School ager with back pain and fevers

MRI of transverse myelitis — Sagittal and axial T2 MRI of the thoracic spine shows centrally located continuous bright signal through the thoracic spinal cord that ends just above the conus medullaris.

The diagnosis was transverse myelitis.

School ager with back pain when bending over

MRI of tethered cord — Sagittal T1 (left) and T2 (right) MRI of the lumbar spine shows a low-lying conus medullaris of the spinal cord which terminates at S1. The T11/T12 vertebral body areas of low signal intensity on T1 and high signal intensity on T2 were felt to be due to aggressive Schmorl nodes as the patient had no clinical signs of infection.

The diagnosis was tethered cord.

Toddler with back pain and scoliosis

MRI of astrocytoma of spinal cord — Sagittal T1 (left), T2 (middle) and T1 with contrast (right) MRI of the thoracic spine shows an expansile lesion of the lower thoracic spinal cord that is isointense on T1, hyperintense on T2, and which enhances avidly with contrast.

The diagnosis was an astrocytoma of the spinal cord.

Preschooler who was abused

Radiographs of a healing skull fracture — Lateral radiograph of the skull initially (left) showed bilateral linear parietal lucencies coursing across the skull which are no longer seen 4 months later (right).

The diagnosis was healing skull fractures.

Infant who fell 3 feet out of bed onto a wooden floor

CT of an (not) accessory skull suture — 3D reconstruction from CT without contrast of the brain (left) shows a linear straight lucency that connects to the left lambdoid suture. Coronal CT (right) shows the same linear lucency lying under a large subgaleal hematoma.

The diagnosis was a linear skull fracture and not an accessory suture of the skull based on the soft tissue swelling associated with the linear lucency.

Toddler in a motor vehicle accident 2 months ago who still has a soft spot on the skull in the region of the fracture

Radiography of a growing skull fracture (leptomeningeal cyst) — 3D CT reconstruction initially (left) showed a diastatic skull fracture which has increased in size on the lateral radiograph of the skull (right) taken 2 months later.

The diagnosis was a growing skull fracture / leptomeningeal cyst.

Preschooler hit in the head with a golf club

CT of a depressed skull fracture — Axial CT without contrast of the brain shows depression of the skull in the left temperoparietal region with an associated subgaleal hematoma containing subcutaneous air.

The diagnosis was a depressed skull fracture.

Toddler in a motor vehicle accident

CT of a diastatic skull fracture — 3D reconstruction from a CT without contrast of the brain shows a wide right parietal lucency between two separated fragments of bone.

The diagnosis was a diastatic skull fracture.

Preschooler who has been abused

Radiograph of a linear skull fracture — Lateral radiograph of the skull shows bilateral linear parietal lucencies coursing across the skull.

The diagnosis was bilateral linear skull fractures.

School ager in a motor vehicle accident

CT of cerebral edema and subarachnoid hemorrhage — Axial CT without contrast of the brain shows diffuse low density through the bilateral cerebral hemispheres (anteriorly) with a normal density cerebellum (posteriorly) that appears relatively hyperdense when compared to the cerebral density. Subarachnoid hemorrhage was also seen bilaterally in the basal cisterns.

The diagnosis was diffuse cerebral edema.

Toddler with hemophillia who fell and hit their head

CT of epidural hematoma — Axial CT without contrast of the brain shows a mixed density biconvex intracranial extra-axial fluid collection posterior to the left cerebellum.

The diagnosis was a posterior fossa epidural hematoma.

School ager in a motor vehicle accident

CT of diffuse axonal injury — Axial CT without contrast of the brain shows multiple high density punctate intraparenchymal lesions at the gray matter-white matter junction in the bilateral cerebral hemispheres.

The diagnosis was diffuse axonal injury.

Teenager who was car surfing and fell off the car

CT of cerebral contusion — Axial CT without contrast of the brain shows multiple high density punctate intraparenchymal lesions in the bilateral frontal lobes.

The diagnosis was cerebral contusion.

Teenager ejected from the back of a pickup truck in a motor vehicle accident

CT of epidural hematoma — Axial CT without contrast of the brain shows a right frontal high density biconvex intracranial extra-axial fluid collection.

The diagnosis was epidural hematoma.

Teenager playing football who had a severe helmet to helmet collision with another player

CT of subdural hematoma — Axial CT without contrast of the brain with normal (left) and sharpened (right) windows shows a left hemispheric high density cresenteric intracranial extra-axial fluid collection that extends anteriorly along the falx.

The diagnosis was subdural hematoma.

School ager hit in head by a golf ball

CT of subgaleal hematoma — Axial CT without contrast of the brain shows a high density fluid collection in the left frontal subcutaneous tissue. There is also an underlying lentiform mixed density intracranial fluid collection.

The diagnosis was a left frontal subgaleal hematoma with an underlying epidural hematoma.

Infant with stridor and a scalp hemangioma

Radiograph of subglottic hemangioma — Lateral radiograph of the airway shows a subglottic soft tissue mass.

The diagnosis was a subglottic hemangioma.

School ager with stridor

Radiograph and nuclear medicine scan of ectopic thyroid — Lateral radiograph of the airway (left) shows a mass at the base of the tongue that when overlaid / registered with a thyroid nuclear medicine scan (right) shows radiotracer uptake in the mass.

The diagnosis was ectopic thyroid.

Preschooler with stridor

US of thyroglossal duct cyst — Transverse (above) and sagittal (below) US of the neck shows a cyst in the midline of the neck that moved in relationship with tongue protrusion.

The diagnosis was thyroglossal duct cyst.

Toddler with stridor

Radiograph of epidermal inclusion cyst of tongue — Lateral radiograph of the airway shows a mass at the base of the tongue.

The diagnosis was epidermal inclusion cyst of tongue.

Toddler with stridor

Radiograph of Pierre Robin syndrome — AP + lateral radiographs of the airway shows a micronathia and posterior displacement of the tongue.

The diagnosis was Pierre Robin syndrome.

Teenager with epistaxis

CT and angiogram of juvenile nasopharyngeal angiofibroma — Axial CT without contrast of the face (above) shows a large left sided sinonasal soft tissue mass. Early (below left) and later (below right) lateral images from a carotid angiogram show the mass to be hypervascular.

The diagnosis was juvenile nasopharyngeal angiofibroma.

Newborn with hypoxia with feeding

Radiograph of choanal atresia — AP + lateral radiographs of the airway after the injection of contrast into the nares bilaterally shows no passage of contrast into the oropharynx with the obstruction at the level of the vomer.

The diagnosis was bilateral choanal atresia.

School ager with stridor

Radiograph of palatine tonsil hypertrophy — Lateral radiograph of the airway shows enlargement of the palatine tonsils.

The diagnosis was palatine tonsil hypertrophy.

Preschooler with stridor

Radiograph of lingual tonsil hypertrophy — AP + lateral radiographs of the airway shows enlargement of the lingual tonsils.

The diagnosis was lingual tonsil hypertrophy.