Teenager with headache and tremors

CT and MR of cavernous malformation — Coronal (above left) and axial (below right) CT without contrast of the brain shows a slightly hyperdense, round, poorly circumscribed lesion in the right frontal lobe. Coronal T1 MRI without contrast of the brain (above right) shows the lesion to have a popcorn appearance with small round lesions of various signal intensities. Axial gradient echo MRI (below right) shows the lesion to be surrounded by a very low signal intensity ring.

The diagnosis was cavernous malformation containing mixed blood products with a hemosiderin ring.

School ager in a motor vehicle accident with back pain

CT of Chance fracture in lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior wedging of the L1 and L2 vertebral bodies and a horizontal fracture through the spinous process of the L1 vertebral body. 3D CT from the left (middle) and right (right) show bilateral L1-L2 facet distraction resulting in a focal kyphosis at L1-L2.

The diagnosis was Chance fracture of the lumbar spine.

Preschooler with constipation and anal stenosis on physical exam

CT and MRI of Currarino syndrome — 3D CT of the pelvis (left) shows near complete absence of the lower sacrum with the sacrum having a sickel shape on the right. Midline sagittal T2 MRI of the lumbar spine (middle) shows the conus medullaris to be low in position terminating at L5. Off center sagittal T2 MRI (right) shows a small round low signal intensity lesion anterior to the S2 vertebral body.

The diagnosis was caudal regression syndrome in the form of Currarino syndrome with anal stenosis, a sickle shaped and hypoplastic sacrum, and a presacral mass in the form of an anterior myelomeningocele.

Teenager with back pain after motor vehicle accident

CT of multiple compression fractures in the lumbar spine — Sagittal CT without contrast of the lumbar spine (left) shows anterior compression fractures of the T12 thru L3 vertebral bodies with corresponding loss of height in each which is more subtly appreciated on the 3D CT (right).

The diagnosis was multiple anterior compression fractures of the lumbar spine.

Teenager with a left neck mass

CT of second branchial cleft cyst — Axial (above), coronal (below left), and sagittal (below right) CT with contrast of the neck show a thin walled low density mass anterior to the left sternocleidomastoid muscle and posterior to the left submandibular gland. Superiorly the mass goes to the angle of the mandible and inferiorly the mass goes to the hyoid bone.

The diagnosis was second branchial cleft cyst.

Infant with multiple congenital anomalies

MRI of Blake pouch cyst — Sagittal (left) and axial (right) T1 MRI without contrast of the brain shows cystic dilation of the fourth ventricle.

The diagnosis was Blake pouch cyst.

Infant with left postauricular swelling

CT of Bezold abscess and coalescent mastoiditis — Axial CT with contrast of the brain (above left) shows two rim enhancing fluid collections in the subcutaneous tissues next to the left mastoid air cells. There is also extensive soft tissue inflammation tracking up the left side of the skull (above right). Axial CT bone windows (below) shows complete opacification of the left mastoid air cells and bone erosion and destruction along the lateral wall of the mastoid bone that is allowing communication between the mastoid air cells and the largest rim enhancing fluid collection.

The diagnosis was Bezold abscess in a patient with coalescent mastoiditis.

Infant with head trauma after motor vehicle accident

CT of atypical teratoid rhabdoid tumor — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the brain show an oval high density solid mass centered in the region of the pineal gland.

The diagnosis was atypical teratoid rhabdoid tumor.

Toddler with a hair tuft at the cranial vertex

MRI of atretic cephalocele — Sagittal T2 MRI of the brain shows in the subcutaneous tissue at the vertex of the skull a subgaleal lipomatous and cystic lesion in close approximation to a persistent falcine sinus.

The diagnosis was atretic cephalocele.

School ager with Trisomy 21 being cleared for general anesthesia

Radiograph of atlanto occipital instability — Lateral flexion view of the cervical spine (left) shows a normal relationship of the occipital condyles to the articular facets of the atlas. The atlanto dental interval is also normal. Lateral extension view of the cervical spine (right) shows posterior displacement of the occipital condyles in relation to the articular facets of the atlas. There is posterior positioning of Wackenheim line and retrolisthesis of the C3 on C4 vertebral body. The atlanto dental interval remains normal.

The diagnosis was atlanto occipital instability in a patient with Trisomy 21.

Teenager after motor vehicle accident

CT of Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation — Midline sagittal CT without contrast of the cervical spine (middle) shows a transverse comminuted fragmented fracture through the C2 vertebral body. There is anterior displacement of the C1 vertebral body resulting in compromise of the spinal canal. There is massive thickening of the retropharyngeal soft tissues due to a retropharyngeal hematoma. The basion-dens interval is abnormally increased. The off midline sagittal CTs (left and right) show distraction between the occipital condyles bilaterally and the C1 articular facets.

The diagnosis was a Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation.

School ager with Ehler Danlos syndrome being cleared for general anesthesia

Flexion and extension radiographs of atlanto axial instability — Lateral radiograph of the cervical spine in extension (left) shows the atlanto dental interval to measure 0 mm. Lateral radiograph of the cervical spine in flexion (right) shows the atlanto dental interval to measure 7 mm.

The diagnosis was atlanto axial instability in a patient with Ehlers Danlos syndrome.

Preschooler with an occipital skull fracture after trauma

CT venogram of arachnoid granulations — Axial CT venogram of the brain (left) shows a single smooth round filling defect in each transverse sinus laterally, left larger than right. Coronal CT (right) again shows the filling defect in the left transverse sinus

The diagnosis was arachnoid granulations in the transverse sinuses.

Preschooler with developmental delay

MRI of arachnoid cyst of the posterior fossa — Axial (above left), coronal (above right) and sagittal (below) T2 MRI of the brain show a midline to right of midline high signal intensity lesion in the posterior fossa which is inferior to an intact cerebellar vermis and the right cerebellar hemisphere and which is having mass effect on the cerebellum.

The diagnosis was arachnoid cyst of the posterior fossa.

Newborn with a skin defect and a bump on the skull

MRI of aplasia cutis — Axial T1 MRI without contrast (above left) and axial T2 (above right) of the brain show an oval lesion in the subcutaneous tissue which is isointense on T1WI and hyperintense on T2WI. Coronal T1 MRI without contrast (below) show a bone defect in the skull beneath the cystic lesion.

The diagnosis was aplasia cutis.

Teenager with nasal stuffiness

CT of antochoanal polyp — Axial CT with contrast of the face (left) shows a low-density left-sided polyp originating in and filling the left maxillary sinus which extends medially to the nasal cavity and which on the sagittal CT (right) is then seen to continue to extend inferiorly into the posterior nasopharynx and oropharynx.

The diagnosis was antrochoanal polyp.

Teenager with gradual onset of gait disturbance

MRI of pediatric cervical spine disc herniation causing cord compression — Sequential sagittal T2 MRI of the spine shows at the level of C5-C6 low signal intensity material herniating posteriorly causing severe stenosis of the spinal canal along with bright signal in the spinal cord at that level.

The diagnosis was disc herniation of the C5-C6 intervertebral disc causing severe spinal canal stenosis and edema of the spinal cord.

School ager with headaches

CT of thrombosed pediatric basilar artery aneurysm — Axial (above left), sagittal (above right) and coronal (below) CT without contrast of the brain show a circular high density lesion posterior to the clivus that is in the course of the basilar artery.

The diagnosis was a thrombosed intracranial aneurysm of the basilar artery.

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.