor

CT of caput succedaneum — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the brain show a large low density fluid collection in the subcutaneous tissues of the scalp that crosses sutures and is seen to surround the skull on the coronal view. Intracranially, there is diffuse loss of gray matter-white matter differentiation secondary to diffuse cerebral edema.

The diagnosis was caput succedaneum in a patient with hypoxic ischemic encephalopathy.

Infant with a flat spot on the back of the head

Radiograph of positional plagiocephaly — AP (left) and lateral (right) radiographs of the skull show the bilateral coronal sutures and lambdoid sutures and sagittal suture to be patent. There is some mild flattening along the posterior aspect of the skull

The diagnosis was positional plagiocephaly.

Infant with a palpable ridge on the top of the head

Radiograph and 3D CT of sagittal craniosynostosis — AP (above left) and lateral (above right) radiographs of the skull show the skull to be lengthened (scaphocephaly / dolichocephaly). The sagittal suture appears sclerotic. Superior (below left) and lateral (below right) 3D CT reconstructions of the skull show the skull to be lengthened and complete fusion of the sagittal suture. The remaining sutures are patent.

The diagnosis was sagittal craniosynostosis.