Newborn who had a traumatic birth and now has a bump on their head and a decreased hematocrit

CT of cephalohematoma in a newborn — Coronal CT without contrast of the brain shows a high density fluid collection over the top of the left skull that does not cross suture lines. A large amount of high density fluid is seen in the anterior and temporal horns of the right lateral ventricle and there is dilation of the lateral ventricles.

The diagnosis was cephalohematoma of the left scalp and intraventricular hemorrhage.

Teenager after motor vehicle accident

CT of mastoid fracture — Axial CT without contrast of the maxillofacial bones shows a linear lucent line extending throughout the left mastoid bone with resultant opacification of the left mastoid air cells.

The diagnosis was left mastoid fracture.

Newborn with a bump on the back of the head

MRI of occipital cephalocele — Sagittal T2 MRI (above) shows a high signal intensity structure projecting inferiorly off the occiput of the skull. Axial T1 MRI without contrast (below left) clearly shows the interruption of the occipital subcutaneous tissues and the saccular structure posterior to it. Axial T2 MRI (below right) shows the saccular structure to be primarily cystic and to contain a small amount of neural tissue.

The diagnosis was occipital cephalocele.

Teenager with jaw pain after trauma

CT of mandibular fracture — AP 3D CT without contrast of the face (left) shows a fracture line through the mandibular symphysis while lateral 3D CT (right) shows a fracture line through the left mandibular ramus causing a dislocated left condyle.

The diagnosis was mandibular fracture.

Newborn with a brain cyst on prenatal ultrasound

MRI of cavum velum interpositum — Axial (left), coronal (above right) and sagittal (below left) T2 MRI of the brain shows a cerebrospinal fluid space between the atria and trigones of the lateral ventricles, behind the foramen of Monro, beneath the columns of the fornices and above the tela choroidea of the third ventricle.

The diagnosis was cavum velum interpositum.

Toddler who was on extracorporeal membrane oxygenation as a newborn one year ago

MRI of diffuse cerebral atrophy due to extracorporeal membrane oxygenation — Axial (left) and coronal (right) T2 MRI without contrast of the brain shows diffuse thinning of the grey matter and white matter with subsequent prominence of the cerebral suci, subarachnoid space, and lateral and third ventricles.

The diagnosis was diffuse cerebral atrophy secondary to extracorporeal membrane oxygenation.

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.