Newborn who cannot have a nasogastric tube passed through the left nares

CT of left choanal atresia — Axial CT without contrast of the maxillofacial bones shows thickening and bowing of the vomer to the left resulting in a narrow left choana.

The diagnosis was left choanal atresia.

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.

Extremely premature newborn now 2 months old

MRI of retinopathy of prematurity — Axial T2 MRI without contrast of the brain shows small orbits bilaterally. Heterogeneity of the vitreous humor could not be assessed for on the other sequences due to patient motion.

The diagnosis was bilateral microphthalmia due to retinopathy of prematurity.

Preschooler with difficulties with vision

MRI of macrophtalmia and optic pathway glioma in neurofibromatosis type I — Axial (above) and coronal (below) T2 MRI without contrast of the brain shows the left globe is larger than the right globe. The optic nerves bilaterally are thickened and tortuous.

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

Preschooler with seizures

CT and MRI of oligodendroglioma — Axial CT without contrast of the brain (above left) shows a right parietal ill-defined subcortical hypodensity. Axial (above right) and coronal (below right) T2 MRI of the brain show right parietal subcortical hyperdensities with associated cortical thickening that on axial T1 MRI with contrast (below left) shows minimal enhancement.

The diagnosis was oligodendroglioma.

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.

Toddler with a nasal lesion

MRI of nasal dermoid — Sagittal T1 MRI without contrast of the face (left) shows a small round lesion of high signal intensity at the tip of the nose which on sagittal T1 MRI with contrast and fat suppression (right) is of low signal intensity (fat suppressed) and to have no enhancement. There was no intracranial connection.

The diagnosis was nasal dermoid.

Toddler with new onset seizure

MRI of congenital lymphocytic choriomeningitis — Axial gradient echo MRI of the brain (above) show bilateral posterior periventricular punctate hypodensities felt to represent calcifications. Axial FLAIR MRI (below) show areas of patchy increased signal bilaterally in the periventricular white matter and in the subcortical white matter.

The diagnosis was congenital lymphocytic choriomeningitis.

Preschooler with seizures for the last 3 days

MRI of brainstem glioma — Sagittal T1 MRI without contrast of the brain (above left) shows a large mass expanding the entire brainstem. Axial T2 (above right) and axial FLAIR (below left) MRI show the mass to be somewhat heterogenous and the mass has multiple foci of enhancement on the axial T1 MRI with contrast (below right).

The diagnosis was brainstem glioma.

Teenager with a phakomatosis undergoing screening neuroimaging

MRI of hemangioblastoma in Von Hippel Lindau disease — Axial (above), sagittal (below left) and coronal (below right) T1 MRI with contrast of the brain shows a round, solid, avidly enhancing lesion in the superior aspect of the left cerebellar hemisphere.

The diagnosis was hemangioblastoma in Von Hippel Lindau disease.

Preschooler who had cytomegalovirus infection in-utero

MRI of diffuse polymicrogyria in a patient with cytomegalovirus encephalitis — Axial T2 MRI without contrast of the brain show thickening and abnormal sulcation of the perirolandic gray matter diffusely bilaterally. There is also evidence of perisylvian fissure syndrome bilaterally.

The diagnosis was diffuse polymicrogyria in a patient with cytomegalovirus encephalitis.

School ager with a headache

MRI of a meningioma in a patient with neurofibromatosis Type 2 — Coronal (above) and axial (below) T1 MRI with contrast of the brain show an oval, solid, homogeneously enhancing parafalcine lesion that is in continuity with the meninges and which appears to have a dural tail.

The diagnosis was meningioma in a patient with neurofibromatosis Type 2.

Teenager with difficulty hearing

MRI of acoustic schwannomas in a patient with neurofibromatosis Type 2 — Axial T1 MRI with contrast of the brain shows bilateral homogeneously enhancing masses in the cebrebellopontine angles. The patient also had an intracranial meningioma.

The diagnosis was multiple acoustic neuromas in a patient with neurofibromatosis Type 2.

Teenager with headache

MRI of a meningioma in a patient with neurofibromatosis Type 2 — Coronal T1 MRI with contrast of the brain shows a round, solid, homogeneously enhancing intracranial lesion above the left orbit that is in continuity with the meninges and which appears to have a dural tail. The patient also had multiple schwannomas.

The diagnosis was a meningioma in a patient with neurofibromatosis Type 2.

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.

Newborn with a bump on the back that is not covered by skin

MRI of meningocele — Sagittal (above left) and axial (above right) T1 MRI without contrast of the spine shows a posterior defect at the S2 level that allows the spinal canal to communicate with a cyst that is not covered by skin or subcutaneous fat. Sagittal (below left) and axial (below right) T2 MRI shows the cyst does not contain any neural tissue.

The diagnosis was meningocele.

Newborn with a posterior fossa cyst on prenatal ultrasound

MRI of mega cisterna magna — Sagittal (above left), coronal (above right), and axial (below) T1 MRI without contrast of the brain shows a prominent retrocerebellar cerebrospinal fluid space (the cisterna magna) with a normal vermis, normal 4th ventricle, and normal cerebellar hemispheres.

The diagnosis was mega cisterna magna.

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.

Toddler with a genetic syndrome undergoing screening neuroimaging

MRI of hamartoma of the tuber cinereum / hypothalamic hamartoma — Sagittal T2 (above), T1 without contrast (below left) and T1 MRI with contrast (below right) of the brain show a suprasellar mass that is solid and heterogenous which is isointense on T1 and T2 and is nonenhancing.

The diagnosis was hamartoma of the tuber cinereum.

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.

Infant with increasing head circumference

MRI of choroid plexus papilloma — Axial (above left), coronal (above right) and sagittal (below) T1 MRI with contrast of the brain shows an avidly enhancing round mass that has a frond-like pattern in the third ventricle causing marked dilation of the lateral and third ventricles.

The diagnosis was choroid plexus papilloma.